Do I need the medical exam, and when do I file it?
Applicants filing Form I-485 must generally submit Form I-693 at the same time, and USCIS may reject an I-485 without it. So book the exam before you assemble the package, and allow time for vaccines or follow-up. A few groups examined abroad may skip a full exam if the panel physician found no Class A condition. Refugees applying one year after admission, and asylee derivatives applying within one year of becoming eligible, submit Parts 1-5, Part 7 and Part 10, the vaccination record. K-1 to K-4 entrants filing within one year of the exam abroad must only show vaccination compliance, using those same parts if the DS-3025 record was incomplete. Afghan nationals who entered under Operation Allies Welcome need no new form if their panel exam is in the A-file with no Class A condition, is no more than 4 years old and nothing suggests a later one.
How do I prepare for the civil surgeon?
Use the USCIS Find a Doctor tool, because only a designated civil surgeon can complete the form for most applicants. Ask about the total price first, since USCIS's $0 does not cover the doctor's bill. Fill out Part 1, but do not sign until the surgeon tells you to: you must sign in front of the surgeon. Bring a government photo ID, such as an unexpired passport or driver's license, and all vaccination records. Children under 14 can use birth certificates with a translation, or affidavits. Use a separate form for each applicant. The surgeon can give some vaccines, and CDC's Technical Instructions set the current requirements, including any COVID-19 rule. Tell the surgeon the truth about health history. The surgeon will not sign until required follow-up is finished, so go early if your filing depends on a Form I-130 priority date or a deadline.
What do I do with the sealed envelope?
The surgeon must give you the completed form in a sealed envelope; USCIS says not to accept it otherwise. Your next step depends on how you file. If you mail the I-485, keep the envelope sealed and put it in the package going to the I-485 address. USCIS can return the form if the envelope is opened or altered. If you file online, USCIS tells you to open the envelope, upload the form, and keep the original and envelope until a final decision on the I-485. If the lockbox rejected your paper package with the envelope already opened, you may refile with the original opened form, your supporting documents and a copy of the rejection notice. Ask the surgeon for a copy for your records. The edition must be 01/20/25 for any exam the surgeon signed on or after July 3, 2025.
How long is the medical valid?
Under the USCIS Policy Manual, a form signed on or after November 1, 2023 is generally valid only for the application filed with it, for as long as that application is pending. That rule took effect June 11, 2025. If that I-485 is denied or withdrawn, you need a new exam for any later filing, so a refiled case means a new appointment and a new bill. A form signed before November 1, 2023 keeps evidentiary value for 2 years from the surgeon's signature. The 01/20/25 instructions still mention a two-year period, so follow the current Policy Manual and ask a lawyer if the two conflict in your case. An officer can still request a new or updated form if your condition may have changed, or if a Class A condition appears to have been acquired after admission. Answer any such request by its deadline.
What if the exam finds a health problem?
The exam tests the health-related grounds of inadmissibility in INA § 212(a)(1), which cover communicable diseases, vaccinations, certain physical or mental disorders with harmful behavior, and drug use or addiction. A finding can hurt the case, so do not skip a follow-up or hide a record. The surgeon must see required follow-up completed before signing, and the results are confidential, although the surgeon may share them with public health authorities when the law requires. If you are not fully vaccinated, ask about blanket waivers the surgeon can note on the form. Other findings may need a waiver through Form I-601 rather than a new exam, so get legal advice before you respond. A medical form says nothing about nonmedical issues such as unlawful presence, which USCIS reviews separately on the I-485.
How does this work in an immigration court case?
If a judge is deciding your adjustment, follow the court's and DHS's instructions on when to submit the medical, rather than the USCIS mailing rules; the USCIS page tells people filing with EOIR to do so. Because a form is tied to the application it supports, ask at your master calendar hearing when the judge wants it, and whether an earlier exam still works. Keep the envelope sealed unless told otherwise. Check dates through the immigration court lookup before you book, so a medical appointment does not collide with a hearing. The address you give the surgeon does not reach the court: after a move, file Form EOIR-33/IC within 5 days and update USCIS within 10 days. Ace Immigration's family immigration practice can tell you whether your exam fits your filing plan.