USCIS Ends Indefinite Validity for Form I-693

USCIS has changed, twice in less than two years, how long a completed Form I-693, the Report of Immigration Medical Examination and Vaccination Record, remains valid — and the current rule is stricter than many applicants expect.

In an April 2024 update to its Policy Manual, USCIS said that a Form I-693 properly completed and signed by a civil surgeon on or after November 1, 2023 would not expire and could be used for any future immigration benefit application. Effective June 11, 2025, USCIS reversed that position. A Form I-693 is now valid only while the specific application it was filed with — typically Form I-485, Application to Register Permanent Residence or Adjust Status — remains pending. If that application is withdrawn or denied, the medical exam becomes invalid, and the applicant must complete a new exam and a new Form I-693 before filing again. USCIS said the earlier indefinite-validity approach was overly broad and could pose a public health risk, since an applicant’s health status can change over time.

For exams signed by a civil surgeon before November 1, 2023, the older rule still applies: the form retains evidentiary value for two years from the signature date.

A separate change affects when applicants can use the exam. USCIS previously required civil surgeons to sign Form I-693 no more than 60 days before the applicant filed for the underlying benefit — a rule that had been temporarily waived since December 2021 and has now been formally removed. USCIS can accept a Form I-693 for up to two years after the civil surgeon’s signature date, regardless of when it was signed relative to the I-485 filing, as long as the form is otherwise valid.

Since December 2, 2024, USCIS has also required applicants to submit Form I-693 concurrently with Form I-485 rather than in response to a later request. Because the exam has to be complete and the results sealed before the I-485 goes in, applicants are generally advised to schedule the medical exam four to six weeks ahead of their planned filing date.

The sealing procedure itself has not changed and remains strict. After the exam, the civil surgeon places the completed Form I-693 in an envelope marked “DO NOT OPEN. FOR USCIS USE ONLY,” initials across the sealed flap, and covers the initials with clear tape. USCIS will not accept the form if that envelope has been opened or altered — doing so can mean repeating the entire exam at additional cost. Applicants filing Form I-485 online must open the envelope themselves to upload the form, then keep the original documents until a final decision is issued; applicants filing by mail submit the envelope unopened.

USCIS is also expected to propose regulatory changes to the civil surgeon designation process itself, with a target of around November 2026. Physicians currently apply for designation using Form I-910, and the anticipated changes would add requirements such as periodic renewal, board certification, background checks, and reporting of negative licensing or criminal history — part of a broader effort to keep the pool of designated civil surgeons qualified and accountable.

USCIS determined that its earlier indefinite-validity policy was “overly broad” and could “potentially threaten public health,” prompting the June 11, 2025 reversal.

For applicants, the practical takeaway is timing: a Form I-693 is only as useful as the application it travels with, and getting the exam done close to — but before — filing remains the safest approach.