A marriage-based adjustment filing can be rejected before USCIS reaches the merits if a required Form I-693 is missing. Since December 2, 2024, USCIS has required applicants who need an immigration medical examination to submit the completed Form I-693 with Form I-485. The practical lesson is simple: treat the medical exam as part of the filing package, not as an item to obtain after the case is already pending.
The examination must come from a designated civil surgeon
A family doctor cannot complete Form I-693 merely because the doctor knows the applicant's medical history. Under 8 C.F.R. § 245.5, an adjustment applicant must be examined by a designated civil surgeon. USCIS maintains a doctor-search tool for this purpose. Before scheduling, confirm that the physician is currently designated and ask the office which records, identification, photographs, laboratory work, and payment methods it requires.
The applicant should also confirm which edition of Form I-693 the office will use. As of August 25, 2026, the USCIS Form I-693 page lists the January 20, 2025 edition. Form editions and signature rules change. A reputable civil-surgeon office should work from the current USCIS page rather than an old saved copy.
Submit the medical exam with Form I-485
USCIS announced on December 2, 2024 that an applicant who is required to provide Form I-693, including a partial vaccination record when applicable, must include it with Form I-485. USCIS may reject the adjustment application if the required medical form is omitted. A rejection is not a denial on the merits, but it can still matter. The filing date may be lost, forms may become outdated, fees may change, and an applicant may need to rebuild and resend the package.
This rule changes the old habit of waiting for a request for evidence or bringing the medical form to an interview. For a new marriage-based adjustment package, the filing checklist should include the civil-surgeon appointment early enough to receive the sealed envelope before the I-485 is mailed or submitted.
Do not open the sealed envelope
The civil surgeon must complete and sign Form I-693, place it and required supporting material in a sealed envelope, and give that envelope to the applicant. USCIS instructs applicants not to accept an envelope that is not sealed and not to open it. Opening it can make the document unusable for filing.
Ask the civil surgeon for a copy of the completed form and vaccination record for personal records. Review that copy before filing. Check the spelling of names, date of birth, identifying information, vaccine entries, dates, and the physician's signature. If something is wrong, return to the civil surgeon for a corrected sealed version. Do not try to correct the USCIS copy yourself.
Bring written vaccination records with dates
The CDC's current technical instructions require the civil surgeon to review vaccination documentation. Acceptable records generally must be written records or medical-chart entries from appropriate medical personnel and must show the month, day, and year each dose was received. A person's memory of a vaccine is not enough.
Records from outside the United States can be accepted if they appear reliable and the schedule is consistent with accepted recommendations. The applicant is responsible for providing reliable English translations. Collecting those records before the appointment can prevent unnecessary repeat vaccinations and reduce the chance that the civil surgeon must delay completion.
Not every applicant needs every vaccine on the list
The immigration vaccination requirement is age-specific. CDC lists diseases covered by the adjustment process, but the civil surgeon determines which vaccines are appropriate for the applicant's age, history, documented immunity, and medical condition. An adult does not automatically need childhood-only vaccines merely because those vaccines appear on the general list.
CDC also recognizes laboratory evidence of immunity for measles, mumps, rubella, hepatitis A, hepatitis B, polio, and varicella when acceptable testing is available. A reliable history of varicella disease may be handled differently under the technical instructions. Applicants should discuss testing and vaccination choices with the civil surgeon. This article does not give medical advice.
A vaccine series usually does not have to be completed before filing
Some vaccine series take months to finish. CDC explains that an adjustment applicant generally does not have to wait until every dose in a multi-dose series has been completed. If the applicant is not current, the civil surgeon generally administers at least the age-appropriate dose that can be given at the examination and documents when there is an insufficient interval to complete the series.
The technical instructions identify blanket-waiver reasons that the civil surgeon may document, including a vaccine not being age appropriate, a medical contraindication, an insufficient interval between doses, or influenza vaccine being unavailable outside flu season. These are medical determinations recorded by the civil surgeon. They do not require the applicant to file a separate waiver application.
Religious or moral objections are a separate legal issue
A refusal based on religious or moral convictions is not the same as a blanket medical waiver. CDC directs the civil surgeon to note that the applicant is requesting an individual waiver. The applicant must then establish eligibility for that waiver with USCIS. Simply declining one medically appropriate vaccine can leave the vaccination requirement incomplete. Anyone considering that path should obtain legal advice before the medical appointment because the required showing is fact-specific.
How long the form remains usable
USCIS changed its validity policy on June 11, 2025. A Form I-693 signed on or after November 1, 2023 is generally valid while the Form I-485 with which it is submitted remains pending. It is not a reusable medical certificate for a different adjustment case. If the associated I-485 is withdrawn or denied, USCIS requires a newly completed Form I-693 for a later I-485.
That policy reduces the risk that a long-pending case will require a new exam merely because time passed. It does not make early examinations risk-free. If the filing never occurs, is rejected and not promptly corrected, or later ends, another examination may be required. Schedule the medical exam as part of a concrete filing plan.
A narrow exception applies to some K visa entrants
The regulation contains an exception for certain people who entered after a medical examination required for a K nonimmigrant visa. If that examination occurred no more than one year before the adjustment application, a new full examination may not be required, although vaccination documentation or other updated material may still be necessary. The prior overseas medical record and timing should be reviewed rather than assuming that every K entrant needs a second complete exam.
A practical pre-filing checklist
Confirm the physician's civil-surgeon designation. Verify the current Form I-693 edition on the day of the appointment. Bring government identification and every available vaccination record, with reliable translations when needed. Review the copy provided by the doctor. Keep the USCIS envelope sealed. Then place that envelope in the same final filing review as Form I-485, the underlying petition, financial sponsorship, civil documents, filing fees, and signatures.
The medical examination is a health assessment, but filing it correctly is a legal-process problem. Zero One Legal includes Form I-693 timing and document review in its marriage green card filing workflow so the package is ready as one coordinated submission.
For related guidance, see Marriage Green Card Evidence Should Tell a Coherent Story, Form I-864 for a Marriage Green Card, and Preparing for a Marriage-Based Green Card Interview.
Official sources
This article provides general educational information and is not legal advice. Immigration rules, forms, fees, and procedures can change, and the law may apply differently to individual facts. Reading this article or contacting Zero One Legal does not create an attorney-client relationship. No result is guaranteed.