Form I-693 steps during Adjustment of Status

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Not all K visa holders are required to submit a new form I-693, Report of Medical examination and vaccination record, while adjusting status to a Green Card.

For most, since your K-1 or K-2 visa medical exam report is less than 1 year old, you don’t have to submit an I-693 to the USCIS. However, if the first report expires by the time you have your I-485 interview, then you must get a fresh report. 

The idea is that in the I-485 Application for Permanent Residency, applicants must show that they’re not inadmissible due to INA 212(a)(1) health-related grounds. And having an up-to-date, unexpired report is key. 

So in this article, I’ll explain when and how you take an I-693 exam for your Green Card being a K visa holder.

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What is the I-693 Report?

Form I-693 is a report that a civil surgeon fills out when he/she completes a medical exam on a Green Card applicant, which in our case is a K visa holder. 

This report combines the different health-related grounds and asks the doctor to test you for specific conditions: communicable diseases, vaccinations, mental or physical disorders, and drug-related conditions.

Upon analyzing the results of this report, a USCIS officer can make a decision whether you’re eligible for a permanent residency or inadmissible due to a health-related condition.

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Do K visa holders take the I-693 exam for the I-485?

At the beginning, usually you don’t need to take it. Here’s why.

Fiance K-1 and K-2 visa holders have already taken, completed, and submitted a medical exam for their K visa interviews. That report is usable for the USCIS for adjudicating your Green Card application in lieu of the I-693. So if you submit your I-485 application within 1 year of the exam, there’s no need to get the I-693 exam. However, the following must also be true:

✔ The K visa medical exam was done less than 1 year ago, and

✔ There was no Class A condition reported. But if you were marked with a Class A condition, then you can’t use the same medical report unless you get a waiver. Otherwise, a new I-693 must be done in the US by a civil surgeon.

In summary, K visa holders get the medical exam and vaccinations while preparing for the visa, they have a valid medical exam for 1 year, and don’t need to repeat it just for the Green Card. This entire concept is explained in this flow diagram.

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While filing the I-485, you have three options

First, if you decided not to take any or some of the vaccinations during the medical exam for the K visa, you must get them now before you file for adjustment of status. Remember to include the vaccination worksheet, DS-3025, with your I-485 application.

Secondly, you’re not required to get the I-693 exam if your green card interview happens within 12 months of your first K visa medical exam. 

Routinely the problem becomes, however, that I-485 procedures take longer than 12 months to process and K visa holders almost always need to do another exam. 

In other words: after filing your I-485, and by the time the USCIS actually gets to process your case, it’ll be most likely past the 1-year validity period. This leaves you with three possible options:

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OPTION 1: Undergo a new exam at any time in anticipation of your I-485 processing taking longer than 12 months. Mail this report to the USCIS.
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OPTION 2 (recommended): Only take an exam once the USCIS starts to adjudicate your case and asks for an updated medical exam. Take the exam anytime before the interview and mail it in or bring it to the interview. This option takes advantage of the possibility that the USCIS may process your case before the 1-year expiration date of the first exam.
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OPTION 3: The final option is to attend the Green card interview without a new medical exam. And if the first medical exam is expired by then, the officer will issue an RFE and you can submit a new exam. This is common and allowed by the USCIS. In fact, it’s written in the I-485 instructions.

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In all cases, you must submit the DS-3025, vaccination record, with your I-485 application regardless of whether or not you need a new I-693. In addition, realize that I-693 exams are valid for 2 years but must be submitted within 60 days of the date of the report.

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Steps if you need to take the I-693

In the likely event that your K visa medical exam expires before your I-485 interview, the process to get a new I-693 exam is simple:

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❒ Find an approved civil surgeon near you using the USCIS directory (findadoctor). No other doctor may perform the exam. 

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❒ Contact the doctor and schedule an appointment. 

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❒ On the day of your exam, the physician will test for four categories: communicable diseases, vaccinations, physical or mental disorders, and drug abuse or addictions. Bring any previous medical records or vaccinations along with you and the physician will administer whatever is necessary and/or missing. 

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❒ The medical results report normally take 1-2 weeks to arrive depending on which physician you use and the complexity of your case. If there are follow ups or problematic results, you may have to do additional testing or procedures. 

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❒ Finally, take the sealed envelope and submit it to the USCIS. If conditions allow, you may bring it to the interview or mail it after the interview in response to an RFE. In all cases, you must submit it to the USCIS within 60 days, either in person or by mail as applicable. This test is valid for 2 years upon completion.

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The cost for the exam varies depending on what, if any, vaccines you require, and if you need further follow-ups, etc. The doctor usually charges a standard price, but you may shop around for cheaper options.

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What Vaccinations are required

Vaccinations requirements, fully explained by the USCIS, are necessary to show that you’re immune to disease. 

All immigrants who adjust status for a Green Card must be vaccinated, or otherwise be approved for a waiver. If not, the USCIS may deny your application for permanent residency according to INA 212(a)(1). 

Vaccines are administered based on age and availability of the vaccine. If you had the vaccinations during the K visa medical exam, then you don’t necessarily need to repeat them all. It depends on a number of factors. A full discussion is available, including waivers if you object to taking the vaccinations on moral or religious grounds.

Tip: you’re allowed to get vaccinations by a private doctor in the US and bring proof of immunity to the civil surgeon who performs your I-693 exam. This official civil surgeon will determine whether new vaccinations are required or whether the ones you just got are acceptable. This can save you money if you use your own health insurance.

Tip: if pregnant, there’s a chance you may be exempt from vaccinations and marked “contraindicated”. You must speak to the physician for details.

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How to fill out the I-693

The K visa holder does NOT fill out the I-693; The approved doctor does. You, the K visa holder, are only responsible to sign your name at the end before the doctor seals the report and hands it to you.

Since this form is filled out by the physician, I won’t do an in-depth line-by-line explanation. Instead, we’ll briefly explain it section by section.

PART 1 is “information about you”, asking for the K visa holder’s name, physical address, gender, date of birth, among other biographical details.

PART 2 is the applicant’s statement and signature. Here, you sign the form after the civil surgeon performs the exam. 

PART 3 is the interpreter’s (if any) contact information and signature. 

PART 4 is the information and contact of the preparer, if any.

PART 5 is where the civil surgeon fills out your identification. You may use a number of different forms of ID to establish identification. 

PART 6 is the actual result of the exam. Here, the physician classifies you into either a “no Class”, “Class A”, or “Class B” condition. Class A is “inadmissible” — meaning you have some condition which makes you ineligible for a Green Card, unless a waiver is granted. Class B is one level down and may make you inadmissible depending on the circumstances. “No class” means the civil surgeon found your health acceptable and you won’t be denied on health-related grounds.

PART 7 is the civil surgeon’s contact information and signature.

PART 8 is an in-depth report on what, if any, condition the K visa holder may have. The first few pages are in connection with communicable diseases: Tuberculosis, Syphilis, Gonorrhea, and leprosy. The next few pages deal with Physical or Mental disorders with associated harmful behavior, where the doctor verbally asks questions.

Finally, the doctor inquires about your drug abuse and addiction history, if any.

They record the results in Part 8. If you need any further evaluation or testing, the doctor may refer you to a specialist by filling out Part 9. This is normally not required unless there’s a problem.

PART 10 is your vaccination worksheet. Here, the doctor administers any shots taking into consideration anything you’ve taken before. If you received vaccinations during the K visa medical exam, you will not repeat these vaccines. However, if you didn’t take the vaccines back then or are missing a few, you must get them now. Bring your DS-3025 to show proof of prior vaccines.

PART 11 is an opportunity for the civil surgeon to write any additional notes to the USCIS officer reviewing your case.

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Does the USCIS have my medical exam information?

During entry to the US on a K-1 or K-2 visa, a Customs and Border Protection (CBP) officer reviews and scans the contents of your sealed medical exam envelope into their system. They return a copy of the DS-3025 vaccination worksheet for your keeping.

You should keep this safe because you need to submit a copy of it within your I-485 to prove that you have the required vaccinations, if that’s true. If you didn’t take the optional vaccinations before, you must get them now when you apply for the I-485.

The USCIS has access to the documents the CBP scans upon your entry into the US. So, the USCIS officer doesn’t necessarily need you to submit your K visa medical report in full. They only need to see the DS-3025 and/or the I-693 as applicable.