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The Complete Guide to the U.S. Immigration Medical Exam

July 2, 2021
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Summary

The immigration medical exam is a crucial part of the green card application process. Under U.S. immigration law, all green card applicants must complete the immigration medical exam to confirm that they are in good health and are fit to live in the United States as permanent residents. If you have wondered what the point of the immigration medical exam is, what exactly the medical process involves - including how much it costs, how to find a doctor, what medical tests you will undergo, and what happens after - this article has it all! We explain the entire immigration medical exam process and discuss certain health conditions that may make you "inadmissible" to the United States.

Overview

What is the immigration medical exam?

Receiving a medical examination is an essential part of your immigration process to obtain a green card. Your green card application process is incomplete without the immigration medical exam. A government-authorized doctor will conduct the exam, which will include: 

  • Mental and physical examination 
  • Medical history and immunization or vaccine record review 
  • Drug and alcohol screening 
  • Testing for various illnesses and diseases

Why do I need to take the immigration medical exam?

 U.S. Citizenship and Immigration Services (USCIS) requires the immigration medical exam to protect the public health of the U.S. population. Anyone applying for permanent residence must undergo an immigration medical exam. Certain health conditions could make you “inadmissible” to the United States. In other words, you may be ineligible to receive a green card because of a current health condition or something in your health history. This is called “medical inadmissibility.”

"Medical Inadmissibility" — Health-related reasons for denial

There are five main health reasons for which U.S. Citizenship and Immigration Services (USCIS) could deny your green card application. These include communicable diseases that could affect public health, drug or alcohol abuse, mental or physical disorders associated with harmful behaviors, inability to work, and an incomplete vaccination record.

Reason 1: Communicable diseases that could affect public health

Suppose you have certain active, untreated, and infectious diseases (including gonorrhea, syphilis, leprosy, or tuberculosis). USCIS may deny you a green card until you are treated or cured and can enter the United States without infecting other Americans. 

Reason 2: Drug or alcohol abuse 

If your medical exam shows that you are currently abusing prescription drugs, illegal drugs, or alcohol, you may not be able to get a green card. If you have a history of abusing drugs, USCIS may ask you to take a drug test or verify you participated in a drug treatment program. 

Reason 3: Mental or physical disorders associated with harmful behaviors 

If you have an illness that could cause you to be violent towards yourself or others, USCIS may deny you a green card. USCIS considers drunk driving one of these disorders since it is harmful to other people besides the drunk driver. 

Reason 4: Inability to work 

If your health conditions prevent you from working and supporting yourself financially, USCIS may consider you ineligible to get a green card. This qualification depends on how likely you would become someone dependent on government benefits. Conditions such as serious fatal diseases could fall in this category. 

Reason 5: Failure to show proof you previously had your required vaccines 

If you cannot provide evidence that you obtained the proper vaccines to enter the United States, you may also be considered “inadmissible.” 

How to avoid “medical inadmissibility”

USCIS will not deny you a green card if you have a cold, a chronic, but well-managed disease, such as diabetes, are HIV positive or previously had an infectious disease, but have since been cured. There are also things you can do to try to prevent facing a health-related denial of your application. Here are some tips: 

  • If you had one of the contagious diseases (including gonorrhea, syphilis, leprosy, or tuberculosis) in the past, you need to show proof of treatment to USCIS. For example, you could bring copies of your medical records that show your treatment and test results, along with a statement from your regular doctor stating your disease is cured or under control. 
  • If you have a history of drug abuse, you should bring proof that you have received treatment. 
  • If you have a history of mental illness, you should bring proof you are managing your mental health well. 
  • If you have other serious diseases, you should bring a statement from your regular doctor that explains how you manage your condition. It should also explain how much your illness affects your life, including its impact on your ability to work. 

If USCIS denies your application for health-related reasons, you can apply for a “waiver of inadmissibility” or a government waiver to still enter the United States. USCIS will communicate with the Centers for Disease Control and Protection (CDC) about providing you a waiver. They could potentially create specific conditions on which they’ll approve your waiver. For example, you may have to see a doctor immediately and receive treatment in the United States if you have an infectious disease. However, USCIS could deny your waiver if you directly refuse to obtain treatment. You should only file a waiver of inadmissibility with the help of a lawyer.

How do I prepare for my immigration medical exam?

To receive an immigration medical exam for your green card application, you need to find a government-approved doctor. Only some doctors are eligible to perform these exams. Your choice of doctors and whether you need to complete the appointment before your scheduled interview depends on your location. Read more about these preparation steps below! 

How do I choose a doctor for my immigration medical exam?

It is important to find the right government-authorized doctor for your medical exam. If you are applying for an immigrant visa outside of the United States, your U.S. embassy or consulate can provide you with a list of panel physicians certified by the Department of State. You can most likely choose your physician, but you should check with your local consulate to make sure. If you are applying for an adjustment of status within the United States, a U.S. civil surgeon should examine you. 

The process of scheduling will also depend on your current location. 

If you're applying from inside the U.S.

You have two different options for scheduling your appointment if you’re in the United States. 

Option 1: Schedule it before beginning your green card application process

You can submit your medical exam results along with the rest of your application, which is called “concurrent filing.” 

However, if you receive your exam before starting your green card application, your medical exam results must be signed by a civil surgeon within sixty days of filing your green card application. If your doctor signed the form more than sixty days before, you can’t do concurrent filing. You should instead wait to submit your medical form until after sending your green card application to the U.S. Citizenship and Immigration Services (USCIS), or you should bring the form to your interview. Otherwise, you have to repeat the medical exam. If you wait until after filing your green card application, you can send in or bring in your medical records within two years. 

Option 2: Schedule it after starting your green card application process

After submitting your green card application, you can send your medical exam results to USCIS or bring them to your green card interview. Your exam forms are valid for two years since the doctor signed your document. 

You can find a doctor through USCIS’s webpage. Be sure to let them know you need an immigration medical exam before scheduling your appointment. 

If you're applying from outside the U.S.

You can schedule your medical exam after the National Visa Center (NVC) sends you an appointment letter for your green card interview. The NVC is the State Department team that reviews green card applications for applicants outside of the United States. 

Before you receive your appointment letter, you should find your local U.S. embassy or consulate. They will give you instructions for the exam and a list of approved doctors within your country. It is your choice which doctor to select. It is best to schedule your medical exam right after you receive an interview date and to let the medical office know you need an immigration medical exam. 

Your exam results are valid for six months unless you have certain medical conditions which could cause your exam results to expire in three months. At the end of your exam, you should check in with your physician about when your results expire. 

What should I bring to my immigration medical exam?

It’s important to prepare documents to bring to your medical exam, so the process goes smoothly. You should bring these items along with you: 

  • Your vaccination records 
  • A copy of your medical history 
  • If applicable, copies of previous chest x-rays 
  • A letter from your regular doctor stating your treatment plan for any of your health problems 
  • A government-issued photo ID 
  • Payment for the medical exam fee — Check with the doctor’s office for payment options before your appointment
  • If applicable, your health insurance card — Check with the doctor’s office to see if they accept your insurance before the appointment 

The final documents you must bring depends on whether you are applying for a green card from inside or outside of the United States. 

If you're applying from inside the U.S.

You should bring Form I-693, officially named “Report of Medical Examination and Vaccination Record.” The civil surgeon will record your exam results on this document.

Even though most doctors can give you a copy of this form at their office, you should bring your copy of Form I-693 from the USCIS website. It would help if you did this to make sure you have the latest version of the form. Sometimes doctors can forget to update their form version when USCIS changes it. If you file an old version, USCIS will reject it and ask you to resubmit the correct form version. You would have to return to the doctor’s office and delay your application. 

You can also fill out your portion of the form before arriving at the doctor’s office to save time. However, don’t sign the record until the authorized doctor tells you to. The document requires you to sign it in the presence of a doctor. 

Afterward, the doctor will complete their portion of the form at the end of the exam, and ask you to sign.  

If you're applying from outside the U.S.

You need to bring your green card interview appointment letter from the National Visa Center (NVC) to the doctor’s office if you’re applying abroad. The doctor will use this letter to confirm your active green card application. Without this letter, you will not receive an immigration-specific medical exam. 

How much does the USCIS medical exam cost?

The cost for your immigration medical exam can vary depending on the authorized doctor and the location of the exam. The U.S. government doesn’t standardize the fee, and prices can range from $100 to $400. You can check with several doctors to see how much they each charge, and make the decision that’s best for you. You should also factor in other indirect costs, such as transportation costs.  

What do they check in the immigration medical exam?

The medical exam will involve many different screenings. The screening processes may vary depending on whether you are applying for adjustment of status while located inside the United States or consular processing while outside of the United States. Regardless of whether you apply for an asylum green card, child green card, parent green card, marriage green card, or any other green card, the general categories of screenings will stay the same. The screening will include a tuberculosis test, vaccination screening, medical history review, physical exam, mental exam, drug and alcohol screening, and blood and urine screening. 

Tuberculosis Test

The Centers for Disease Control and Prevention (CDC) has different tuberculosis test guidelines depending on whether you are inside or outside the United States. 

If applying from the U.S.

The CDC requires the doctor to conduct an “interferon gamma release assay” (IGRA) test on all green card applicants ages two and older. You most likely won’t have to return to the doctor’s office to obtain results. 

However, if the IGRA test indicates you may have tuberculosis, you will have to undergo further testing and a chest x-ray. 

One important note is that the USCIS no longer accepts the tuberculin skin test (TST) for green card applicants within the United States. Be sure you receive the right kind of test. 

If applying from outside the U.S.

The CDC requires you to undergo a chest x-ray if you are fifteen and older and located in a country considered “heavily tuberculosis-burdened.” 

If the x-ray or any other medical examination results indicate you may have tuberculosis, you will have to return to the clinic for further testing. 

You should check for further tuberculosis exam instructions from your U.S. embassy or consulate. 

Vaccination Screening

The Immigration and Nationality Act requires certain vaccines, and the CDC requires others. You will need to prove you have received the following vaccinations:

  • Mumps, measles, and rubella 
  • Diphtheria toxoids and tetanus
  • Polio
  • Pertussis
  • Hepatitis A
  • Hepatitis B
  • Haemophilus Influenza Type B
  • Influenza
  • Varicella
  • Pneumococcal Pneumonia
  • Meningococcal
  • Rotavirus

These guidelines could vary over time, so you can check the list U.S. Citizenship and Immigration Services (USCIS) provides. 

Medical History Review

The doctor will also check your medical history. They will specifically note:  

  • If you ever stayed in the hospital or had any significant events in your health history 
  • If you ever were disabled or highly sick and unable to function as an average member of society 
  • If you were ever in an institution for a chronic mental or physical condition 

Physical Exam

During your physical exam, your doctor will likely examine these areas: 

  • Ears
  • Eyes
  • Throat
  • Nose
  • Heart
  • Lungs
  • Extremities
  • Abdomen
  • Skin
  • Lymph nodes
  • External genitalia

You will also undergo a chest x-ray and blood test to check for syphilis. USCIS will excuse child green card applicants from this requirement. 

If you are pregnant, contact your embassy or consular office to ask for a postponement in your medical examination filing process. An x-ray could harm your pregnancy. 

Mental Exam

Your doctor will also examine your mental health. They will likely assess your intelligence, judgment, mood, behavior, and comprehension. 

They will especially note: 

  • Current mental or physical disorders associated with harmful or violent behavior 
  • Past mental or physical conditions associated with dangerous or violent behavior and that are likely to reoccur 

If these two categories apply, you could be inadmissible. 

Drug & Alcohol Screening

The doctor will also ask you about any prescription drugs you take, your past and current drug and alcohol use, and whether you have had a history of substance abuse. If you are currently abusing substances, you will not qualify for a green card. If you can prove you have recovered, you are still eligible. 

Blood & Urine Screening

You will receive a blood test to check for syphilis and a urine test to check for gonorrhea if you are older than fifteen. This test applies whether you are inside or outside of the United States. 

It’s important to note that even if you are having a menstrual period, you still must complete the medical exam.

If you are pregnant, you must give consent before undergoing a chest x-ray. The doctor will provide extra protection. You can also postpone the chest x-ray until after giving birth. Still, you must complete it before entering the United States if you are currently living abroad or before completing your green card application or Form I-485 if you are applying from within the United States. 

What happens after the immigration medical exam?

After you complete your immigration medical exam for your green card, your next steps will depend on whether you are applying for consular processing outside of the United States or adjustment of status within the United States. Regardless, be sure to sign your forms when your doctor asks. Otherwise, U.S. Citizenship and Immigration Services (USCIS) will not accept them. 

If you're applying from inside the U.S.

Your doctor will provide you an unopened, sealed envelope of your medical records and your Form I-693. Do not open this envelope and break the seal, or USCIS will not accept it. Send the envelope to USCIS or bring it to your green card interview, depending on whether you schedule your medical exam before or after filing your application. 

If you're applying from outside the U.S.

Your doctor may give you a sealed, unopened envelope and x-ray results to bring to your green card interview. They may also directly send your results to your U.S. embassy or consulate. It depends on your home country’s requirements for your medical exam.

Conclusion

It can be tough to figure out how to get your immigration medical exam done, but working with a good immigration attorney on your green card application can make it easier to get guidance. If you can't afford the attorney fees and don't want to handle your green card application case alone, we may be able to help. If you are eligible, our free web app will walk you through the process and help you prepare and file your application with the U.S. government. Click "Get Started" to see how we can help make your American dream come true!

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