If you are applying for a green card and expect to decline one or more vaccines, the immigration medical exam is not just a medical appointment. It is a legal checkpoint that can affect whether you obtain permanent resident status, whether USCIS issues a Request for Evidence, and whether you need a waiver of inadmissibility.
Key Takeaways
- The immigration medical examination is required for all adjustment of status applicants and immigrant visa applicants, and it includes a physical exam, medical history review, mental health questions, a blood test, tuberculosis screening, possible chest x ray, and a vaccination assessment.
- Under U.S. immigration laws, individuals applying for an immigrant visa or seeking to adjust their status to lawful permanent resident must receive vaccinations against certain diseases as specified in the Immigration and Nationality Act (INA) section 212(a)(1)(A)(ii).
- Religious or moral vaccine waivers are legal determinations, not medical determinations. A lawyer experienced in immigration vaccine waivers, like Siri & Glimstad, is often crucial to success.
- Applicants should bring complete medical history, vaccination records, written vaccination documentation, and evidence of any medical contraindications before the exam date to avoid delays.
- Answers given to a civil surgeon about medical history, substance use, mental health, and vaccine history can affect both the medical examination and the immigration case.
This guide walks you through how to prepare for immigration medical exams when you plan to request a vaccine waiver, and when to contact an attorney.
What Is an Immigration Medical Exam and Why Does It Matter if You Want a Vaccine Waiver?
An immigration medical exam is the USCIS-required medical examination, often recorded on Form I-693, that most green card applicants must complete during the green card process. For applicants inside the United States, the exam is performed by a USCIS approved civil surgeon. For applicants abroad, the exam must be performed by a panel physician authorized by the U.S. Embassy or Consulate.
The medical exam usually includes a physical examination, review of chronic medical conditions, mental health questions, syphilis bloodwork, urine testing for gonorrhea, tuberculosis testing, and a vaccination component. During the immigration medical exam, you will undergo a physical examination, which includes checking vital signs, reviewing your medical history, and possibly conducting tests for tuberculosis and other conditions.
The immigration and nationality act, also called the nationality act in some discussions, requires certain vaccinations for people seeking lawful permanent residency. The Centers for Disease Control and Prevention, part of Health and Human Services, regularly assesses which vaccines recommended by the Advisory Committee on Immunization Practices should be required for immigration purposes, based on specific criteria. The CDC’s Technical Instructions direct civil surgeons and panel physicians on how vaccination assessments conducted during the exam must be documented.
Missing vaccines can create a serious problem. If an applicant refuses to receive the required vaccines for immigration purposes, they may be considered inadmissible and need to apply for a waiver of inadmissibility. Some waivers are based on medical contraindications; others are based on religious or moral convictions. At Siri & Glimstad, we approach these cases as immigration attorneys who understand that the medical form and the legal waiver strategy must work together.
Who Performs Immigration Medical Exams and What Do They Actually Check?
Inside the United States, only a civil surgeon designated by USCIS can perform immigration medical exams for Form I-693 purposes. You cannot use your regular family physician for the immigration medical examination unless they hold a specific federal designation. A healthcare provider may help gather records or write supporting letters, but that doctor cannot replace the designated civil surgeon unless properly authorized. Outside the United States, you must use a panel physician selected through the consular process.
The doctor will conduct a physical exam, check vital signs, listen to the heart and lungs, examine the abdomen and skin, and look for signs of communicable diseases of public health significance. Tuberculosis testing often begins with an IGRA blood test for many applicants and may lead to a chest x ray if results, symptoms, or history raise concern.
The mental health portion focuses on whether a mental health condition is associated with harmful behavior, such as violence, serious self-harm, or dangerous conduct. The physician may also ask about alcohol or drug use and may order a drug test if substance abuse is suspected. A current diagnosis of drug abuse or dependence can create inadmissibility issues.
For vaccine waiver seekers, the vaccination assessment is often the most important part. Civil surgeons are required to document the vaccination history and any vaccines administered during the immigration medical examination on Form I-693, which must be submitted to USCIS as part of the immigration application process. A civil surgeon must document the reason for not administering a required vaccine on Form I-693, which may include medical contraindications or religious/moral beliefs, and this documentation is necessary for the waiver process.
How Should You Organize Your Medical History and Records Before the Exam?
You must gather official documentation to prepare for an immigration medical examination. Start several weeks early by creating a written medical history summary covering surgeries, hospitalizations, chronic medical conditions, allergies, medications with dosages, mental health diagnoses, and substance-use history.
Bring medical records that explain serious conditions. Examples include cardiology reports, psychiatric treatment summaries, allergy evaluations, prenatal records, and hospital discharge papers. These records help the civil surgeon decide whether a particular vaccine is medically appropriate and whether the civil surgeon should administer it at that appointment.
It is important to bring all available written records of your vaccination history to the immigration medical exam, as the civil surgeon will review these records to determine which vaccines you may need. Gather childhood cards, school forms, military records, clinic records, foreign vaccination booklets, and lab reports. If documents are not in English, obtain clear translations before the appointment.
Some lab tests showing immunity may help with missing vaccination documentation. For example, titers for measles, mumps, rubella, varicella, hepatitis A, or hepatitis B may help show protection, depending on current CDC rules and the civil surgeon’s review.
Here is a practical way to organize your file:
| Record type | Why it matters |
|---|---|
| Government ID, such as passport or driver’s license | Confirms identity for the medical examination |
| Vaccination records and vaccination chart | Shows completed vaccines and missing vaccines |
| Prior chest x ray or TB testing | Helps evaluate tuberculosis history |
| Specialist letters | Supports contraindications or stability |
| Religious beliefs statement | Supports religious or moral beliefs waiver strategy |
The table describes vaccine requirements only in broad terms. Always confirm current vaccine requirements through USCIS, the CDC, or counsel because CDC’s vaccination list can change.
What Special Steps Should You Take If You Plan to Decline Vaccines or Request a Vaccine Waiver?
Requesting a vaccine waiver blends medical facts with legal standards. Preparation should start before you meet the civil surgeon.
Medical waivers may apply when a vaccine is not medically appropriate because of age, pregnancy, allergy, immune status, lack of availability, or timing. Pregnant women, for example, may be unable to receive certain live vaccines during pregnancy, but pregnancy does not excuse all the vaccines automatically. Issues involving vaccinating pregnant women should be documented by a prenatal provider and reviewed by the civil surgeon.
Non-medical waivers are different. Religious or moral convictions are evaluated by USCIS, not by the civil surgeon. Applicants should prepare a detailed written statement explaining when their religious beliefs or moral beliefs developed, how those beliefs guide daily life, and why those beliefs conflict with the vaccines required for immigration, but note this gets submitted to USCIS and not to the civil surgeon.
USCIS generally looks for sincere, deeply held objections to vaccination, not merely political disagreement, personal preference, or concern about one product. If you object to a particular vaccine but have accepted certain vaccinations in other contexts, talk to an attorney before the exam. Selective refusal can create legal complications.
The required vaccines may include vaccines against measles, mumps, rubella, polio vaccine, hepatitis B, adult formulation tetanus and diphtheria toxoids, pertussis vaccine, acellular pertussis vaccine, Haemophilus influenzae type B, and other vaccine preventable diseases. The phrase vaccine preventable diseases refers to vaccines the CDC evaluates through advisory committee guidance and immunization practices. The CDC may also address other vaccine preventable diseases based on public health criteria and disease control concerns.
The seasonal flu vaccine is handled differently because the seasonal flu vaccine requirement generally applies during flu season, typically September 1 through March 31, when available. If the vaccine is not available or not required at that time, the civil surgeon should mark the proper reason.
Siri & Glimstad regularly helps applicants prepare waiver packets so that what is said to the civil surgeon, what appears on form I-693, and what is submitted to immigration services are consistent.
How Do You Prepare for the Day of the Immigration Medical Exam?
Day-of preparation matters. Bring government-issued photo identification, vaccination records, and any previous chest X-rays to your appointment. You should also bring Form I-693, the Report of Medical Examination and Vaccination Record, to your immigration medical exam, as it is where the civil surgeon will document the results of your exam.
If you are inside the United States, print the latest Form I-693 from the USCIS Form I-693 page, complete only the applicant section, and wait to sign until instructed. If USCIS sent an appointment letter, bring it. If you are abroad, follow the embassy or consulate instructions for the panel physician.
Bring:
- Passport, driver’s license, or other government ID
- Vaccination records and English translations
- Medication list
- Medical records for serious conditions
- Prior chest x ray or TB records
- Doctor letters supporting contraindications
- Religious or moral waiver statement, if prepared with counsel (not required)
- Interpreter, if you are not fully comfortable in English
Wear comfortable clothing, drink enough water for urine testing, and confirm food instructions with the clinic. Fasting is usually not required for immigration bloodwork, but it is best to confirm with the specific clinic.
Before the appointment, review key dates in your medical history, mental health treatment, hospitalizations, vaccine reactions, and prior refusals. If you plan to decline vaccines, review with your attorney how to explain your religious, moral, or medical reasons accurately and honestly.
What Happens After the Exam and How Does It Affect Your Immigration Case?
After the exam, the physician will provide your exam results and medical forms in a sealed envelope that should not be opened. In most adjustment of status cases, the sealed Form I-693 is submitted to USCIS with Form I-485 or in response to a USCIS request. If you open the envelope, USCIS may reject it. You are entitled to receive a full copy of the exam for your own records and you should request it from the civil surgeon if they do not automatically give it to you.
Medical exam results are currently valid indefinitely, though sometimes USCIS changes the rules and they are valid for specific time periods. Timing matters, especially if tuberculosis testing, vaccine series timing, or waiver preparation could delay the case.
USCIS or a consular officer reviews medical examinations for inadmissibility grounds, including communicable diseases, substance abuse, and vaccine refusal without a qualifying waiver. If the civil surgeon marks vaccines as refused, USCIS may issue a Request for Evidence or require a waiver filing.
If you receive a troubling result, do not try to fix it alone. You may need a corrected I-693, supplemental medical opinion, waiver packet, or legal argument. If you have procedural questions, the USCIS Contact Center can provide general case assistance, but it cannot give legal advice about your waiver strategy.
With proper preparation and legal support, many applicants with vaccination issues can continue toward approval.
How Can an Immigration Attorney Help You Navigate Vaccine Requirements and Waivers?
Siri & Glimstad is a U.S.-based national law firm focused on immigration law, vaccine injury, and immigration vaccine waivers. We help applicants seeking legal permanent residence status, visas, and adjustment of status understand how the immigration medical process affects their case.
An attorney can first determine which vaccines are actually required for your age, category, and timing. Status adjustment applicants often assume every vaccine on a list applies to them, but age, season, pregnancy, contraindications, and prior immunity may change the analysis.
Counsel can also evaluate whether your facts fit a recognized waiver category. The form used to apply for a waiver depends on the adjustment category under which the applicant is seeking legal permanent residence status, such as Form I-602 for refugees and Form I-601 for other categories.
An attorney can help draft a personal declaration, review blood tests and medical records, coordinate with treating physicians, and prepare evidence that a vaccine is not medically appropriate. Legal guidance is especially important before sensitive answers about mental health, substance use, prior vaccine injury, or refusal of vaccines are recorded.
After the immigration medical examination is completed by the civil surgeon, an attorney can review the report for errors. Common issues include an incomplete vaccination chart, a missing waiver notation, or an unclear statement that the applicant refused vaccines without explaining the legal basis.
If you are considering declining vaccines, contact Siri & Glimstad before the exam whenever possible. Early strategy gives you more control over the record.
Frequently Asked Questions
Can I safely refuse all vaccines at my immigration medical exam and apply for a waiver later?
Refusing all vaccines without a clear legal plan is risky. If the vaccines required for your age are medically appropriate and you refuse them without a waiver strategy, USCIS may find you inadmissible. The safer approach is to consult counsel before deciding which vaccines to decline and how to document the basis for refusal.
Will my mental health history or psychiatric medications cause my immigration medical exam to fail?
Usually, no. Depression, anxiety, or another well-managed diagnosis does not automatically make someone inadmissible. The concern is whether a condition is linked to harmful behavior or current danger. Bring records showing treatment, stability, and compliance with care.
What if my vaccination records from my home country are incomplete or missing?
Missing records are common. The civil surgeon may rely on new vaccines, lab evidence of immunity, or reliable foreign records. Search for childhood cards, school records, clinic files, and translations. If proof cannot be found, an attorney can help evaluate testing, vaccination, or waiver options.
Does pregnancy change how the immigration medical exam and vaccine requirements are handled?
Yes. Pregnancy can make some live vaccines medically inappropriate, and the civil surgeon should document that on Form I-693. Pregnant applicants should bring prenatal documentation and discuss medications, prior reactions, and timing with both the civil surgeon and legal counsel.
