The U.S. Citizenship and Immigration Services (USCIS) has implemented immediate changes to the medical examination requirements for individuals applying for permanent residency, commonly known as a green card. The adjustment centers on Form I-693, the “Report of Immigration Medical Examination and Vaccination Record,” and is designed to strengthen public health protections while streamlining the application process. Big Breaking: Trump Admin Enforces Sudden Green Card Rules Change – Details Inside.
What Changed in the I-693 Medical Exam Policy?
Immediate Policy Shift
On June 11, 2025, USCIS announced that every new application for permanent residency will now require a renewed medical examination form. This marks a reversal from the policy established in April 2024, which allowed applicants to reuse a previously submitted I-693 form indefinitely, provided it was signed by a civil surgeon after November 3, 2023.
Validity and Reuse Restrictions
Under the new rule, if an applicant withdraws their green card application or it is denied, they cannot reuse the same I-693 form for a subsequent application. Instead, they must undergo a new medical examination and obtain a freshly signed I-693 document. This policy is intended to ensure that all applicants receive current medical evaluations, reducing potential public health risks.
Why Did USCIS Change the Policy?
Public Health Concerns
USCIS stated that the previous policy, which permitted indefinite use of medical exam forms, was “excessively broad and could potentially put public health at risk in the United States.” By requiring new exams for each application, the agency aims to guarantee that individuals receive timely and appropriate medical examinations and treatment.
Streamlining and Clarity
The change also aims to simplify the application process and reduce confusion. Previously, applicants could find themselves in limbo if their original medical exam expired while their application was pending, sometimes requiring multiple exams due to lengthy processing times. The new policy clarifies when a new exam is required and eliminates ambiguity for applicants and immigration attorneys.
Who Is Affected by These Changes?
Green Card Applicants
All individuals applying for adjustment of status to lawful permanent resident (Form I-485) are required to submit a current Form I-693 with their application. If the application is withdrawn or denied, a new medical exam must be completed for any future submission.
Refugees, Asylees, and Special Cases
Refugees and derivative asylees who have already completed an immigration medical examination outside the United States may only need to submit a partial I-693 form, focusing on vaccination records, if they apply within one year of eligibility. Afghan nationals under Operation Allies Welcome may also use previous exam results under specific conditions.
How Much Does the Medical Exam Cost?
Exam Fees
The cost of the immigration medical examination can range from $100 to $500, depending on the provider and location. Applicants should budget for this expense as part of their green card application process1.
How to Prepare for Your Medical Exam
Step-by-Step Guide
-
Find a USCIS-Approved Civil Surgeon: Only doctors designated by USCIS as civil surgeons can perform the required examination.
-
Gather Medical and Vaccination Records: Bring all relevant health records to your appointment.
-
Complete Parts of Form I-693: Fill out the required sections of the form, but do not sign until instructed by the civil surgeon.
-
Attend the Examination: The civil surgeon will review your medical history, conduct a physical exam, and verify your vaccination status.
-
Receive a Sealed Envelope: After the exam, the civil surgeon will provide the completed Form I-693 in a sealed envelope. Do not open this envelope—submit it directly to USCIS.
-
Submit with Your Application: Include the sealed envelope with your Form I-485 when filing for adjustment of status.
What Happens If You Don’t Comply?
Application Rejection
If you fail to submit a current and properly completed Form I-693 with your green card application, USCIS may reject your application outright. This underscores the importance of following the updated procedures carefully.
Expert Reactions and Legal Implications
Attorney Perspectives
Immigration attorneys have noted that the change is relatively specific and does not introduce a new pre-filing expiration period for the I-693 form. However, the requirement for a new exam if the application is withdrawn or denied is a notable shift. Some experts appreciate the clarity, while others caution that the immediate implementation could catch applicants off guard, especially given recent confusion over other form changes.
Recent Precedent
Earlier in 2025, USCIS faced backlash after abruptly changing several application forms without advance notice, leading to legal challenges and eventual policy reversals. The agency now aims to provide at least two weeks’ notice before implementing changes, but the recent I-693 policy shift was announced with immediate effect.
What Applicants Should Know
Revised Form Edition
A revised version of the I-693 form will come into effect on July 3, 2025. Until then, applicants can use either the 03/09/23 or the 01/20/25 edition if the civil surgeon signs the form on or before July 2, 2025. After July 3, only the 01/20/25 edition will be accepted.
Timing Is Critical
Applicants should plan their medical exams carefully to ensure they meet all deadlines and use the correct form edition. Any delay or error could result in application rejection or additional costs.
Frequently Asked Questions (FAQs)
1. Do I need a new medical exam if my green card application is denied or withdrawn?
Yes, you must undergo a new medical examination and obtain a new I-693 form if your application is denied or withdrawn before reapplying.
2. Can I use my old I-693 form if it hasn’t expired?
No, under the new policy, you cannot reuse an old I-693 form if your previous application was withdrawn or denied, even if the form itself has not expired.
3. How much does the immigration medical exam cost?
The exam typically costs between $100 and $500, depending on the provider and location.