Concerns for public health and immigration law have been tied together in the United States for over 100 years. Since the Immigration Act of 1891, individuals seeking admission into the U.S. have been subject to potential immigration bars due to the fear of communicable diseases and pandemics. In the past, this required a physical inspection at the port of entry.

The Immigration Act of 1990 provides the current law on public health grounds of inadmissibility for those seeking permanent resident status in the United States, and the Illegal Immigration Reform and Immigrant Responsibility Act of 1996 introduced a vaccination requirement. Under the modern law, all applicants applying for a green card, whether from inside the United States or from abroad, must demonstrate that they are not inadmissible to the United States on public health grounds by completing a government-mandated medical exam.

What is the Form I-693, Medical Exam?

The Form I-693, Report of Medical Examination and Vaccination Record, as the name would imply, is a report prepared by an authorized civil surgeon that includes the results of various medical examinations performed on an applicant by the civil surgeon, as well as a record of the applicant’s vaccination status. USCIS uses the report to determine whether the applicant is “inadmissible to the United States on public health grounds,” which is defined by Section 212 of the Immigration and Nationality Act (“INA”).  While applicants for permanent resident status from within the U.S. (“adjustment of status”) complete the Form I-693 as part of their application process, individuals seeking an immigrant visa at a U.S. consulate abroad complete a similar medical exam done by a panel physician, completed on Form DS-2054.

Under the INA, applicants may be denied permanent residency if they “have a communicable disease of public health significance,” or have not been vaccinated against certain diseases. The current list of “communicable diseases” includes infections such as tuberculosis, leprosy, gonorrhea, and others. The Secretary of Health and Human Services has discretion to expand this list to include any individuals deemed to have a “communicable disease of public health significance.”

The examination performed by the civil surgeon/panel physician includes a physical examination, blood tests, and specific tests for tuberculosis, including a skin test and x-ray. These examinations are used to determine whether an applicant has one of the “communicable diseases” listed above.

Applicants are also expected to have vaccinations against certain diseases, including: (1) mumps, (2) measles, (3) rubella, (4) polio, (5) tetanus and diphtheria, (6) pertussis, (7) haemophilus influenzae type B, (8) hepatitis A, (9) hepatitis B, (10) rotavirus, (11) meningococcal disease, (12) varicella, and (13) pneumococcal disease. The list may be expanded to include any other vaccinations recommended by the Advisory Commission for Immunization Practices – and was in fact recently expanded to include COVID-19 (see below). A waiver of the vaccination requirement may be required if an applicant is unable to receive the required vaccinations for medical reasons, or an individual waiver may be sought if an applicant is opposed to all vaccinations in any form based on religious beliefs or moral convictions. These waivers of inadmissibility will be addressed in a subsequent post on this blog.

In addition to the these requirements, applicants may also be found inadmissible if they are determined to have physical or mental disorders with associated behavior that pose a threat to the property, safety, or welfare of the applicant or other persons, or if the applicant is determined to be a drug addict or abuser.

Recent changes to the medical exam

Generally, Form I-693 medical exams completed in the United States are valid for two years from the date they are signed by the civil surgeon. If the medical exam is completed before an applicant submits his/her Form I-485 Adjustment of Status application, the medical exam must be submitted to USCIS within 60 days of when it is signed by the civil surgeon. On August 12, 2021, USCIS announced that the validity period for Form I-693 reports would be temporarily extended from two years to four years.  This change was made to address on-going processing delays caused by the COVID-19 pandemic. This temporary extension is scheduled to end on September 30, 2021, so all medical exams submitted after September 30 will return to having a two-year validity period.

The most recent change to the medical exam requirements is that as of October 1, 2021, all applicants for permanent resident status in the U.S., whether applying from within the U.S. or for an immigrant visa at a US consulate, will require proof of a completed COVID-19 vaccination. For vaccinations requiring two doses, such as Pfizer and Moderna, an applicant is only deemed vaccinated after receiving both doses. This requirement applies prospectively to all Forms I-693 signed by the civil surgeon on or after that date. USCIS has indicated that blanket waivers may be available in situations where the COVID-19 vaccine is not age appropriate, is contraindicated due to a medical condition, is not routinely available where the civil surgeon practices, or is limited in supply and would cause significant delay for the applicant to receive the vaccination.

How/when do I submit the medical exam?

For adjustment of status applicants in the United States, although the medical exam is a required component of the green card process, it is not required to be submitted up front with the Form I-485 application. The completed medical exam may be submitted along with the Form I-485 application, but it is also permissible to submit it at a later point in the process (in response to a USCIS Request for Evidence (“RFE”) or in person at an interview if one is required).

USCIS has recently updated its instructions on how to submit a Form I-693 if it is filed after the adjustment of status application. Applicants will receive a notice in the mail from USCIS following the submission of their application, titled, “Form I-693 Medical Exam Reminder.” This reminder encourages applicants to send their Form I-693 to USCIS upon receipt of the reminder. This is a recent change, as USCIS previously recommended submitting the Form I-693 at a later stage, either after the applicant receives a formal RFE or at their interview. If an applicant opts to follow the notice’s instructions, they should include a copy of their reminder notice with their Form I-693 submission, as this will ensure that USCIS properly connects the Form I-693 to their pending Adjustment of Status application. Alternatively, the applicant may still file their Form I-693 at a later stage, either at their interview or after receiving an RFE.  

What is the best option for submitting a medical exam?

USCIS recommends filing the Form I-693 at the same time as the Form I-485 (green card application), as it will eliminate the need for USCIS to issue a later Request for Evidence (RFE) for the Form I-693. According to USCIS, submitting the two together may help them process the application more quickly.

In prior years, there was a greater risk of the Form I-693 expiring before USCIS could process an adjustment of status, making a concurrent filing inadvisable. Due to USCIS processing delays, it was common for the Form I-693 to expire before the green card application was processed, resulting in USCIS issuing an RFE for a new medical exam report, and causing applicants an unnecessary waste of time and money. Now, with the two-year validity period—and the temporary four-year validity period for those submitted before September 30, 2021—many applicants may wish to file the report concurrently with the Form I-485 to avoid delays on the back-end of their green card processing.

If you have questions about your particular case, contact the Harris Beach immigration team to discuss the options that may be available to you. Our Immigration Law Practice Group includes immigration attorneys that work across New York state in our Albany, Buffalo, Ithaca, Long Island, New York City, Rochester and Syracuse offices. Our immigration lawyers focus on strategies – including immigrant visas for permanent U.S. resident status and temporary visas for foreign nationals – to ensure that companies are able to hire, transfer, and retain the brightest and best non-U.S. talent.