For many people, the dream of moving to America from another country is full of hope and optimism. Most people find the actual steps to getting a Green Card or becoming a US citizen, on the other hand, to be cumbersome, long and time-consuming. One major step in this journey is undergoing and passing the USCIS medical exam, also known as an immigration physical exam and I-693 exam.
We put this article together to summarize the steps involved with getting a USCIS physical exam so you, or an applicant you know, can know what to expect and be prepared.
Effective October 2018, a tuberculosis (TB) blood test, also known as an IGRA test, is required for tuberculosis screening as part of the USCIS physical exam:
USCIS Physical Exam – The Process
What is the USCIS physical exam? The USCIS, or United States Citizenship and Immigration Services, exam was established to screen immigrants interested in living in the US. When most people think of a physical exam, they think of a medical exam that involves a basic history and physical and perhaps some screening lab testing. The I-693 physical exam, on the other hand, is not your run-of-the-mill physical. Instead, it involves the completion of various forms and tests to make sure you are medically clear before you stay in the United States and engage with its residents.
Here is a general overview to the process of getting the USCIS medical exam:
1. I-693 Medical Form Completion
The first step to getting an I-693 medical exam is to complete the required applicant information on the I-693 medical form (available on the USCIS website). This immigration exam form captures basic demographic information like name, address and gender and includes some certification statements from the applicant. Because many immigrants do not speak English well, the I-693 form includes a section that enables an interpreter to communicate and sign off on some of the information.
2. USCIS Civil Surgeon Appointment
The process of getting an immigration medical exam (more below) is more complicated than getting a standard physical exam. Just having an active medical license is not enough for a doctor to be certified to perform the I-693 medical evaluation. Instead, doctors need to be specially certified by the USCIS in order to be allowed to perform and sign off on the results of the medical exam. These doctors, also known as USCIS civil surgeons, are experienced doctors who must go through an application process to be qualified to perform an acceptable USCIS exam. USCIS medical doctors qualified to perform the exam can be found through the USCIS website.
3. Immigration Physical Exam
Once the applicant has completed the necessary documentation and made an appointment, the next step is to undergo the medical exam. The applicant may need to go to the appointment after an overnight fast but this is something that should be confirmed with the USCIS civil surgeon performing the medical exam. On the day of the appointment, the applicant should arrive early in case there is additional paperwork to fill out before the actual I-693 examination starts. Once the physical exam is complete and all of the diagnostic test results are available, the documentation will be completed and provided to the applicant.
With this overview, it is useful to look at what goes on during the USCIS medical exam in more detail.
USCIS Physical Exam – Detailed Information
During the immigration physical exam, a variety of questions will be asked regarding the applicant’s health history. This is strictly a health-based exam and applicants can breathe easy that they should not be asked to name the four presidents on Mt. Rushmore. Instead, the USCIS doctor will ask to see the applicant’s I-693 form and other medical records so that any relevant medical history can be reviewed. If the applicant has ever suffered from a serious condition – mental or physical – the included medical records should reflect such history. The USCIS civil surgeon will also review symptoms that might uncover a cardiovascular, pulmonary, musculoskeletal, neurological, or psychiatric disorder.
The immigration physical exam is comprehensive. The civil surgeon will evaluate the applicant’s mental state, including comprehension, mood, appropriateness of behavior, capacity of thought and the ability to make reasonable judgements. The USCIS doctor will also run through some of more standard physical exam techniques: checking the ears, nose and throat, eyes, listen to the heart and lungs, and so forth.
Diagnostic evaluations and testing are also an important part of the I-693 examination.
Special Medical Conditions
Applicants with ongoing medical conditions will need additional evaluation by the USCIS medical doctor. Additionally, there are specific medical conditions that occur commonly in the course of immigration physicals that are worth discussing in more detail:
Tuberculosis screening is an important part of the USCIS physical exam given the prevalence of tuberculosis in many countries around the world. Like other parts of this medical examination, make sure to have any medical records regarding tuberculosis – including copies of any chest x-ray films – with you to avoid delays in the processing of your I-693 paperwork.
There are more specialized requirements depending on one’s medical history. If an applicant has had a positive skin test for tuberculosis in the past, a letter from the testing physician is generally required to discuss any relevant circumstances and treatment that was performed.
While tuberculosis skin testing has been accepted for many years as a screening process by the USCIS, the requirements have changed. Starting in October of 2018, the only acceptable form of tuberculosis screening will be a blood test known as an Interferon Gamma Release Assay, or IGRA, test. The IGRA test is a much more accurate way of checking for tuberculosis in people who come from areas where tuberculosis is more prevalent because the skin test is often falsely positive in immigrants. Applicants should consider ordering the IGRA test, or QuantiFERON-TB blood test, ahead of time and bringing the lab results with them to their I-693 exam if there are any concerns about tuberculosis.
Women who are pregnant can still undergo the immigration physical exam. However, there are specific precautions that need to be taken by pregnant women. While this is standard for pregnant women at imaging and x-ray facilities, any pregnant woman that needs a chest x-ray for tuberculosis clearance should make sure she is properly draped to reduce the likelihood that her fetus is exposed to radiation. Also, specific types of immunizations should not be received during pregnancy given the risks of vaccination to the growing baby. The most important thing for a pregnant applicant to do is to discuss the pregnancy with the USCIS civil surgeon so that the appropriate steps can be taken to protect both the mother and the baby.
Routine vaccination, especially during childhood, is not part of medical care in many countries. Applicants desiring a Green Card or US citizenship will need to prove immunity to a variety of diseases or else get the vaccinations required to attain immunity. Proof of immunity is sometimes done through verifying private vaccination records or through special immunity titer tests such as the MMR titer or the varicella titer.
The list of routine vaccination requirements for applicants is set forth by the Advisory Committee for Immunization Practices (ACIP). At times, the list might be adjusted by other agencies such as the Center For Disease Control (CDC) if a determination is made that there is a public health risk at the time of the immigration exam.
One other important note is that immunity and immunizations are consider in the context of the age of the applicant. Some vaccinations are neither safe nor appropriate for certain age groups and, as a result, children will generally need to prove immunity to different diseases than their parents. The point of immunity assessment during the immigration physical exam is meant to screen for immunity concerns in order to protect the public as a whole as opposed to immunizing people inappropriately and causing harm.
Given the prevalence of specific types of infectious agents in other parts of the world, it may not be uncommon to be going into your USCIS physical with a history of an infectious disease. Syphilis is one example and specific information about one’s syphilis history is requested on the I-693 form. In cases where the applicant has had an infection like syphilis in the past, it is important that any records, including written certificates from past doctors or health officials, are brought in at the time of the immigration physical so that they can be reviewed by the USCIS doctor.
Health Issues in a USCIS Exam
In some applicants, a new medical issue will be discovered during the course of the physical. If it is a routine medical issue, it can sometimes be handled by the USCIS civil surgeon or else it will be referred out to another medical provider for ongoing care. Certain medical conditions such as sexually transmitted diseases, tuberculosis, or HIV/AIDS are treated differently. While they are usually not causes for someone to fail the immigration medical exam, they may require more complex intervention by the civil surgeon.
Regardless of how the USCIS doctor decides to handle these types of medical issues, there are other ways in which an applicant can pass the medical exam even when these issues are present. For example, an applicant can sometimes obtain a health waiver which would allow the person to remain in the United States. Applicants who are eligible for health waivers generally fall into one of the following categories:
- Is a spouse or the unmarried son or daughter, or the minor unmarried adopted child of a U.S. citizen or lawful U.S. resident
- Has a son or daughter or lawfully adopted child who is a U.S. citizen or lawful U.S. resident
- Is a self-petitioning spouse or child because of abuse
Stepping back, an important point to remember about the USCIS physical exam is that it is not a substitute for a complete annual physical examination administered by one’s primary care doctor. Instead, the sole purpose of the immigration physical exam is to screen for certain medical conditions that the USCIS and the CDC deem critical to protecting the general public’s health. In the event that a substantial communicable disease is identified (e.g. active tuberculosis, leprosy), the civil surgeon is responsible for taking the necessary steps to ensure that the applicant gets treatment and the public is protected. To that end, it is not the responsibility of the examining civil surgeon to provide the applicant with any invasive medical treatment or advice in the event that complex medical issues outside of the scope of the exam arise.
USCIS Medical Exam – Reasons for Failure
There are a bevy of reasons why an immigrant seeking a Green Card or US citizenship might fail the process. General reasons why a person might be ineligible to receive a visa are detailed in the United States Immigration and Naturalization Act (INA) 212. Here are some examples of past behaviors that might lead to an applicant being denied:
- Hijacking a vessel, train or automobile
- Engaging in prostitution or a commercialized vice
- Fundraising for a terrorist organization
The I-693 medical examination is not about screening for these types of behaviors. Instead, the civil surgeon is going to be looking for health-related issues that might pose a public health risk if the applicant gets a visa. As part of the USCIS physical, the civil surgeon will be looking for conditions known as Class A or Class B medical conditions. Knowing the difference between Class A and Class B medical conditions can help one better prepare for the USCIS physical. More details are available on the USCIS website.
Class A Medical Conditions
An applicant who has a Class A medical condition is considered inadmissible and ineligible for a visa or adjustment of status. Here is a list of Class A medical conditions and circumstances:
- Communicable disease of public health significance per HHS regulation
- A failure to present documentation of having received vaccinations against vaccine-preventable diseases
- Present of past physical or mental disorder with associated harmful behavior or harmful behavior that is likely to recur
- Drug abuse or addiction
Class B Medical Conditions
Class B conditions are another class of medical conditions that can prevent someone from getting a visa. Class B medical conditions are defined as physical or mental health conditions, diseases of disabilities serious in degree or permanent in nature. An important aspect of Class B medical conditions is that they cause enough deviation from a normal state of health and are significant enough to cause one or more of the following:
- Interfere with the applicant’s ability to care for himself of herself, to attend school, or to work
- Require extensive medical treatment or institutionalization in the future
I-693 Exam & Process – Next Steps
Despite all of the requirements, most applicants will clear the immigration physical without any major issues. What are the next steps after completing the I-693 medical exam process?
Once your immigration physical exam is complete and all of the boxes are checked, the USCIS civil surgeon will prepare a special packet that includes your physical exam findings and any associated medical paperwork. This packet of immigration documents will be placed into a sealed envelope. It is very important that the applicant confirms that the packet is sealed and that it is not opened as the USCIS will return an opened I-693 packet, delaying the process. It is the responsibility of the applicant to submit the sealed I-693 packet by mail or in person at a USCIS field office.
The results from an I-693 immigration exam are valid for one year. If necessary, the examining civil surgeon may share your results with public health authorities but, otherwise, the medical exam results are considered confidential.
Immigration Physical Exam – Other Considerations
The USCIS medical exam is not free for most people. Unfortunately, depending on where you go and what you need to complete the exam, the immigration physical can cost a lot of money. Health insurance generally does not cover the cost of the medical exam, either. Luckily, there are hundreds of USCIS doctors who offer the immigration medical exam so applicants may have a chance to shop around for prices before making a commitment.
Also, some applicants may want to consider getting any necessary vaccinations or lab tests ahead of time and present proof of them at the time of their USCIS physical. While the process of becoming of clearing the requirements necessary to be get a visa to the United States, advanced preparation can go a long way towards staying organized and saving time and money.