Immigration Medical Exam Validity: I-693 Expires With Each I-485

(UNITED STATES) The U.S. Citizenship and Immigration Services has tightened how long an immigration medical exam stays valid, reshaping green card filing strategies across the United States. Effective June 11, 2025, the latest USCIS policy states that Form I-693 medical reports signed by a designated civil surgeon on or after November 1, 2023, remain valid only while the adjustment of status application Form I-485 is pending. If that application is denied or withdrawn, the medical becomes invalid right away and cannot be reused for another filing. This shift ends the short-lived period of indefinite validity and makes the immigration medical exam effectively single-use for each case.

Key Changes Announced

Under the new USCIS policy, three rules now define how long medical results are good:

• Form I-693 signed on or after November 1, 2023 is valid only while the linked Form I-485 is pending. If USCIS denies or you withdraw that filing, the medical expires immediately and cannot support any future application.
• Form I-693 signed before November 1, 2023 keeps the prior two-year validity. After two years, a fresh exam is required.
• Applicants should file the medical with the adjustment packet. USCIS may reject a filing that lacks a medical, instead of sending a Request for Evidence (RFE) later.

Effective Dates and Rationale

• Change effective date: June 11, 2025.
• This replaced an interim period (through June 10, 2025) when USCIS had allowed indefinite validity for exams signed on or after November 1, 2023.
• USCIS and the Centers for Disease Control and Prevention cite public health and the need for current medical information as the reason for the shift.

Allowing exams to remain valid for years could leave officers with outdated records at decision time. The new rule aligns medical results with the moment of decision.

In a related update, the COVID-19 vaccine is no longer required as of January 22, 2025, reflecting revised vaccination guidance cited by USCIS.

Practical Effects for Applicants

• The immigration medical exam is effectively single-use for each adjustment case. If your Form I-485 is denied or withdrawn, your Form I-693 cannot carry over to a new filing.
• You must book a new civil surgeon visit and submit a fresh sealed envelope for any refiling after denial or withdrawal.
• This removes debates about reusing older exams but increases costs and logistical burdens for applicants who must restart after a setback.

USCIS also aims to reduce RFEs and rework by encouraging applicants to include the medical at filing. Officers have spent time issuing RFEs to chase missing medicals or older vaccine entries. By making applicants file the medical up front, USCIS expects steadier processing and fewer delays. Analysis by VisaVerge.com suggests the up-front filing rule could save months for some cases, especially in high-volume field offices.

What Applicants Should Do

• Plan the medical close to the filing date and include it with the packet.
• Review official instructions for Form I-693: Report of Immigration Medical Examination and Vaccination Record on USCIS: see the agency’s page at Form I-693: Report of Immigration Medical Examination and Vaccination Record.
• When preparing Form I-485, file the medical at the same time using the official application page at Form I-485.

This policy affects most applicants filing for permanent residence inside the United States through adjustment of status, including:
– Family-based applicants
– Employment-based applicants
– Certain special immigrants
– Those adjusting after humanitarian approvals

It does not change consular processing abroad, where panel physicians follow separate Department of State procedures.

Timing and Practical Tips

• Schedule the exam after you gather core documents but before you sign and send your packet, so the sealed envelope is fresh.
• If you wait too long after a denial to refile, plan for a new exam — old results no longer remain valid.
• Keep copies of your vaccine history and test results for reference, even though the civil surgeon seals the official packet.

Two clocks apply based on the civil surgeon’s signature:
– Signature before November 1, 2023: medical stays valid for two years.
– Signature on or after November 1, 2023: medical remains valid only while the linked Form I-485 is pending; after denial/withdrawal it cannot be reused.

USCIS reversed the brief indefinite window because health risks change over time and officers need reliable snapshots at the point of decision. The agency also aims to cut staff time tracking down missing documents, reducing case suspense caused by RFEs.

Filing Steps Under the Current Rule (Numbered)

1. Find a USCIS-designated civil surgeon and schedule the exam.
2. Bring identity documents, vaccine records, and any prior test results.
3. Complete the exam; ensure the doctor signs Form I-693 (note the signature date).
4. Receive the sealed envelope; do not open it.
5. File the sealed medical together with your Form I-485 packet.
6. Track your case. If denied or withdrawn, plan for a new exam before refiling.

Example Scenarios

• Spouse of a U.S. citizen filed in April 2024; civil surgeon signed Form I-693 on October 15, 2024. Under the two-year rule, that medical stays valid until October 15, 2026. If the case remains pending, USCIS can use it; if a denial occurs after that date, a new exam is required.
• EB-2 engineer with Form I-693 signed December 2, 2023: the medical is limited to the life of the pending Form I-485; it cannot be reused after denial or withdrawal.

Costs, Planning, and Employer Considerations

• Medical exams are private services and prices vary by clinic and location.
• Because results can no longer bridge to a new application after denial, families should budget for a potential repeat exam.
• For employers sponsoring workers: counsel should time medicals so the priority date is current and the packet can move together. If retrogression appears, consider delaying the exam until filing resumes to avoid wasted costs.
• Dependents following-to-join should time their exams to match the principal applicant’s filing.

Sealing, Errors, and Rejections

• The civil surgeon must place the completed Form I-693 in a sealed envelope. USCIS can return or question packets if the seal is broken.
• Keep a copy of the doctor’s worksheet for your records when allowed, and verify your name, date of birth, and A-number are correct.
• USCIS warns failing to include the medical at filing may lead to rejection, not an RFE. A rejection means the packet is sent back and not receipted, which affects work and travel timelines tied to receipt dates.

Rejection vs. RFE: A rejection sends your packet back unreceipted; an RFE pauses adjudication while you supply missing items. Including the medical up front reduces the risk of rejection.

Frequent Filing Mistakes to Avoid

• Using a non-designated doctor; only civil surgeons approved by USCIS can sign Form I-693.
• Forgetting to include the sealed envelope with the initial filing, risking rejection.
• Sending photocopies of the medical form instead of the original sealed packet.
• Reusing a medical after denial or withdrawal (not allowed under the current rule).
• Letting a pre-November 2023 exam pass the two-year limit before filing.

When picking a civil surgeon:
– Ask about appointment slots, lab turnaround, and whether they stock needed vaccines.
– Bring translated records if not in English, with a translator certificate.
– Confirm your A-number and personal data are typed correctly.
– Check the signature date and verify the sealed flap before leaving.

Agency Goals and Applicant Impact

USCIS expects overall efficiency gains: fewer RFEs should mean fewer pauses, and complete files move more quickly through the line. For applicants, this can translate into steadier timelines, especially in local offices with limited staff.

However, attorneys note the rule brings clarity but adds risk for those who face denials or must withdraw to fix errors. Families with tight budgets may need to repeat exams, while others welcome faster decisions and fewer RFEs.

Policy Background and Recent History

• Before November 1, 2023: Form I-693 carried two-year validity.
• Between November 1, 2023 and June 10, 2025: USCIS allowed some exams a period of indefinite validity.
• On June 11, 2025: USCIS adopted the current policy limiting exams signed on/after November 1, 2023 to the duration of the pending Form I-485.

Filing the medical with your packet offers three benefits:
– Reduces chances of rejection for missing items.
– Gives officers everything at once, avoiding address or spacing issues.
– Locks your health snapshot near the filing date, which matches how the new rule treats validity.

If your case is denied, review the notice to determine whether issues were curable by refiling. Because your medical no longer works for a fresh case, schedule a new exam and gather any updated vaccine records. If you must withdraw for strategy reasons, expect to repeat the medical when you return to filing. Keep the old copy for reference, but do not send it again.

Visa bulletin movement can complicate timing. If a cutoff date might retrogress, consider holding the exam until the filing month is certain to avoid an unused sealed envelope. If dates are current, book the exam so you can send everything together — fees, photos, and forms — aligning with the new rule’s intent.

Packaging and Submission Tips

• Place the sealed medical near the top of your packet but protect it from bending.
• Use clips, not staples, to avoid damage during scanning.
• Label the sealed medical and include your full name and A-number on the outside of your packet.
• Verify the civil surgeon used the correct edition of Form I-693 and that vaccine entries are current.

Dates and Rules at a Glance (Table)

Final Takeaways

• Plan your exam close to filing and include the sealed medical with your packet.
• Expect to repeat the exam if you refile after denial or withdrawal.
• Correct forms, accurate dates, and a current medical help USCIS decide without delays.
• For the latest forms, filing tips, and medical exam guidance, check USCIS resources for Form I-693 and Form I-485, and contact the National Customer Service Center for case-specific questions.