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June 19, 2024

Preparing for the Green Card process involves many steps, and most applicants have a lot of questions and concerns along the way. Attorney Kara Hart and Dr. Vasanth Kainkarya, founder of 4 Elements Direct Primary Care, sat down to discuss the legal process and medical exam, answering some of the most common questions they get from their clients.



The questions and answers refer to immigrants who have the intention of becoming permanent residents of the United States; those seeking temporary residency do not have the same requirements.

Why does immigration require the I-693 medical exam?

The I-693 medical exam looks for any medical issues that make an immigrant inadmissible to the U.S., including:

  • Communicable diseases that may be a threat to public health (determined by the CDC in conjunction with the USCIS)

  • Behaviors that may be harmful to oneself

  • Behaviors that may create a threat to the public


If the applicant has health conditions that could make the person inadmissible, further documentation, testing, or treatment may be needed. 

When does an applicant get an I-693 exam?

There are various stages when an applicant can get their I-693 exam. Under current circumstances, Kara Hart recommends completing the exam prior to filing, in order to enable inclusion of the report at the time of filing. Once the medical exam has been completed, it is valid indefinitely—under current rules (as of June 2024). That said, the validity of the medical exam can change from time to time, so it is best to speak with your attorney when you are nearing this stage of the immigration process.

What is a Civil Surgeon and why does a Civil Surgeon complete the I-693 exam?

A civil surgeon is a physician designated by USCIS to be able to perform I-693 exam medical exams in the U.S. Contrary to the name (and to ease many nerves!), it’s worth noting that there isn’t a surgical portion of the medical exam.

What should I bring to my I-693 medical exam?

When you go to your I-693 medical exam appointment, bring anything that relates to your health that can be valuable to the physician conducting the exam. Suggested items include:

  • Vaccine records (in English)

  • Lab test results

  • Detailed treatments for diseases, such as tuberculosis

  • Physical exam notes

  • Medication list

  • Medical records

  • Unexpired passport


The best approach an applicant can take during the medical exam is to be fully transparent and honest. The physician will want to know as much detail about your medical history as possible. It is important to understand that providing these details and notifying the doctor of any health issues does not automatically make you inadmissible. 


If you are unable to obtain a copy of your vaccine records, blood testing can be conducted to verify your immunity. In some cases, vaccines may need to be administered if there is no evidence that the applicant has received them in the past. 

What should I expect during my I-693 medical exam?

The I-693 medical exam portion of the immigration process is intimidating to many people. Dr. Vasanth Kainkaryam tells his patients to expect a conversation regarding their past and current medical history, along with a basic medical exam (similar to a yearly physical) with a few added components. During the exam, the physician will: 

  • Review your medical history

  • Take vitals

  • Ask health-related questions

  • Examine the skin 

  • Draw blood for testing


It is important to note that this medical exam does not contain a gynecology exam.


The turnaround time of the completed report depends on the clinic that processes the blood tests. The civil surgeon should be able to provide a general timeframe when you can expect to receive documentation.

What happens if the doctor finds a health condition during the I-693 medical exam?

There are protocols in place when a health condition is found during the I-693 medical exam; they largely depend upon the findings. For example, if an applicant has a positive blood test for tuberculosis, followed by an X-ray with abnormal findings, the physician will notify the CDC and involve a specialist, who can devise a treatment plan. 


It is important to ensure that you attend your medical exam without any current known acute infections—these may present themselves in an x-ray as a sign of tuberculosis. Rather, notify the civil surgeon if you have had any infections recently. The civil surgeon may elect to postpone further testing in order to avoid the risk of false signs of inadmissible instances. 


Some conditions are no longer considered grounds for inadmissibility once the applicant has followed proper protocol, completed treatment, and is clear of the condition. There are Class A and Class B medical conditions that are reported on the medical exam. Class B conditions don’t indicate immediate inadmissibility. However, Class A conditions (such as tuberculosis) are automatically a grounds of inadmissibilty.

What happens if USCIS finds something missing or needs clarification on the I-693 medical exam?

Once USCIS has opened the application and reviewed the medical report, they might send a letter to the applicant and the applicant’s attorney if they have concerns, questions, or need further clarification. Once the requested information has been provided to USCIS, the process may continue. However, if USCIS sees the need for additional information once again, they may issue a Notice of Intent to Deny or outright deny the case. 


If the USCIS sees something on the report that they believe makes the person inadmissible, there might be the opportunity to apply for a waiver of inadmissibility. 


In many cases, the applicant and attorney have limited time to respond with the required information. This is why it is crucial to be prepared, communicate promptly, complete the full exam as early as possible given the circumstances, and be honest and transparent with the physician and attorney.

Can I work with an immigration attorney or Civil Surgeon in any state?

Because immigration is a matter of federal law, in general, a person can work with an attorney or get their I-693 exam in any state. There may be benefits to working with someone nearby, particularly considering the need for in-person interviews and travel costs. However, considering attorneys and Civil Surgeons in other states may open doors to services, pricing, and skill sets that work better for your situation.

How do I find a  Civil Surgeon to complete the I-693 exam?

There are multiple ways that an applicant can find a Civil Surgeon in their area:

  • The USCIS has a database of all Civil Surgeons where applicants can go to find a physician in their area who is designated to complete the I-693 exam. 

  • Recommendations from an immigration attorney.

  • Recommendations from friends, family, or colleagues who have also completed the immigration process.


It is important to call ahead to ensure the Civil Surgeon is still certified to perform the exam, has availability, and that the pricing is fair as fees are not standardized and can vary greatly from office to office. 

What if I need a vaccine update rather than a full medical exam?

In some cases, immigration applicants will have received a Panel Physician medical exam in another country and will not need a full I-693 medical exam—only a vaccine update. With proper supporting documentation and no indications of inadmissibility from the Panel Physician who completed the prior exam, it’s generally true that a vaccine update is all that’s needed. However, this is a case-by-case situation and would need to be discussed with your attorney and physician. 


At the Law Office of Kara Hart, the goal is to prepare an application that is complete and ready to be approved. The full medical exam is a significant part of the application. 

Can I ask for a vaccination exemption?

If an applicant wants to apply for a vaccination exemption, he or she must apply for a waiver of inadmissibility. In order to qualify for a waiver of the vaccine based on religious beliefs, the applicant must be opposed to all vaccinations (not only select vaccines). Vaccination exemptions are difficult to get approved by the USCIS. If you intend to ask for a vaccine exemption, planning ahead of time is key to obtaining supporting documents. If the vaccination exemption waiver is declined, the applicant can either get the required vaccine(s) or withdraw the application.


We recommend consulting with a primary care physician before applying for the waiver if only select vaccines are of concern. The physician may determine that the vaccine is medically contraindicated, in which case a waiver might be unnecessary.

What if I don’t tell the Civil Surgeon that I had a DUI?

Criminal arrests, such as DUI’s, are not automatically grounds of inadmissibility. However, if USCIS sees a pattern of alcohol-related arrests, they may determine that further treatment or evaluation by the Civil Surgeon is needed before proceeding. 


Being open and honest with both the physician and attorney is critical. Doing so saves the whole team from surprises that could result in denial, or quick deadlines to provide supporting documentation.

If I abandoned my permanent residency in the past and want to return to the United States, do I need to start the process over?

Generally, yes. If your green card has been relinquished, you must go through the petitioning process again in order to obtain permanent residency.

Could an error in my Green Card process affect me later when I apply for citizenship?

Errors or inconsistencies in the Green Card process could affect a person’s eligibility to naturalize (i.e. become U.S. citizen), in the future. When USCIS reviews an application for naturalization, they have to confirm that the person’s application for permanent residence was properly approved in the first place. Working with an attorney who reviews past applications and all documentation in detail can help you avoid putting your Green Card at risk. 


When going through the immigration process, be honest and transparent with your attorney, as well as the Civil Surgeon completing the I-693 medical exam. Omitting information, or providing false information, could jeopardize your ability to become a permanent resident. Your attorney's office is a safe place to be honest and open. Furthermore, keep in mind that items you may be worried about don’t necessarily make you ineligible for a Green Card.


For further questions regarding the legal side of the immigration process, please reach out to our team at any time. If you need an I-693 medical exam, you can find Dr. Vasanth Kainkaryam at 4 Elements. Click here to find a listing of all designated civil surgeons. 


Kara Hart is an immigration attorney practicing in Connecticut, with over two decades of experience representing clients in complex immigration matters. She focuses on helping individuals navigate the entire process, from sponsorship through the application process to becoming a U.S. citizen.


Dr. Vasanth Kainkaryam is a Civil Surgeon and is authorized to perform I-693 Immigration Medical Examinations for individuals working their way through the immigration process to become a U.S. citizen. He focuses on providing affordable, quality exams and care to immigrants and those visiting from abroad at his practice 4 Elements Direct Primary Care in Connecticut.


Disclaimer: The content of this discussion is not meant to be medical or legal advice. Dr. Kainkaryam and Attorney Hart are independent business owners and do not represent USCIS or any other government entity in this educational seminar.

Call 860.512.8400 to schedule a consultation with Kara.

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