Every adjustment-of-status applicant files a medical examination report, Form I-693, before USCIS can approve the I-485. It is the one step in an employment green card that is not about the job, the queue or a priority date, and it has its own rules about who can do it and how long the result lasts. Those rules changed in 2023 and a lot of what is written about them online is from before the change.
Everything below is from USCIS's Policy Manual, Volume 8, Part B, Chapter 4, read on September 8, 2026. Where a rule has a date, the date is USCIS's.
Who can do the exam
Only a physician USCIS has designated as a civil surgeon may perform the exam and sign the form inside the United States. USCIS designates doctors of medicine and doctors of osteopathy who hold a current licence; a family doctor who is not designated cannot sign an I-693, however good the exam.
The exam covers what the health-related grounds of inadmissibility ask about: a physical, a review of vaccination records against the required list, and screening for the conditions the CDC's technical instructions name. The surgeon seals the completed form in an envelope. Do not open it; USCIS wants it sealed.
Applicants outside the United States going through a consulate have their exam with a panel physician instead, arranged through the consulate. That is a different process and this guide does not cover it.
How long the form is valid
This is the rule that changed, and the one to check the date on when reading anything else.
The old 60-day rule, which required the signature to be no more than 60 days before the I-485 was filed, was removed on March 31, 2023. A page that still tells you to time the exam inside a 60-day window before filing is describing a rule that no longer exists.
One caution that follows from the new rule: "for the whole time the application is pending" attaches the form to that application. An I-693 filed with an I-485 that is later denied or withdrawn does not carry over to a new one.
When to have it done
Know which filing chart applies to you
An I-485 can only be filed when your priority date is current on the chart USCIS designates that month. Until then there is nothing to attach the exam to. The next visa bulletin page shows what the bulletin usually does in a given month, and the I-485 queue position tool shows the inventory ahead of your date.
Book the exam once filing is in sight
Because a form signed on or after November 1, 2023 lasts as long as the application is pending, there is no longer a reason to wait until the last weeks before filing. Booking a month or two ahead avoids the rush that follows a bulletin advance, when every applicant in a category becomes eligible at once.
Bring your vaccination records
Missing records mean the surgeon either finds the record, gives the vaccine, or documents a waiver reason. Each of those is a second visit or a fee, and the form cannot be completed without them.
File it with the I-485 if you can
USCIS accepts the I-693 with the initial filing or later by request. Filing it with the I-485 avoids a Request for Evidence for the medical, which is one of the most common RFEs on an employment-based adjustment.
Finding a civil surgeon
USCIS runs the only authoritative list, and it changes weekly: doctors are added and removed, and a doctor who was designated last year may not be now. The list is behind USCIS's search form, Find a Civil Surgeon, which takes an address, city, state or ZIP code and can filter by language spoken.
This site does not keep a copy of that list. USCIS publishes it only through its search form, the form refuses automated queries, and a copy that is a week stale would send people to doctors who are no longer designated. Use the locator, and confirm with the office when booking that the physician is still a USCIS-designated civil surgeon; the receptionist will know the phrase.
What it costs
There is no USCIS fee for the I-693 itself. The civil surgeon sets the fee for the exam, and any vaccines or lab work needed are charged on top. Prices vary widely by city and practice. Ask for the total for the exam, the vaccines you are missing and the required tests before you book, because the I-693 is not covered by most health insurance.
What this cannot tell you
- Which surgeon to choose. This site holds no reviews, prices or wait times for civil surgeons and does not rank them.
- Whether your vaccination record will be accepted. That is the surgeon's determination against the CDC's instructions.
- Your consular exam. Panel physicians and the consular medical are a different process with different validity.
- Whether USCIS will ask for a new exam. It can, in a Request for Evidence, if the form on file was signed under the old rule and has aged out.
Related
- The three 180-day clocks, including I-485 portability.
- Waiting on your green card, the whole road from PERM to adjustment.
- I-485 queue position, the inventory ahead of your priority date.
