When you apply to immigrate to the United States, a medical examination is typically required as part of the process. The rules and conditions for the medical exam vary from country to country, so make sure that you check the individual requirements for the medical exam with your local U.S. embassy or consulate.
However, one consistent requirement during the medical exam is that you must show proof that you have had certain vaccinations. This guide explains what vaccinations you need, if there are exemptions, and what the process is if you don’t have proof of vaccination.
Important: If you’re applying from within the United States, you will see a civil surgeon designated by U.S. Citizenship and Immigration Services (USCIS). If you’re applying from abroad, you will see a panel physician authorized by the U.S. Department of State. For this article, we use the term “physician” to describe the doctor that administers your medical examination for visa-related purposes. For more in-depth information about the medical examination, check out our guide on how to prepare for the medical exam.
The following vaccinations are required when applying to immigrate to the United States:
The vaccinations that are required are determined by the Advisory Committee for Immunization Practices (ACIP), which recommends immunizations for the general U.S. population.
The ACIP also recommends new vaccines for the general U.S. population, and the CDC will assess whether these vaccines should be required for immigration purposes on a regular and on an as-needed basis according to specific criteria set by CDC.
Some of the vaccines that are required are specifically listed in the Immigration and Nationality Act. These include mumps, measles, rubella, polio, tetanus and diphtheria toxoids, pertussis, haemophilius influenza type B, and hepatitis B.
In addition to these, the statute also requires that an individual receive any other vaccinations recommended by the ACIP. CDC uses the following criteria in determining which of these recommended vaccines should be required for immigration purposes:
The physician that carries out your medical exam can provide information on which vaccines you require. They must review all your vaccination records and, if the documentation appears valid, record the vaccination history and vaccines given during the medical exam on Form I-693 (Report of Medical Examination and Vaccination Record).
You can find the physician’s information by contacting the U.S. embassy or consulate that you will interview at or by checking their website. You can then contact the physician and ask them about your specific requirements.
No. Only the ones that are deemed age-appropriate for you.
The following vaccinations are required when applying to immigrate to the United States:
No. The physician will review your vaccination records during your medical exam to see whether you have proof of earlier vaccinations against vaccine-preventable diseases that are appropriate for your age category.
It is important that you take any written vaccination documents you might have to the physician when you have your immigration medical examination. If you lack any vaccinations required for your age category, the physician will administer the vaccines as needed.
You can also choose to obtain the required vaccines from your private healthcare provider. However, you must return to the physician with the proof that you have received the missing vaccines. If you’d prefer to use a private healthcare provider, make sure that you get the vaccines before the medical exam and bring proof of this to the physician. This will likely cause less delay to your visa application.
Often, if you don’t have proof of a vaccination, it can be quicker to get vaccinated before your medical examination. However, make sure that you contact the physician that will carry out your medical examination and check what proof or paperwork they require.
You only need to have the first dose at the physician’s office. The physician will then complete Form I-693. Afterwards, you should follow up with other doses by using your private healthcare providers to complete the vaccine, but you will not be required to show proof to U.S. officials.
The physician follows Centers for Disease Control and Prevention (CDC) guidelines on which vaccinations can be administered during pregnancy. If they cannot safely administer a required vaccine, they will annotate Form I-693 by marking the vaccine as contraindicated.
Yes, you require a seasonal flu vaccine if your medical appointment occurs during flu season. Flu season starts on October 1 and ends on March 31 each year.
The applicant is responsible for all costs associated with the medical examination and the vaccines that are required.
It is possible that unless the applicant has moral or religious objections to vaccinations, their refusal to take any of the required vaccines could cause a potential denial of their visa application.
Tell the physician if you don’t wish to receive the required vaccines or a particular vaccine. You should also tell the physician the reason that you do not wish to receive the vaccines.
A waiver could be available to you, but only under the following circumstances:
The form used to apply for a waiver depends on the adjustment category under which you are seeking legal permanent residence status.
Ask the physician whether another healthcare provider has the vaccine. If another physician or department or pharmacy carries the vaccine and can administer the vaccine, you should get the vaccine and request documentation that you have received the vaccine.
No. The vaccination chart should have at least one entry in each row for each vaccine. If the vaccination chart is not properly completed at the time of the medical exam, USCIS might return the Form I-693 to you with instructions on how to correct it.
There are only two types of doctors who can perform the medical exam, and the right one for your situation depends on where you’re applying from:
The process for scheduling the medical exam and the validity period of the results depend on where the family member seeking a green card is applying from.
When to schedule: You have two options as far as when to schedule your appointment:
USCIS recommends option 1 to save time and lower your risk of receiving a Request a Evidence (RFE).
When you schedule your appointment, make sure to let the doctor’s office know that you seek a medical exam to immigrate to the United States.
The exam results will be valid for six months (unless the relative seeking a green card has certain medical conditions, in which case the exam results could expire in three months).
Having all of your documents ready before your appointment can help the medical exam go smoothly. Here’s what you’ll need to bring with you:
You must also bring an additional document, depending on where you’re applying from:
You must also bring Form I-693 (officially called the “Report of Medical Examination and Vaccination Record”), which is where the civil surgeon will document the results of your exam.
Most doctors will provide a copy of this form at their office. Generally, however, it’s best to download Form I-693 from the USCIS website yourself (to make sure you’re using the latest version) and bring it with you to the doctor’s office. USCIS periodically updates these forms, and some doctors forget to replace old copies with current ones. If you submit an expired form, USCIS will reject it and ask you to submit the newest edition of the form, which means returning to the doctor’s office and delaying the application process.
To save time, it’s a good idea to complete your portion of the form before going to your appointment, but do not sign the form until the civil surgeon instructs you to do so. The civil surgeon will complete their portion of the form at the end of your exam.
The green card medical exam is not like a routine physical you’d receive from your family doctor. Nor will the doctor give you a “pass” or “fail” grade based on your overall health. (See below for important medical exam information for women.)
The exam will last roughly two hours, and during that time, the doctor will review your immunization and medical history with you. They will ask both general and specific questions about your health. You’ll also get a basic checkup (or “physical”).
In addition, the doctor will look for specific conditions that fall into the following categories (see below for information about how the presence of such conditions can affect your green card application):
Civil surgeons in the United States and panel physicians abroad follow different tuberculosis testing guidelines from the Centers for Disease Control and Prevention (CDC):
The civil surgeon will follow the CDC’s Tuberculosis Technical Instructions for Civil Surgeons, which currently require them to conduct a test called the “interferon gamma release assay” (IGRA) on all green card applicants aged 2 and older. Generally, you will not be required to return to the doctor’s office to obtain the IGRA results.
If, however, the IGRA results reveal signs or symptoms of tuberculosis, you’ll be required to return to the clinic in order to get a chest X-ray and undergo other further testing.
The panel physician will follow the CDC’s Tuberculosis Technical Instructions for Panel Physicians, which currently require all green card applicants aged 15 and older (in countries considered to be “heavily tuberculosis-burdened”) to have a chest X-ray.
If necessary, you may be required to return to the clinic for further testing if the chest X-ray and other relevant screening (medical history review and physical checkup) show signs and symptoms of tuberculosis.
It’s important to also check the specific medical exam instructions from your U.S. embassy or consulate that may be relevant to tuberculosis testing.
Doctors are required to perform a blood test for syphilis and a urine test for gonorrhea on all green card applicants aged 15 and older — whether applying from within the United States or abroad.
The doctor is required to make sure that you’ve received all required vaccines. If you’re missing any, you’ll be required to obtain these before you attend your green card interview, but the doctor should be able to provide these vaccines during your medical exam.
The doctor will ask questions about any prescription drugs you take, as well as your past and present drug and alcohol use.
To learn more about specific screening procedures for green card applicants, check out the CDC’s guidance for civil surgeons (if you’re applying from within the United States) or its guidance for panel physicians (if you’re applying from abroad).
The civil surgeon will ask you to sign the form once the exam is complete. Do not forget to sign the form — USCIS will not accept unsigned forms. Unless you’re instructed to come back to the doctor’s office, the doctor will provide your medical exam results in a sealed envelope at the end of your appointment. Do not break the seal or open the envelope.
Doctors normally provide a copy of the results for your records. This is the only copy you are allowed to open. If they don’t automatically give you a copy, it’s generally a good idea to ask for one before they seal the envelope.
You must send the sealed, unopened envelope (which also contains your completed Form I-693) to USCIS or bring it to your interview, depending, again, on whether you schedule your medical exam before or after filing your green card application package.
The doctor will either give you the sealed, unopened envelope (and your X-ray) to bring to your interview, or they may send it directly to your U.S. embassy or consulate, depending on your home country’s specific requirements for the medical exam.
All female applicants must complete the medical exam even if they are having a menstrual period.
In addition, women who are pregnant must have a chest X-ray, if required. They must, however, give prior consent to the doctor and must be provided additional protection during the procedure.
Pregnant women may also postpone the X-ray until after giving birth, but the X-ray must be completed before entering the United States (if applying from abroad) or before completing a green card application, or Form I-485 (if applying from within the United States).
The following vaccinations are required when applying to immigrate to the United States:
During the exam, the doctor’s job is to make sure that the relative seeking a green card doesn’t pose a health threat to current residents of the United States.
The main health-related reasons why a person might be denied a green card include the following:
Communicable diseases: If you have active, untreated, and infectious gonorrhea, leprosy, syphilis, or tuberculosis, you will be unable to get a green card until the disease has been treated and/or cured.
Drug and alcohol abuse: If you have a history of drug abuse, you might be asked to take a drug test and/or certify that you have completed a drug treatment program. If you’re currently abusing prescription drugs, illegal drugs, or alcohol, you will not be allowed to get a green card.
Mental illness with a history or threat of violence: If you have a mental illness that has caused you to be violent in the past or is associated with violence, either against yourself or others, you may have trouble getting a green card. According to USCIS policy, drunk driving falls into this category.
Inability to work: If your health is so poor that you won’t be able to support yourself financially, you could be denied a green card based on your likelihood of becoming a “public charge,” basically a person who has depended, or is likely to depend at any time in the future, on government benefits. This is likely the case for people with serious degenerative or fatal diseases.
A relative seeking a green card generally would not be denied on medical grounds if they:
If, however, a relative seeking a green card has a health-related condition that could lead to denial of their application, it’s generally best to do the following:
If you’ve tested positive for gonorrhea, syphilis, leprosy, or tuberculosis in the past: It’s important to show USCIS or the State Department that you have been successfully treated. Typically, the best way to do so is to bring copies of your medical records showing the treatment you received and the results of that treatment, as well as a statement from your regular doctor confirming that your disease is either cured or being managed.
If you have any history of drug abuse or mental illness: It’s important to bring proof to the medical exam that your drug addiction has been treated or that your mental health is under control.
If you have any other potentially serious disease: It’s good practice to get a letter from your regular doctor explaining how your disease is controlled and how your life is affected — including how your illness impacts your ability to work, if at all.
If your green card application is denied for health-related reasons: You can apply for a “waiver of inadmissibility” (basically, “forgiveness” from the U.S. government in order to enter the United States).
USCIS will generally consult with the CDC to determine if a waiver should be granted. USCIS can also attach conditions to the grant of a waiver as they see fit. For example, an applicant with tuberculosis would need to agree to see a doctor immediately upon entering the United States and make arrangements to receive treatment. USCIS may deny a waiver if the applicant openly states that they’re unwilling to obtain treatment for their medical condition.