- USCIS now requires Form I-693 to be submitted simultaneously with Form I-485 applications.
- Missing medical evidence can lead to immediate rejection rather than a later request for evidence.
- The policy aims to accelerate case processing and reduce adjudication delays for green card applicants.
USCIS now expects most green card applicants to file Form I-693 with Form I-485 from the start. Since December 2, 2024, missing medical evidence can lead to rejection, not a later request for evidence, and that has changed the pace of adjustment-of-status cases across the country.
For families, workers, and diversity visa applicants, the rule matters because it puts the medical exam at the front of the process. Applicants who wait to schedule the exam risk losing time, money, and sometimes a filing window tied to the Visa Bulletin. According to analysis by VisaVerge.com, the policy has pushed applicants to prepare earlier and submit cleaner cases.
USCIS puts the medical exam at the center of Form I-485 filing
USCIS revised the Form I-485 instructions on December 2, 2024, saying that failure to include a required Form I-693 “may result in rejection.” That language is direct, and it replaces the older practice that let many applicants submit the medical form later.
The change reflects how USCIS handles adjustment cases. A civil surgeon’s exam checks vaccination records, medical history, and health grounds of inadmissibility under Immigration and Nationality Act section 212(a)(1). Those checks include communicable diseases and certain drug-related findings.
The agency’s goal is faster adjudication. When the medical evidence is already in the file, officers do not need to pause the case for a missing document. That matters most for employment-based applicants and family-based applicants with time-sensitive priority dates.
USCIS has kept the rule in place through 2026. The policy remains in the agency’s Policy Manual, Volume 7, Part A, Chapter 3. Applicants can review the current guidance on the USCIS Policy Manual medical examination chapter, along with the official Form I-485 page and Form I-693 page.
How the filing sequence now works
The safest approach is simple: complete the medical exam before filing or file both forms together. USCIS accepts the filing as long as the medical package is properly prepared, sealed, and signed.
A proper Form I-693 must meet these standards:
- It must be completed by a USCIS-designated civil surgeon.
- It must be signed and dated.
- It must be sealed in an unopened envelope.
- It must include vaccination records and required test results.
- The applicant should keep the courtesy copy for personal records.
Civil surgeons use the latest form edition and send data electronically to USCIS and the CDC. That reduces errors, but it does not remove the need for a clean paper package. An unsealed envelope, missing signature, or wrong edition still leads to rejection.
USCIS also changed the Form I-485 edition rules. Since February 10, 2025, only the 10/24/24 edition has been accepted. Older versions are rejected outright. The agency also removed the old Form I-864W process, so exemptions from the Affidavit of Support are now handled directly on Form I-485.
Who must file Form I-693 with Form I-485
Most applicants adjusting status inside the United States need the medical exam. That includes family-based applicants, employment-based applicants from EB-1 through EB-5, diversity visa winners, and many special immigrants.
Immediate relatives of U.S. citizens are also covered. Spouses, parents, and unmarried children under 21 still need to submit Form I-693 with the adjustment package unless an exemption applies.
The pressure is strongest for applicants waiting on the Visa Bulletin. A completed medical exam helps prevent a situation where a priority date becomes current and the case cannot move because the medical record is missing. In busy areas such as California and New York, civil surgeon appointments can take one to three weeks to secure.
Fees also matter. The exam often costs $300 to $600, plus vaccination costs. The Form I-485 filing fee is $1,440 as of 2026, with an $85 biometrics fee and a $260 work permit fee if filed together.
Rejection risks are now immediate, not slow
Before this rule, many applicants learned about a missing medical form through an RFE. That is no longer the normal path. USCIS now rejects many filings that arrive without the required Form I-693.
That creates hard consequences. A rejected package means the applicant must refile, repay the fee, and lose time. For people whose status is about to expire, the delay can also create unlawful presence problems. For workers, it can interrupt a path to employment authorization and green card timing.
Other mistakes trigger the same result. A form that is unsigned, altered, or sent in an opened envelope is not valid. An outdated Form I-485 edition also fails. For cases tied to current Visa Bulletin movement, that can mean missing the window and waiting months for the next chance.
Exceptions still exist, but they are narrow
Not every applicant needs a new medical exam. The main exemptions include:
- K-1 and K-2 visa holders who file Form I-485 within one year of a CDC-approved overseas medical exam.
- Certain refugees and asylees with qualifying prior exams or approved waivers.
- Some children under 15 in limited categories, often with vaccination records rather than a full exam.
- Applicants with valid panel physician exams from U.S. embassy or consular processing.
Those exceptions are narrow, and USCIS still expects the applicant to fit the exact category. The agency’s Civil Surgeon guidance gives the official list of doctors approved to complete the exam. Applicants should use the USCIS civil surgeon locator rather than relying on a general physician.
Planning ahead now saves the most time
The current process rewards early preparation. Applicants should gather vaccination records first, especially records from other countries that may need translation. Then they should schedule the exam as soon as they are ready to file Form I-485.
A practical filing sequence looks like this:
- Check whether the priority date or immediate-relative category is ready.
- Book the civil surgeon exam and bring the passport, I-94, and vaccination records.
- Make sure the medical report is fully signed and sealed.
- File Form I-693 with Form I-485 using the current USCIS editions.
- Keep copies of everything and respond quickly if USCIS asks for updated evidence.
That approach matters because the policy has already cut many medical RFEs. USCIS data cited in 2026 shows faster processing for compliant cases and fewer delays tied to missing exams. Still, the rule puts the burden on applicants to arrive fully prepared.
For people filing from tight visa windows, that preparation is now part of the case itself. The medical exam is no longer a later step. It is part of the filing package, and USCIS treats it that way from the moment the application arrives.
