Immigration Services

What to Expect at Your Immigration Medical Exam: A Complete Guide

Dr. Rachel Gougian is a USCIS-designated Civil Surgeon who has completed thousands of immigration medical exams at Pandora Family Medicine. She conducts exams in both English and Spanish, and she understands that this process can feel unfamiliar and stressful. This guide walks you through exactly what happens so you know what to expect before you arrive.

The I-693 is a medical examination required by United States Citizenship and Immigration Services (USCIS) for anyone applying for a green card from inside the United States. It is also called an "adjustment of status medical exam." The purpose is to confirm that the applicant does not have any conditions that would make them inadmissible on health-related grounds and that they are up to date on required vaccinations.

Only a physician designated as a Civil Surgeon by USCIS can perform this exam. You cannot go to any doctor. You can verify that a physician holds this designation by checking the USCIS Civil Surgeon locator on the USCIS website.

The completed exam results in a sealed envelope (Form I-693) that you submit with your immigration application. You do not open this envelope. USCIS opens it during the adjudication of your case.

The exam typically takes about 30 to 45 minutes, depending on whether you need vaccinations. Here is how the visit flows at our office.

1. 1

   Document review

   Dr. Gougian will review your government-issued photo ID, your vaccination records, and any relevant medical records you bring. If you have previous lab results showing immunity to certain diseases, bring those too. They can save you from needing repeat vaccinations.

2. 2

   Medical history and physical exam

   The exam covers a standard health history review and a physical examination. Dr. Gougian will ask about your medical history, any current medications, and whether you have ever been diagnosed with specific conditions listed on the I-693 form. The physical exam itself is straightforward: checking your eyes, ears, heart, lungs, and skin.

   The physical also includes a vision screening, a check for signs of communicable diseases, and a brief mental health screening. This is not an invasive exam. It is similar to an annual physical. Dr. Gougian will walk you through each part as it happens so nothing feels unexpected. If she needs to examine a specific area more closely, she will explain why before proceeding.

3. 3

   Lab work and immunity testing

   Blood is drawn to test for syphilis and, in most cases, tuberculosis (using a blood test called an interferon-gamma release assay, or IGRA, rather than the older skin test). The blood test is more accurate and only requires a single visit, whereas the skin test requires you to come back 48 to 72 hours later for a reading.

   If you do not have documented proof of immunity to certain vaccine-preventable diseases, titer blood tests can check your immunity levels. This is how we determine which vaccines you actually need and which ones you can skip. All blood draws are done on-site at our in-office lab, so you do not need to schedule a separate appointment at an outside facility.

4. 4

   Vaccinations (if needed)

   You will only receive vaccines that you actually need. If your records show you have already been vaccinated or if titer results confirm immunity, those vaccines are skipped. We do not take a one-size-fits-all approach. Dr. Gougian reviews your specific situation and administers only what USCIS requires based on your documented history.

5. 5

   Form completion and sealed envelope

   Once all results are back, Dr. Gougian completes the I-693 form, signs it, and seals it in an envelope. You submit this sealed envelope with your immigration application or bring it to your USCIS interview.

Coming prepared saves time and can reduce the number of vaccines you need. Here is what to bring to your appointment.

If you do not have vaccination records, that is okay. It is common, especially for people who received vaccinations in another country years ago. We can run titer blood tests to check your immunity levels and determine which vaccines you need based on those results rather than guessing.

If your records are in a language other than English, bring them anyway. Dr. Gougian can often interpret vaccination records from other countries based on the vaccine names, dates, and standard medical abbreviations. If a formal translation is needed, we will let you know, but in most cases the original documents are sufficient for determining your vaccination history.

If you are missing records entirely and cannot locate them, the titer blood tests become your primary tool. The results take a few days to come back, which may add a short delay before your I-693 can be completed, but it ensures you only receive vaccines where there is a confirmed gap in immunity.

This is one of the most common concerns patients bring to the appointment, and it is understandable. Nobody wants to receive vaccines they do not actually need, especially when each one adds to the cost of the visit.

USCIS requires that green card applicants be up to date on certain vaccines. The specific list depends on your age and is based on the CDC's recommended immunization schedule. For most adults, this includes vaccines for measles, mumps, rubella (MMR), varicella (chickenpox), tetanus/diphtheria/pertussis (Tdap), influenza (during flu season), hepatitis B, polio, and COVID-19.

At Pandora Family Medicine, Dr. Gougian takes a titer-first approach. That means we draw blood to test your immunity levels before administering any vaccines. If your titers show that you already have immunity to measles, for example, you do not need the MMR vaccine regardless of whether you have documentation of a previous vaccination.

This approach often reduces the number of vaccines a patient needs. Many adults have natural immunity from childhood infections or previous vaccinations that they simply cannot document. Rather than vaccinating everyone for everything, we test first and vaccinate only where there is a genuine gap. You only get the shots you actually need.

The USCIS-required vaccines for most adults include MMR (measles, mumps, rubella), varicella (chickenpox), Tdap (tetanus, diphtheria, pertussis), hepatitis B, polio, influenza (during flu season), and COVID-19. The exact list depends on your age and which vaccines were part of the standard schedule when you were a child. Patients over 50 may have a slightly different set of requirements than patients in their 20s.

Vaccination costs are separate from the exam fee and vary depending on which vaccines you need. We discuss costs before administering anything. If titers show you already have immunity, you do not pay for that vaccine. This is one of the reasons the titer-first approach saves patients money in addition to sparing them unnecessary injections.

Some vaccines require multiple doses spread over weeks or months. Hepatitis B, for example, is a three-dose series given over six months. If you need a multi-dose vaccine, Dr. Gougian can note on the I-693 that the series is in progress. USCIS generally accepts this. We will work with you on scheduling follow-up doses at intervals that fit your timeline.

Most patients receive their sealed I-693 envelope within five to seven business days of completing all required lab work and vaccinations. The timeline depends primarily on how quickly lab results come back.

If you need a multi-dose vaccine series (like hepatitis B, which requires three doses over several months), Dr. Gougian can complete the I-693 form noting that the series is in progress. USCIS generally accepts this, but you should discuss the timing with your immigration attorney to make sure it aligns with your filing deadlines.

Once signed by the Civil Surgeon, the I-693 form is valid for two years from the date of the physician's signature. If your immigration case takes longer than two years, you may need a new exam. Keep this in mind when deciding when to schedule your appointment. If your filing date is coming up soon, scheduling early gives you a buffer in case any lab results take longer than expected.

If timing is a concern, mention it when you call to book. We understand that immigration cases often operate on tight timelines, and we can sometimes accommodate urgent requests.

The sealed envelope contains the completed I-693 form with Dr. Gougian's findings, your vaccination records, and the results of your lab work. You submit it to USCIS either by mailing it with your application or by bringing it to your in-person interview. Your immigration attorney can advise you on which method applies to your case.

One important note: the I-693 is valid for two years from the date of the civil surgeon's signature, not from the date of your exam appointment. In most cases these dates are close together, but if lab results take several days, the signature date will be when Dr. Gougian completes and signs the form. Plan accordingly if your case has a specific filing window.

Pandora Family Medicine is located at 6300 Baltimore Ave in University Park, MD. Dr. Gougian performs immigration medical exams in English and Spanish. Patients come from across Washington, DC, Prince George's County, and Montgomery County for this service.

The initial exam costs $200. Follow-up visits (for additional lab results or vaccine doses) are $100. Vaccine and lab costs vary depending on what you need. We are transparent about costs before administering anything, so there are no surprises at checkout.

If you have questions before booking, call us at 301-200-0960. We are happy to answer questions about the process, what to bring, and what to expect.

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