Master prompt
Form I-693 medical exam + civil surgeon checklist (US)
Civil surgeon vs panel physician, exam contents, vaccination panel, validity window, sealing rules, and the chest X-ray / mental-health screening for I-485 AOS applicants.
USI-693Medical examCivil surgeonPanel physicianCDCI-485 AOS
Prepare [CLIENT_NAME] for the Form I-693 medical examination required for [FILING_TYPE]. The medical exam is governed by INA §212(a)(1) (health-related inadmissibility) and operationalised through Form I-693 + CDC Technical Instructions for Civil Surgeons and Panel Physicians.
§1 — WHO PERFORMS THE EXAM
If [FILING_TYPE] is I-485 AOS (US-based):
• USCIS-DESIGNATED CIVIL SURGEON
• Find via USCIS "Find a Doctor" tool on uscis.gov (filter by ZIP / city)
• For Bay Area — generate the list during consultation
• Civil surgeon must be currently designated (designations expire; verify on uscis.gov)
• Fees vary USD 200-500+ (not a USCIS fee; paid directly to clinic)
If [FILING_TYPE] is Immigrant visa abroad:
• EMBASSY-DESIGNATED PANEL PHYSICIAN
• Per 9 FAM 302.2 and CDC Technical Instructions for Panel Physicians
• Find via the issuing US Embassy / Consulate's website (e.g. US Embassy New Delhi panel physicians list)
• Common India panel physicians: Max Healthcare (Delhi), Apollo (Chennai), Lilavati (Mumbai), Yashoda (Hyderabad) — verify current designation
• Fees in India typically ₹7,000-15,000 // 2026-05 — verify with panel physician
§2 — VALIDITY WINDOW (CRITICAL — RULE CHANGED NOV 2023)
USCIS policy update effective 1-Nov-2023:
• I-693 is valid for 2 YEARS FROM THE DATE THE CIVIL SURGEON SIGNED IT
• Previously the rule required signing within 60 days of filing AND validity of 2 years from filing
• The new rule is simpler: 2 years from civil surgeon signature
// 2026-05 — verify current USCIS policy via USCIS Policy Manual Volume 8 Part B Chapter 4
For PANEL PHYSICIAN exams (consular processing):
• Different rule — exam typically valid 6 months for IV admission to the US (per 9 FAM 302.2-3)
• Some medical conditions trigger 3-month or shorter validity
PRACTICAL TIMING:
• For AOS — schedule the exam after biometrics and within a window where the 2-year validity will cover the expected interview date
• Filing strategies:
(a) File I-485 WITH I-693 (sealed envelope) — uses up validity from start
(b) File I-485 WITHOUT I-693 and respond to subsequent RFE with the medical — preserves more validity
(c) Bring I-693 to the interview (current USCIS practice often accepts this)
§3 — EXAM CONTENTS — CDC TECHNICAL INSTRUCTIONS
The civil surgeon / panel physician must perform and document:
A. PHYSICAL EXAMINATION
• Vital signs
• General appearance, skin, lymph nodes
• Eyes, ears, nose, throat
• Heart, lungs, abdomen
• Extremities, neurological exam
• Mental status — see §6 below
B. TUBERCULOSIS SCREENING
• Applicants 2+ years old: tuberculin skin test (TST) OR Interferon Gamma Release Assay (IGRA blood test — Quantiferon / T-SPOT)
• Positive screening → chest X-ray
• Chest X-ray showing TB → sputum testing (3 specimens) → if positive, full treatment per CDC protocol before approval
• PRIOR TB HISTORY (per None): document treatment completion, sputum-negative status, current medical letter
C. SYPHILIS AND GONORRHEA SCREENING
• Applicants 15+ years old: serologic test for syphilis (VDRL/RPR) + gonorrhea NAAT
• Positive → treatment + documentation of cure
D. OTHER COMMUNICABLE DISEASES
• Leprosy, HIV (HIV no longer inadmissibility ground since 2010 but may be evaluated per case)
• Hansen's disease, lymphogranuloma venereum, chancroid, granuloma inguinale
§4 — VACCINATION PANEL (CDC LIST)
USCIS requires the following vaccines per the Form I-693 Technical Instructions (updated periodically; current as of 2026-05):
□ Measles, Mumps, Rubella (MMR)
□ Diphtheria, Tetanus, Pertussis (DTaP / Tdap)
□ Polio (IPV)
□ Hepatitis A
□ Hepatitis B
□ Haemophilus influenzae type B (Hib) — children under 5
□ Rotavirus — infants
□ Meningococcal — adolescents and certain ages
□ Varicella (chickenpox)
□ Pneumococcal — by age criteria
□ Influenza — seasonal, age-dependent
□ COVID-19 — STATUS UNCERTAIN as of 2026-05: USCIS removed COVID-19 from the required panel effective Jan-2025 (verify against current Form Instructions) // 2026-05 — verify current USCIS / CDC requirement
WAIVERS / EXEMPTIONS:
• Age-inappropriate (vaccine not recommended for age)
• Medical contraindication (documented by physician)
• Religious / moral conviction (file Form I-601 waiver application)
• Not routinely available in country of origin (extremely rare in India context — most vaccines are available)
PROCESS WITH Partial:
• Bring all prior vaccination records to the civil surgeon (Indian "yellow card" / school records / hospital records)
• Civil surgeon updates Form I-693 vaccination chart
• Missing vaccines: civil surgeon administers OR refers to alternative provider; client returns with proof
• Titers (serology to prove past immunity) accepted as alternative to documented vaccination history
§5 — CHEST X-RAY RULES
• Required if tuberculin/IGRA test positive
• Required for ALL applicants 15+ years in some panel physician protocols (verify with specific country)
• Pregnant women: chest X-ray can be deferred OR done with abdominal shielding (CDC protocol)
• X-ray report must be signed by the civil surgeon / panel physician
• The X-ray film itself does NOT need to be submitted; only the report and Form I-693 entries
§6 — MENTAL HEALTH SCREENING (I-485 AOS)
INA §212(a)(1)(A)(iii) — mental disorder with associated harmful behavior is inadmissibility ground.
Civil surgeon screens for:
• Current or past mental disorders
• Substance-related disorders (alcohol, drug use)
• History of harmful behavior (self-harm, harm to others, property damage)
• DUI history is reviewed — single old DUI typically not an issue; multiple or recent DUIs warrant deeper screening
PRACTICAL NOTE for None:
• If mental health treatment in past — bring treating physician's letter (current status, treatment compliance, prognosis)
• If substance use treatment in past — completion records, sobriety documentation
• Civil surgeon makes the call on whether to refer for psychiatric evaluation
§7 — DRUG USE / DRUG ABUSE / DRUG ADDICTION
INA §212(a)(1)(A)(iv) makes "drug abuse or drug addiction" an inadmissibility ground.
• Current users (within 12 months typically): inadmissible
• Past users in remission (5+ years): generally admissible
• Marijuana: STILL a Controlled Substance Act Schedule I drug federally; state legalisation does NOT change USCIS treatment
• Disclosure to civil surgeon — be truthful; the surgeon is required to ask
§8 — SEALING AND FILING
After the exam:
• Civil surgeon completes Form I-693 (current edition)
• Place I-693 in an envelope, SEAL IT, and the civil surgeon signs across the seal
• Applicant DOES NOT OPEN THE ENVELOPE — opened envelopes are typically rejected by USCIS
• Civil surgeon often provides a copy of the unsealed Form I-693 to the applicant for their records (acceptable)
• Sealed envelope is submitted with the I-485 filing OR at the interview OR in response to an RFE
If Panel Physician (abroad):
• Some posts use electronic transmission directly to the Embassy
• Some still use sealed envelope handed to applicant for IV interview
• Confirm with the specific Embassy / Consulate before exam
§9 — SPECIAL POPULATIONS
REFUGEES / ASYLEES adjusting under §209:
• Often have prior medical exam from refugee processing
• May need only updated vaccination evaluation (Form I-693 partial)
VAWA SELF-PETITIONERS / U-VISA / T-VISA AOS applicants:
• Standard I-693 requirements apply
• Special accommodations for sensitive medical history
CHILDREN UNDER 14:
• Some vaccination requirements age-adjusted
• TB testing typically not required under age 2
• Parent / guardian must accompany
§10 — RED FLAGS TO COVER WITH [CLIENT_NAME] BEFORE EXAM
□ Bring photo ID matching the I-485 name (passport + driver's license)
□ Bring all prior vaccination records — Indian yellow card if available
□ Bring records of any prior TB, hepatitis, mental health, substance treatment (None)
□ List of current medications + prescribing doctor contacts
□ Allow 2-3 hours at the clinic for the exam + counseling
□ If vaccines need to be administered: budget a second visit
□ Bring exam fee (usually paid same-day, cash or card)
□ DO NOT OPEN the sealed envelope after exam
□ Photograph the sealed envelope (front + back) for the file before mailing / handing in
End with: "DRAFT I-693 preparation guide — for licensed US immigration attorney or accredited representative review. Verify against current USCIS Form Instructions, CDC Technical Instructions for Civil Surgeons, and 9 FAM 302.2 before submission. The validity window, vaccination panel, and COVID-19 requirement specifically have changed multiple times since 2020 — re-check uscis.gov within 7 days of scheduling the exam."Unlock the vault to see the full prompt