By Mei-Lin Chen
Attorney, Student Visas & Compliance · June 14, 2026
Form I-693 is the immigration medical exam required for adjustment of status. Since 2018 it's sealed in an envelope by a USCIS-designated civil surgeon and expires 2 years after signature. The physical part of the exam rarely creates problems. The vaccination table on page 5 does — it's the single most common reason I-693s come back rejected or delayed.
What the exam covers
- Physical examination
- Mental health evaluation
- Vaccination review (the trap)
- Communicable disease tests: TB, syphilis, gonorrhea
- Drug abuse/addiction screening
The required vaccines in 2026
- MMR (measles, mumps, rubella)
- DTaP or Td/Tdap (tetanus, diphtheria, pertussis)
- Polio
- Hepatitis A and Hepatitis B
- Varicella (chickenpox)
- Influenza (seasonal, if between October and March)
- Pneumococcal (if 65+ or high-risk)
- Rotavirus (children under 8 months)
- Hib (children under 5)
- COVID-19 (removed from mandatory list in 2024 but still recorded)
Age-appropriate exemptions
Not every vaccine applies to every age. Rotavirus and Hib only apply to young children. Varicella isn't required if you have documented history of the disease. Pneumococcal is only required at 65+. The civil surgeon marks "not age appropriate" on the form — don't let them skip that mark or USCIS will RFE.
The blood titer workaround
For adults who can't find childhood vaccination records, a blood titer test can prove immunity to MMR, varicella, or hepatitis without requiring redose. Titers cost $150-300 and take 3-5 days for results. Get them BEFORE the medical exam so the civil surgeon can mark immunity on the vaccination table.
When to schedule the exam
Since 2024, USCIS allows I-693 to be submitted concurrently with the I-485. Filing them together avoids the 2-year I-693 expiration risk of getting the exam early. Schedule the medical 4-6 weeks before your target I-485 filing date, giving time for lab results and any catch-up vaccinations to complete.
The waiver route
Religious objections and medical contraindications qualify for vaccination waivers. Religious waivers require a sincere religious belief (Christian Scientist, some Amish communities). Medical contraindications need documentation from a licensed provider — pregnancy, immunocompromise, prior severe reaction. File waivers with the civil surgeon at the exam, not later.
If your I-485 filing is coming up and you're unsure whether your vaccination record is complete, our free consult includes a checklist you can bring to the civil surgeon. Book 30 days before your target medical exam date.
