What happens at an immigration medical exam?

All immigration strategies described in this resource require – at some stage in the process – an immigration medical examination. This examination is required because of the grounds of inadmissibility relating to medical conditions. Certain diseases of public health significance, like sexually transmitted diseases, make an individual and admissible to the states. (For more on medical inadmissibility, consult that section of this resource). What actually happens at these medical examinations?

The medical examination is fairly similar regardless of whether you are applying for a visa outside of the United States or pursuing adjustment of status within the United States. For those seeking a visa, the examination is performed by a Panel Physician. These doctors are certified by the Department of State. A list of the doctors will be available from the consulate in charge of your case. For those pursuing adjustment of status, you must attend a medical examination with a Civil Surgeon. These are doctors who have been certified by USCIS. A list of Civil Surgeons in the United States is available on the USCIS website at https://my.uscis.gov/findadoctor. There are far more civil surgeons than panel physicians. Most major metropolitan areas have multiple civil surgeons. Price can vary substantially between civil surgeons, so it makes sense to call around for prices and availability. Costs range roughly from $90-$400. Panel Physicians generally are more expensive and in the $400 range. None of these clinics will typically accept medical insurance, though you may be able to save a small amount of money by requesting that the urine, skin and blood tests be performed by a clinic that is covered by your insurer.

You may conduct an examination with a Civil Surgeon without any special documentation from the immigration agencies – for example, you do not need to provide a receipt notice for an active immigration application. Historically, the medical examination was submitted with the initial adjustment of status application. Since the medical examination is valid for a period of only 12 months, however, my approach is to wait until just prior to the interview before conducting the examination. Under current guidelines, the applicant is permitted to submit the examination at any point up to the interview. If you do not the medical examination with the initial application filing, you will receive a reminder notification. But this does not indicate an error in your application, and it does not slow the processing of your case. By contrast, if you receive your examination at the time of filing, it is possible that you will have to redo your medical examination prior to or after the interview.

Procedures for scheduling examinations with Panel Physicians in visa cases differ by consulate. Sometimes you will need to have received your appointment notification before the panel physician will agree to conduct examination. You need to check with the immigrant visa guidelines for your consulate to see what the current procedures. Appointments are often available only in the city where the U.S. consulate is housed. Typically – for my clients who live elsewhere in the country – individuals will travel to the consulate city several days prior to the visa interview to complete their medical examination. Make sure to check with the clinic in advance, since appointments are often limited and fill up fast.

You are not required to fast or abstain from drinking prior to your medical examination. When you go to the clinic, you should bring your current passport, a second form of photo identification, and your record of immunizations if that is available to you. If you have previously been diagnosed with tuberculosis (TB) or any sexually transmitted disease you should bring those lab results and documentation of any treatment that you have received.

There are basically four components of the medical examination. First, you will give a urine sample which is used for gonorrhea screening. Second, the clinic will administer a skin test for TB. This is administered via a small prick on the surface of the skin. Third, the clinic will draw blood for use in syphilis testing. Fourth, you will have a physical examination and clinical interview with the doctor. The full body examination includes the eyes, ears, nose and throat, extremities, heart, lungs, abdomen, lymph nodes, skin and external genitalia. The examination also includes an interview component, when the doctor can inquire about past drug and alcohol use, and mental health issues. Lastly, those receiving a Panel Physician evaluation for a visa will also receive a chest X-ray.

An individual is required to have the following vaccinations:

• Mumps, measles and rubella (MMR);
• Polio;
• Tetanus and diphtheria;
• Pertussis;
• Influenza type B; and
• Hepatitis B.

If you lack that does vaccinations, will generally have to receive it.

Past illicit drug use or alcohol abuse has the potential to make an individual inadmissible. The doctor is entitled to ask about such matters, and we observe a trend towards being more rigorous in this regard. Likewise, prior mental illness associated with harmful behavior can lead an individual to be inadmissible. An applicant with a history in any of these three categories would be well advised to consult an attorney or thoroughly explore the issue in advance of the medical examination.

Medical conditions other than those described above will generally not make a person automatically inadmissible. Even things like serious heart conditions or other life-threatening diseases like HIV do not make an individual inadmissible on medical grounds. There is an important catch here, however. Although the medical condition itself does not create an inadmissibility issue, it can raise concerns about how the individual is going to be able to afford health care. As described elsewhere in this resource, the applicant has the burden of proof to establish that she will not become training on public resources. This is called Public Charge inadmissibility. For any form of serious ailment, the applicant should consider early on how she is going to provide for her own care in the United States. For example, if the applicant will be getting herself added to her spouse’s health insurance, secure a letter from the insurer that she will be eligible

After the medical appointment, you will be required to return to the clinic after 2 to 3 days so the results of the tuberculosis screening.

For adjustment of status cases, the Civil Surgeon will hand you a sealed copy of your examination results. The results are contained on a Form I-693, Report of a Medical Examination and Vaccination Record. Applicants over age 14 are required to sign the Form I-693. You must keep the envelope sealed for submission in your case. Typically the doctor will be willing to provide a copy of the results, which you should review. If the doctor has made a finding that you have a “Class A” condition you will want to speak to an attorney immediately to assess whether you may be able to overcome in invisibility.

In visa cases, the Panel Physician submits the medical results directly to the consulate. The results will be documented on a Form DS-3025. As with adjustment cases, you should request a copy of the results so that you can review them prior to your interview.

Want to learn more? You can find the Department of State’s detailed explanation of medical inadmissibility at 9 FAM 302.2.