I693-011-INS-REV-OMBReview-10032022

Instructions for Report of Immigration Medical Examination
and Vaccination Record
Department of Homeland Security
U.S. Citizenship and Immigration Services

USCIS
Form I-693

OMB No. 1615-0033
Expires 07/31/2025

What Is the Purpose of Form I-693?
Form I-693 reports results of an immigration medical examination to U.S. Citizenship and Immigration Services (USCIS).
USCIS requires the examination to establish that applicants who are seeking immigration benefits are not inadmissible
to the United States on health-related grounds. You can find a list of the health-related grounds in the Immigration
and Nationality Act (INA) section 212(a)(1). The list is also available in these Instructions in the Frequently Asked
Questions section, Item Number 9.
The results of your immigration medical examination are confidential, and USCIS uses them primarily for immigration
purposes. When required by law, the civil surgeon may share your results with public health authorities. USCIS will
generally not discuss your medical issues with other individuals, such as your attorney or BIA-accredited representative,
immigration officers, or other government officials, unless they have a need to know the information.

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NOTE: If you are applying for adjustment of status as a refugee, a derivative of an asylee, or a K nonimmigrant visa
holder, before reading any further, see section entitled Frequently Asked Questions, Item Numbers 2. - 5., of these
Instructions.

Applicant Instructions

How Do I File Form I-693?

You must submit a separate Form I-693 for each applicant. There is no filing fee for this form.
1. Carefully read all these instructions, including the Frequently Asked Questions section.

2. Contact a doctor who is designated as a civil surgeon by USCIS to make an appointment.

3. Fill out Part 1. Information About You of Form I-693. Do not sign the form until the civil surgeon tells you to
sign it. You must sign in the presence of the civil surgeon.
4. Attend your medical examination appointment and all follow-up examinations, as required. If you have any medical
records, including vaccination records, take them with you to the initial appointment.
NOTE: For applicants who are required to receive the COVID-19 vaccine, you must do
so and provide documentation of vaccination to the civil surgeon, or the civil surgeon can
administer the vaccine(s). See CDC’s COVID-19 Technical Instructions for Civial Surgeons at
https://www.cdc.gov/immigrantrefugeehealth/civil-surgeons/covid-19-technical-instructions.html for current
requirements.
5. The civil surgeon must give you the completed Form I-693 in a sealed envelope for you to submit to USCIS. Do
not accept the form from the civil surgeon unless it is in a sealed envelope. USCIS will return your Form I-693 to you
if it is not in a sealed envelope or if the envelope is opened or altered in any way. The civil surgeon should also give
you a copy of the completed Form I-693 for your records.
6. Submit your completed Form I-693 in the sealed envelope to USCIS. Form I-693 remains valid for two years from
the date of the civil surgeon’s signature.

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A. If you are applying for adjustment of status, Form I-485: Submit Form I-693 according to the instructions
for Form I-485, Application to Register for Permanent Residence or Adjust Status, which you may find on our
website at www.uscis.gov/I-485.
B. For all other applicants: Follow the application’s instructions, follow the instructions that the office requesting
the immigration medical examination gave you. Visit the USCIS Contact Center at www.uscis.gov/contactcenter
to learn more, including where to file this application. The USCIS Contact Center provides information in
English and Spanish. For TTY call: 1-800-767-1833.
NOTE: The civil surgeon will ask you to verify your identity. Bring a valid government-issued form of photo
identification to your appointment (for example, your unexpired passport or driver’s license). If you are under 14
years of age, acceptable documents for proof of identity must show your name, date and place of birth, parents’ full
names, and any other identifying information about you. Acceptable documents include birth certificates (with a
translation, if necessary) or affidavits.

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How Do I Find a Designated Civil Surgeon in My Area?

To find a designated civil surgeon in your area, visit the USCIS website at www.uscis.gov. (Enter “Find a Doctor”
into the “Search our Site” box. The “Find a Doctor” site will provide instructions on how to search for a civil surgeon
in your areas. If you are a member or veteran of the U.S. armed forces or a dependent of one, or if you are a refugee
seeking adjustment of status, you may be eligible to undergo an immigration medical examination conducted by a blanket
designated civil surgeon. For more information, visit our website to see USCIS Policy Manual guidance for blanket
designated civil surgeons at https://www.uscis.gov/policy-manual/volume-8-part-c-chapter-3.

General Instructions

USCIS provides forms free of charge through the USCIS website. To view, print, or fill out our forms, you should use the
latest version of Adobe Reader, which you can download for free at http://get.adobe.com/reader/. If you do not have
internet access, you may call the USCIS Contact Center at 1-800-375-5283 (TTY 1-800-767-1833) and ask that we mail
you a form. The USCIS Contact Center provides information in English and Spanish.
Signature. Each Form I-693 must be properly signed and filed. For all signatures on this form, USCIS will not accept
a stamped or typewritten name in place of a signature. If you are under 14 years of age, your parent or legal guardian
may sign the form on your behalf. A legal guardian may also sign for a mentally incompetent person. If the request is
not signed or if the requisite signature on the request is not valid, USCIS will reject the request. See 8 CFR 103.2(a)(7)
(ii)(A). If USCIS accepts a request for adjudication and determines that it has a deficient signature, USCIS will deny the
request.
There are special rules for blanket designated health departments or military physicians. Refer to these Instructions
for additional information on how blanket designated civil surgeons may sign the form. (See section entitled How
Do I, as a Civil Surgeon, Fill Out My Portion of This Form I-693?, subsections “Health departments performing
the vaccination assessment for refugee adjustment applicants ONLY,” and “Military physicians performing the
medical examination for members and veterans of the U.S. Armed Forces or U.S. Coast Guard, their eligible
dependents, and other applicants as deemed necessary by USCIS in emergent circumstances.”)
Filing Fee. There is no filing fee for this form.
Evidence. At the time of filing, you must submit all evidence and supporting documents listed in the Specific
Instructions section of these Instructions.

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Copies. You should submit legible photocopies of documents requested, unless the Instructions specifically state that you
must submit an original document. USCIS may request an original document at the time of filing or at any time during
processing of an application or petition. If USCIS requests an original document from you, it will be returned to you after
USCIS determines it no longer needs your original.
NOTE: If you submit original documents when not required or requested by USCIS, your original documents may be
immediately destroyed after we receive them.
Translations. If you submit a document with information in a foreign language, you must also submit a full English
translation. The translator must sign a certification that the English language translation is complete and accurate, and that
he or she is competent to translate from the foreign language into English. The certification must include the translator’s
signature, printed name, the signature date, and the translator’s contact information.
How To Fill Out Form I-693

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1. Type or print legibly in black ink.

2. If you (the applicant or the civil surgeon) need extra space to complete any item within this application, use the space
provided in Part 11. Additional Information or attach a separate sheet of paper. Type or print your name and Alien
Registration Number (A-Number) (if any) at the top of each sheet; indicate the Page Number, Part Number, and
Item Number to which your answer refers; and sign and date each sheet.
3. Answer all questions fully and accurately. If a question does not apply to you (for example, if you have never been
married and the question asks, “Provide the name of your current spouse”), type or print “N/A” unless otherwise
directed. If your answer to a question which requires a numeric response is zero or none (for example, “How many
children do you have” or “How many times have you departed the United States”), type or print “None” unless
otherwise directed.

How To Fill Out My (the Applicant’s) Portion of Form I-693

Form I-693 is divided into 11 parts. These instructions will help you and the civil surgeon complete Form I-693.
Only complete Part 1. of Form I-693 and the identifying information at the top of each page. The civil surgeon and any
other doctors, clinics, or health departments that you are referred to will complete the remaining parts of Form I-693.
Part 1. Information About You

Complete this part before your medical examination appointment. Fill out your name and A-Number (if any) at the top of
each page of Form I-693. The civil surgeon will check that this information matches Part 1.
Item E. in Item Number 3. Alien Registration Number (A-Number) (if any). Provide your A-Number. Your
A-Number is the number used to identify your immigration records. It begins with an “A” and can be found on
correspondence that has been received from the Department of Homeland Security (DHS) or USCIS. If you do not have
an A-Number, type or print “N/A.”
Item F in Item Number 3. USCIS Online Account Number (if any). Providing your unique USCIS Online Account
Number (OAN) helps you manage your online account. You have an Online Account Number if you previously filed an
application, petition, or request online or by mail and were issued a receipt number that begins with IOE. If you filed a
form online, you can find your OAN in your USCIS Online Account profile. If you mailed your form, you can find your
OAN at the top of the USCIS Account Access Notice we sent you. The OAN is not the same as an A-Number. If you do
not have a receipt number beginning with IOE, you do not have an OAN.
Part 2. Applicant’s Statement, Contact Information, Certification, ans Signature

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You must sign and date your application and, if applicable, provide your daytime telephone number, mobile telephone
number, and email address. The signature of a parent or legal guardian, if applicable, is acceptable. A stamped or
typewritten name in place of a signature is not acceptable.
Part 3. Interpreter’s Contact Information, Certification, and Signature
If you used anyone as an interpreter to read the Instructions and questions on this application to you in a language in
which you are fluent, the interpreter must fill out this section, provide his or her name, the name and address of his or her
business or organization (if any), his or her daytime telephone number, his or her mobile telephone number (if any), and
his or her email address (if any). The interpreter must sign and date the application.
Part 4. Contact Information, Declaration, and Signature of the Person Preparing this Application, if Other Than
the Applicant

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The person who completed your application, if other than the applicant must sign this section. If the same individual
acted as your interpreter and your preparer then that person should complete both Part 3. and Part 4. A stamped or
typewritten name in place of a signature is not acceptable.
We recommend that you print or save a copy of your completed application to review in the future and for your
records.

Civil Surgeon’s Instructions

What Are My Responsibilities as a Designated Civil Surgeon?

1. Truthfully and accurately report the results. You are responsible for reporting the results of the medical
examination and all laboratory reports on Form I-693 where indicated, and for signing the civil surgeon’s certification
provided on the form.
You must take reasonable steps to ensure that the person appearing for the medical examination is the same person
applying for the requested immigration benefit. All applicants must present a valid government-issued form of
photo identification or another form of government-recognized identity documentation. You must note in Part 5.,
Applicant’s Identification Information, Item Numbers 1. - 2., the form of identification presented and identification
number, if applicable. The law imposes severe penalties for knowingly and willfully falsifying or concealing a
material fact or using any false documents in connection with this medical examination.
You should direct the applicant to complete and sign in Part 2., Item Numbers 1. - 3., in your presence. You should
also ensure that the applicant’s name and A-Number (if any) are at the top of each page of the Form I-693 and match
the information provided in Part 1.
2. Follow U. S. Department of Health and Human Services (HHS) regulations and Centers for Disease Control
and Prevention (CDC) guidelines. As a USCIS-designated civil surgeon, you are required to perform the medical
examination according to HHS regulations. These regulations include the specific guidelines found in the Technical
Instructions for Civil Surgeons, published by the CDC. The Technical Instructions for Civil Surgeons (including periodic
updates posted by the CDC) are available at https://www.cdc.gov/immigrantrefugeehealth/civil-surgeons.html.
3. Make referrals and file case reports, as required. According to the CDC’s Technical Instructions for Civil
Surgeons, you are required to:
A. Refer the applicant to the local health department if a chest X-ray suggests TB or other circumstances described
in the CDC’s Technical Instructions for Civil Surgeons.
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(1.) Abnormal chest x-ray findings suggestive of TB that require health department referral include infiltrate
or consolidation, reticular markings suggestive of fibrosis, cavitary lesion, nodule(s) or mass with poorly
defined margins (such as tuberculoma), pleural effusion, hilar/mediastinal adenopathy, miliary findings,
discrete linear opacity, discrete nodule(s) without calcification, volume loss or retraction, irregular thick
pleural reaction, or other.
(2.) Chest x-ray findings that do not require referral to the health department include smooth pleural
thickening (if at costophrenic angle, must confirm that it is not an effusion y doing lateral or decubitus
radiograph or ultrasound), diaphragmatic tenting, single or scattered calcified pulmonary nodule(s), and
calcified lymph node(s).
B. Ensure that any applicant diagnosed with syphilis is treated with the standard treatment regimen described in the
CDC’s Technical Instructions for Civil Surgeons.
C. Ensure that the applicant is tested for gonorrhea and given appropriate therapy, if applicable.
D. Refer the applicant to a Hansen’s disease specialist for evaluation to confirm a suspected diagnosis of Hansen’s
disease (leprosy).

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E. File a case report with the appropriate public health authorities if a case report is required by local laws or
regulations. You must also advise the applicant that a case report is being filed.

How Do I, as a Civil Surgeon, Fill Out My Portion of This Form I-693?

You, as the civil surgeon, are responsible for ensuring that Form I-693 is completed and signed as follows.
1. Part 5. Applicant’s Identification Information. You are responsible for verifying the identity of the applicant and
noting in Part 5., Applicant’s Identification Information, Item Numbers 1. - 2., the form of identification that the
applicant presents to you and the identification number, if applicable. You are also required to check the top of each
page of Form I-693 to make sure the name and A-Number (if any) are correct. Finally, you must require the applicant
to sign the Applicant’s Certification in Part 2. in your presence. The applicant should sign at the beginning of the
immigration medical examination, following the completion of Parts 1. through 5.
2. Part 6. Summary of Overall Findings. After the medical examination and any required follow-up visits or
examinations, summarize the results in Part 6. When completing Item Number 2, be sure to use the date that you
obtained the applicant’s permission to conduct the immigration medical examination and any required testing or labs
(by obtaining their signature in Part 2).
3. Part 7. Civil Surgeon’s Contact Information, Certification, and Signature. You must sign the certification after
the medical examination is complete. Fill out your identifying information in this part before referring an applicant
for further tests or evaluation. Do not sign and date this part until the referral or follow-up evaluation (if required) is
completed and the applicant is medically cleared. Your signature must be original. Stamped signatures or typewritten
names are not acceptable (except for blanket-designated health department or military physicians as described below).
You must also enter your Civil Surgeon Identification Number (CSID), unless you are preforming the examination
under a health department or military blanket designation. You can locate your CSID on the initial designation
approval letter sent to you by USCIS, National Benefits Center. If you cannot locate your CSID, send an email to
[email protected].
In signing the Form I-693 in this part, you certify under penalty of perjury that you have a valid, unrestricted license
in the jurisdiction in the United States in which you are conducting immigration medical examinations. You also
certify under penalty of perjury that no other jurisdiction in the United States in which you conduct immigrationrelated medical examinations has revoked or placed restrictions on your license to practice medicine in that
jurisdiction.

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For health departments performing the vaccination assessment for refugee adjustment applicants ONLY: You
must complete Part 7. Civil Surgeon’s Contact Information, Certification, and Signature of Form I-693. The
original or stamped signature of the physician on staff at the health department must be present in Part 7. USCIS
will reject signatures by attending nurses, physician assistants, or other medical professionals who are not licensed
physicians. Health departments must also place either the official stamp or raised seal, whichever is customarily used,
in Part 7. where indicated.
Military physicians performing the medical examination for members and veterans of the U.S. Armed
Forces or U.S. Coast Guard, their eligible dependents and other applicants as deemed necessary by USCIS in
emergent circumstances must also complete Part 7. The original or stamped signature of the military physician
operating under the blanket civil surgeon designation must appear in Part 7. USCIS will reject signatures by
attending nurses, physician assistants, or other medical professionals who are not licensed physicians. Military
treatment facilities must also place either their official stamp or raised seal in Part 7. where indicated.
4. Part 8. Civil Surgeon Worksheet and Part 10. Vaccination Record. You must fill out this worksheet and
provide the results of each component of the medical examination relating to: communicable diseases of public
health significance, physical or mental disorders with associated harmful behavior, drug abuse or drug addiction,
and vaccinations (including the COVID-19 vaccine series, one or two doses, depending on the formulation, and as
applicable). You must also include the results of any lab work or other studies required to determine whether the
applicant is inadmissible on health-related grounds.

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NOTE: If you indicate that the applicant may be eligible for blanket waivers for some vaccines but has otherwise
completed all other medically appropriate and available vaccination requirements, select the box “Applicant
completed vaccination requirements or may be eligible for blanket waivers as indicated above.”
5. Part 9. Referral Evaluation. If you refer the applicant to a local health department or to another physician or clinic,
you must also fill out Item Number 5. Required Referral to Health Department or Other Doctor in Part 8. Civil
Surgeon Worksheet in Form I-693. The health care professional receiving the referral must fill out and sign Part 9.
Referral Evaluation. Do not complete Item Number 5. in Part 8. if the referral is recommended and not required.

How Do I Complete Form I-693 If I Need to Make a Required Referral?

Advise applicants that they must complete all health-related follow-up requirements before you can certify Form I-693.
You must fill out Item Number 5. Required Referral to Health Department or Other Doctor in Part 8. Civil Surgeon
Worksheet with the contact information of the physician or public health facility that will conduct further evaluation or
provide treatment. You should also specify the type of examination and additional tests or treatment that the applicant
should receive in the Remarks section of Item Number 5. The health care professional receiving the referral must fill
out and sign Part 9. Referral Evaluation. Complete your identifying information in Part 7., but do not sign or date the
application. Make a copy of the Form I-693 for your records and give the original to the applicant in a sealed envelope.
(See the next section for additional instructions for sealing the envelope.)

What Should I Do After the Medical Examination and Health-Related Follow-Up Requirements (If
Required) Are Completed?
After the medical examination and any health-related required follow-up is complete, summarize the results in Part 6. of
Form I-693. Do not sign Form I-693 until the applicant has met all health-related follow-up requirements. After that,
sign the civil surgeon’s certification in Part 7., Item Number 8.
Make two copies of the completed and signed Form I-693 and any supporting documents. Keep one copy for your
records. Give the other copy to the applicant. The vaccination portion of Form I-693 will serve as the applicant’s official
vaccination record for future use (for example, school or employment purposes.)

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Prepare the original of the completed and signed Form I-693 for submission to USCIS.
Follow these steps:
1. Place the Form I-693 and any supporting documentation into an envelope.
2. Seal the envelope.
3. On the front, write in capital letters: “DO NOT OPEN. FOR USCIS USE ONLY.”
4. On the back, write your initials across the seal where the flap meets the envelope.
5. Seal the entire flap with clear tape. Make sure the tape covers your initials as well as the flap.
6. Give the sealed envelope to the applicant.
The applicant must submit the sealed envelope to USCIS.

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IMPORTANT: USCIS will not accept Form I-693 unless it is in a sealed envelope that is not opened or altered in
any way.
Return to the applicant all supporting medical documents that you were not required to include in the sealed
envelope.

Frequently Asked Questions

1. Who must submit Form I-693?

Most applicants filing for adjustment of status to become a lawful permanent resident must submit Form I-693
completed by a designated civil surgeon. Certain other applicants may also be required to submit Form I-693
completed by a civil surgeon.
2. What if I am a refugee and already completed an immigration medical examination abroad?
If you are now applying for adjustment of status under INA section 209 one year after your first admission as a
refugee, then you only need to repeat the entire immigration medical examination if the panel physician found a Class
A medical condition during your examination.
If the panel physician did not find a Class A medical condition and therefore, you do not need to repeat the full
immigration medical examination, then you must still comply with the vaccination requirements. This means you
only need to submit Part 10. Vaccination Record and Parts 1. - 5., and Part 7. of Form I-693. Contact your state or
local refugee health coordinator to find out whether a state or local health department can complete the Part 10. of
Form I-693. The health department must also complete Part 7. of the benefit request.
3. What if I am a K nonimmigrant visa holder and already completed an immigration medical examination
abroad?
If you were admitted as a:
A. K-1 fiancé(e) or a K-2 child of a K-1 fiancé(e); or
B. K-3 spouse of a U.S. citizen or a K-4 child of a K-3 spouse of a U.S. citizen; and
C. You received a medical examination prior to admission, then:
(1) You are not required to complete another immigration medical examination as long as you file your Form
I-485 within one year of an immigration medical examination completed outside the United States; and
(a) The panel physician did not find a Class A medical condition during your imigration medical examination;
or
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(b) The panel physician did find a Class A medical condition, you received a waiver of inadmissibility, and
you have complied with the terms and conditions of the waiver.
(2) Even if a new immigration medical examination is not required, you must still show proof that you complied
with the vaccination requirements. If the vaccination record (DS 3025) was not properly completed and
included as part of the original medical examination report completed abroad, you will need to have the Part
10. Vaccination Record completed by a designated civil surgeon. In this case, you must submit Parts 1. - 5.,
7., and 10.
of Form I-693.
4. What if I am an asylee derivative applying for adjustment of status and already completed an immigration
medical examination abroad?
If you were admitted to the United States as an asylee derivative, you generally do not need to repeat, at the time you
submit Form I-485, the entire immigration medical examination provided that:
A. The panel physician found no Class A medical condition during your immigration medical examination completed
outside the United States; and

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B. You are applying for adjustment of status within one year of becoming eligible to file.

You must, however, comply with the vaccination requirement and submit Part 10. Vaccination Record and
Parts 1. - 5., and 7. of Form I-693 with your Form I-485.
5. What if I am an Afghan national who entered the United States under Operation Allies Welcome (OAW), am
applying for adjustment of status, and already completed an immigration medical examination abroad?
If you are an Afghan national who applying for adjustment of status who entered the United States under OAW, you
do not have to repeat the immigration medical examination by submitting Form I-693 if:
•

The results of the immigration medical examination completed outside the United States by a panel physician are
in your A-File and do not report a Class A medical condition;

•

The panel physician completed the immigration medical examination no more than 4 years before the date you
file to adjust status; and

•

No evidence suggests that you have acquired a Class A medical condition after entry into the United States

6. May any doctor perform the required immigration medical examination?

Only a doctor who was designated by USCIS as a civil surgeon may perform the medical examination (except for
limited exceptions for military and health department blanket designated civil surgeons). USCIS will not accept a
Form I-693 completed by a doctor who is not a currently designated civil surgeon.
7. How do I know if a doctor is a designated civil surgeon?

Doctors found through the USCIS website at www.uscis.gov or through the USCIS Contact Center are generally
current in their designation as civil surgeons. Applicants who are unsure should ask doctors to confirm their status as
a civil surgeon.
8. Who pays for the immigration medical examination?
You, the applicant, must pay all costs of the immigration medical examination, including the cost of any follow-up
tests or treatment that is required. Make payments directly to the civil surgeon or other health care provider.
9. What are the health-related grounds of inadmissibility?
U.S. immigration law divides the health-related grounds of inadmissibility into the following four general categories:
A. Communicable diseases of public health significance;
B. Lack of proof of having received required vaccinations;

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C. Physical or mental disorders with associated harmful behavior or a history of associated harmful behavior; and
D. Drug abuse or addiction.
See INA section 212(a)(1)(A). HHS regulations classify these and other medical conditions into class A or B medical
conditions. Class A medical conditions result in inadmissibility while Class B medical conditions do not. See 42 CFR
34.2(d) - (e).

Medical Evaluations
1. Communicable Diseases of Public Health Significance
The civil surgeon is required to perform specific tests for tuberculosis, syphilis, and gonorrhea. The medical
examination also requires the civil surgeon to evaluate for other sexually transmitted diseases and Hansen’s disease
(leprosy).

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If you have a communicable disease of public health significance, the civil surgeon will advise you on how to obtain
treatment. USCIS will inform you of whether you also need to apply for a waiver of inadmissibility. To learn more
about this waiver, visit the USCIS website at www.uscis.gov.
A. Testing for Tuberculosis

All applicants two years of age and older must be tested for tuberculosis (TB) with an initial
screening test. Civil surgeons may require an applicant younger than two years of age to undergo
testing if there is evidence of contact with a person known to have TB or other reasons to suspect
TB. Testing must be completed per CDC guidelines, which can be found on the CDC website at
https://www.cdc.gov/immigrantrefugeehealth/civil-surgeons/tuberculosis.html. If that test is positive, the
applicant is required to have a chest X-ray and if that is abnormal and suggestive of TB, the applicant must be
referred to the health department.
B. Testing for Syphilis (See CDC’s Syphilis Technical Instructions for Civil Surgeons for required testing ages)
Civil surgeons must consult the latest version of CDC’s Technical Instructions for Civil Surgeons
(https://www.cdc.gov/immigrantrefugeehealth/civil-surgeons/syphilis.html) to ensure they are testing the
currently required age ranges, using an approved type of test and following appropriate screening and testing
procedures. Civil surgeons may require testing for applicants outside the CDC specified age ranges if there is
reason to suspect infection with syphilis.
C. Testing for Gonorrhea (See CDC’s Gonorrhea Technical Instructions for Civil Surgeons for required testing
ages)
Civil surgeons must consult the latest version of CDC’s Technical Instructions for Civil Surgeons
(https://www.cdc.gov/immigrantrefugeehealth/civil-surgeons/gonorrhea.html.) to ensure they are testing the
currently required age ranges, using an approved type of test, and following appropriate screening and testing
procedures. Civil surgeons may require testing for applicants outside the CDC specified age ranges if there is
reason to suspect infection with gonorrhea.
2. Physical or Mental Disorders
This category of physical or mental disorders includes any diagnosis of substance-use disorders that involve any
substance that is not listed in Schedule I, II, III, IV, or V of section 202 of the Controlled Substances Act (for example,
diagnosis of an alcohol-use disorder). Mental disorders are diagnosed according to the diagnostic criteria in the most
recent edition of the Diagnostic and Statistical Manual (DSM) or by another authoritative source as determined by
the CDC director. Physical disorders are diagnosed according to the diagnostic criteria in the most recent edition of
the World Health Organization’s Manual of the International Classification of Diseases, Injuries, and Causes of Death
(ICD) or by another authoritative source as determined by the CDC director. See the CDC’s Technical Instructions
for Civil Surgeons for more information.
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The presence of a physical or mental disorder alone does not make you inadmissible on health-related grounds.
The civil surgeon must also determine that there is behavior associated with the disorder that is harmful to you, to
others, or to property. USCIS will only consider you inadmissible if there is a current associated harmful behavior or
a history of associated harmful behavior that is likely to recur.
The civil surgeon will ask you general questions during the medical examination to determine whether you have such
a condition. The civil surgeon may refer you to a specialist for further evaluation, if necessary.
If the civil surgeon finds that you have a physical or mental disorder with associated harmful behavior, you may apply
for a waiver. If the waiver is granted, you may be subject to terms, conditions, and controls as determined by USCIS
in consultation with HHS. For more information about these waivers, visit the USCIS website at www.uscis.gov.
3. Drug Addiction and Drug Abuse
HHS sets the medical guidelines for determining drug abuse and drug addiction. The terms are defined at 42 CFR
34.2(h) and (i). The civil surgeon will review your medical history during the medical examination and ask you
questions necessary to determine whether you are currently using any drugs or other psychoactive substances or have
used them in the past.

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“Drug abuse or drug addiction” is “current substance use disorder, mild, moderate, severe” but only with respect
to substances listed in Schedule I, II, III, IV, or V of section 202 of the Controlled Substances Act. The diagnosis is
made according to the diagnostic criteria in the most current edition of the DSM or by another authoritative source as
determined by the CDC Director.
If the civil surgeon determines you have a substance-related disorder, you are not eligible to apply for a waiver unless
you are applying for adjustment of status one year after you were admitted as a refugee or granted asylum.
You will no longer be inadmissible based on drug abuse or drug addiction if, after a later medical examination by
a civil surgeon, the civil surgeon finds your drug abuse or addiction is in remission. The diagnosis of remission is
made according to the diagnostic criteria in the most current edition of the DSM or another authoritative source as
determined by the CDC director.

Vaccination Requirements

All applicants for adjustment of status must present documents showing they were vaccinated against a broad range of
vaccine-preventable diseases. The civil surgeon will review your vaccination history with you to determine whether you
have had all the required vaccinations. Make sure you take your vaccination records with you to your appointment with
the civil surgeon.
NOTE: With the exception of those required to get the COVID-19 vaccine, you should not attempt to
meet the vaccination requirements before the civil surgeon evaluates you in case any of the required
vaccines are not medically appropriate for you. However, completing the COVID-19 vaccination
process before your appointment with a civil surgeon will expedite the immigration medical
examination process. For more information about the COVID-19 vaccination requirements, see
https://www.cdc.gov/immigrantrefugeehealth/civil-surgeons/covid-19-technical-instructions.html.
You can find information about other required vaccines at
https://www.cdc.gov/immigrantrefugeehealth/civil-surgeons/vaccinations.html.
If you never received certain vaccines, or you are unable to prove you received them, the civil surgeon can provide them
to you. You also have the option to ask your family doctor to administer those vaccines to you after your evaluation by
the civil surgeon. If you choose that option, show the records to the civil surgeon to note on Form I-693.
If you initially did not have documents proving you received all the required vaccines, but later submit those documents,
USCIS may grant you a waiver based on the civil surgeon’s certification on Part 10. Vaccination Record of Form I-693.
USCIS may also grant you a blanket waiver if the civil surgeon indicates that you may be eligible for blanket waivers for
some vaccines but have otherwise completed all other medically appropriate and available vaccination requirements.
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HHS has determined that a vaccine is “not medically appropriate” if:
1. The vaccine is not recommended for your specific age group;
2. There is a medical reason why it would not be safe to have the vaccine (for example, you are allergic to eggs and/or
yeast or you had bad reactions to prior vaccines);
3. You are unable to complete the entire series of a required vaccine within a reasonable amount of time;
4. For the influenza vaccine, it is not available in the location where the civil surgeon practices; or
5. For the COVID-19 vaccine, it is not routinely available in the location where the civil surgeon practices.
If you object to required vaccinations because of sincerely held religious beliefs or moral convictions, you may apply for
a waiver of these requirements. If you hold these objections, inform the civil surgeon that you will apply for a waiver.
If USCIS denies the waiver application, we may also deny the immigration benefit that you are seeking. For more
information about these waivers, visit the USCIS website at www.uscis.gov.

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Address Change (For Applicants Only)

An applicant or petitioner who is not a U.S. citizen must notify USCIS of his or her new address within 10 days of moving
from his or her previous residence. For information on filing a change of address, go to the USCIS website at
www.uscis.gov/addresschange or reach out to the USCIS Contact Center at www.uscis.gov/contactcenter for help. If
you do not have internet access, you may call the USCIS Contact Center at 1-800-375-5283 (TTY 1-800-767-1833).
The USCIS Contact Center provides information in English and Spanish.
NOTE: Do not submit a change of address request to the USCIS Lockbox facilities because the Lockbox does not
process change of address requests.

USCIS Forms and Information

To ensure you (the applicant or the civil surgeon) are using the latest version of this form, visit the USCIS website at
www.uscis.gov where you can obtain the latest USCIS forms and immigration-related information. If you do not have
internet access, you may call the USCIS Contact Center at 1-800-375-5283 (TTY 1-800-767-1833). The USCIS Contact
Center provides information in English and Spanish.
Please visit us at www.uscis.gov/contactcenter to get basic information about immigration services and ask questions
about a pending case. Through our digital self-help tools and live assistance, the USCIS Contact Center provides a
pathway for you to get consistent, accurate information and answers to immigration case questions.

Penalties
If you (the applicant or the civil surgeon) knowingly and willfully falsify or conceal a material fact or submit a false
document with the Form I-693, we will deny your Form I-485 and may deny any other immigration benefit. In addition,
you will face severe penalties provided by law and may be subject to criminal prosecution.

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DHS Privacy Notice
AUTHORITIES: The information requested on this form, and the associated evidence, is collected under the
Immigration and Nationality Act section 212(a)(1)(a).
PURPOSE: The primary purpose for providing the requested information on this form is to report results of a medical
examination and provide vaccination records to USCIS. DHS uses the information to assist with determining eligibility
for the immigration benefit you are seeking.
DISCLOSURE: The information you provide is voluntary. However, failure to provide the requested information,
including your Social Security number (if applicable), and any requested evidence, may delay a final decision or result in
denial of your form.

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ROUTINE USES: DHS may share the information you provide on this form and any additional requested evidence with
other Federal, state, local, and foreign government agencies and authorized organizations in accordance with approved
routine uses described in the associated published system of records notices [DHS/USCIS/ICE/CBP-001 Alien File, Index,
and National File Tracking System and DHS/USCIS-007 Benefits Information System] and the published privacy impact
assessments [DHS/USCIS/PIA-003 Integrated Digitization Document Management Program (IDDMP) and
DHS/USCIS/PIA-067 Civil Surgeon Designation] which you can find at www.dhs.gov/privacy. DHS may also share this
information, as appropriate, for law enforcement purposes or in the interest of national security.

Paperwork Reduction Act

An agency may not conduct or sponsor an information collection, and a person is not required to respond to a collection
of information, unless it displays a currently valid Office of Management and Budget (OMB) control number. The public
reporting burden for this collection of information is estimated at 3 hours per response, including the time for reviewing
instructions, gathering the required documentation and information, completing the form, preparing statements, attaching
necessary documentation, and submitting the form. Send comments regarding this burden estimate or any other aspect
of this collection of information, including suggestions for reducing this burden, to: U.S. Citizenship and Immigration
Services, Regulatory Coordination Division, Office of Policy and Strategy, 5900 Capital Gateway Drive, Mail Stop #2140,
Camp Springs, MD 20588-0009; OMB No. 1615-0033. Do not mail your completed Form I-693 to this address.

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