Immigration
I-693 Vaccines: What Is Required, and What Immunity Testing Can Replace
The USCIS Vaccine Requirement
The vaccine list for your immigration medical exam is not something your doctor decides. It comes from the CDC, and USCIS requires every Civil Surgeon to follow it. That list can be updated from year to year, so what a friend or family member needed for their exam a few years ago may not be exactly what you need today.
For most adults, the required vaccines include MMR (measles, mumps, and rubella), varicella (chickenpox), Tdap (tetanus, diphtheria, pertussis), influenza (seasonal), COVID-19, hepatitis B, and polio. Hepatitis A and HPV are also on the CDC schedule, but whether they apply to you depends on your age. Your Civil Surgeon will go through the current requirements with you based on your specific situation.
The goal of this part of the exam is not to vaccinate you as many times as possible. It is to confirm that you are protected against certain diseases. If you already have that protection, there are ways to show it without getting a shot you do not need.
What Immunity Testing (Titers) Can Replace
A titer is a blood test that measures whether your body already has enough antibodies to be considered immune to a specific disease. For immigration purposes, a titer showing sufficient immunity can substitute for the vaccine itself. This matters a lot if you received vaccinations in another country and do not have complete records, or if you simply want to avoid repeating vaccines you know you have already had.
MMR, varicella, and hepatitis B are the vaccines where titers are most commonly used during the I-693 process. If your blood work shows you are immune, you do not need the corresponding vaccine. For varicella specifically, a positive titer is actually considered strong evidence of immunity even when there is no vaccination record at all, which is helpful since many people had chickenpox as children before the vaccine was widely available.
Some vaccines cannot be replaced by a titer. Tdap is one of them. There is no reliable blood test that proves protection against pertussis in a way USCIS accepts, so if you are due for Tdap, you will need the vaccine. The same applies to influenza and COVID-19. Those are time-sensitive vaccines tied to current strains and current recommendations, not something a past blood test can substitute for.
Knowing which vaccines can be confirmed by titer and which cannot helps you plan ahead. It also means fewer surprises on the day of your appointment.
How the Process Works at Our Office
When you come in for your immigration medical exam, the first thing we do is sit down and review whatever vaccination records you have brought with you. Some patients arrive with detailed records. Others have very little documentation. Both situations are manageable, and we will work with what you have.
Based on your records and your age, we determine which vaccines appear to be covered and which ones are missing or uncertain. For the ones where a titer is an option, we can order the blood work right away. Titer results typically take a few days to come back. Once we have them, we know exactly what you still need, and we schedule a follow-up appointment to administer those vaccines and complete the rest of your I-693.
You will only receive vaccines that are actually required. We are not running through a checklist without looking at your records. Every step is based on your specific history and the current USCIS requirements.
After everything is done, your completed I-693 form is placed in a sealed envelope that you bring to your USCIS interview or submit as directed. That envelope cannot be opened by you. It goes directly to USCIS. We make sure everything inside is filled out correctly so there are no delays on your case because of a paperwork error on our end.
What to Bring to Your Appointment
The most important thing you can bring is your vaccination history. This might be a yellow international vaccination booklet, records from a doctor in your home country, school immunization records, or prior lab work showing immunity. Bring whatever you have, even if it is incomplete or in another language. Something is always better than nothing.
If you have had blood work done before that included immunity testing, bring those results too. They may save you time and money.
If you received a USCIS appointment notice or have an I-20 from a school, bring that along as well. It helps us understand your timeline and make sure we get your sealed envelope back to you before your interview date. If your appointment is coming up soon, let us know when you call. We will do our best to work around your schedule.
We see patients in both English and Spanish. If you are more comfortable speaking Spanish, just let us know when you book.
Cost and Insurance
The immigration medical exam itself costs $200 for the initial visit and $100 for any follow-up appointments needed to complete the process, for example, when we are waiting on titer results or administering vaccines at a second visit. Those are flat fees with no hidden add-ons for the exam itself.
Vaccines and lab work are billed separately because the cost depends entirely on what you actually need. We cannot quote you a total upfront without knowing your vaccination history, but we will always be clear about what something costs before we order it or administer it.
Some insurance plans do cover vaccines, even when they are being given as part of an immigration exam. It is worth calling your insurance company ahead of your appointment to ask. We can also bill certain labs through insurance depending on your plan. If you are paying out of pocket for everything, we will let you know the cost of each item so you can make informed decisions.
If you have questions before booking, you are welcome to call the office. We are here to help you get through this process without confusion or unnecessary cost.