What Screening Data Reveals About I-693 Exam Results

Form I-693 exists to catch a specific set of public health concerns: communicable diseases of public health significance, missing required vaccinations, and physical or mental conditions associated with harmful behavior. The screening protocols civil surgeons follow are set by the CDC’s Technical Instructions, and the resulting classifications determine whether an applicant is found inadmissible on health grounds.

Tuberculosis screening applies to nearly every applicant age two and older, with children under two tested only if they show symptoms or have a known HIV infection. A positive blood test result triggers a chest X-ray, and an X-ray suggestive of TB leads to further sputum testing. The classification that results matters a great deal: active, infectious TB is a Class A condition that makes an applicant inadmissible until treatment is complete, while latent infection or non-infectious disease is classified as Class B and generally does not block immigration, though it may require referral to a local health department for follow-up.

Gonorrhea testing requirements are narrower than they once were. Current CDC technical instructions, in place since September 1, 2021, limit mandatory testing to applicants aged 18 through 24, though civil surgeons may still test older or younger applicants if there’s a specific reason to suspect infection. As with TB, the health classification carries real consequences: untreated gonorrhea is a Class A condition and blocks approval until treatment is documented, after which the classification changes to Class B. The nucleic acid amplification tests used for this screening are reported to be highly sensitive — cited figures put sensitivity above 90 percent — which is why gram stains, which can miss asymptomatic infections, are no longer accepted.

Syphilis follows a similar pattern. Testing requirements are age- and risk-based, a positive result requires confirmatory testing, and untreated infectious syphilis is likewise a Class A condition requiring antibiotic treatment, typically penicillin, before an application can move forward. Notably, syphilis testing must be performed by the civil surgeon or panel physician conducting the exam — results from an applicant’s outside doctor are not accepted for this purpose.

Vaccination data plays a comparably large role in the exam. Applicants must show proof of age-appropriate vaccination against measles, mumps, rubella, polio, tetanus, diphtheria, pertussis, Haemophilus influenzae type B, and hepatitis B, with several other vaccines required depending on age, season, or risk factors. As of January 22, 2025, COVID-19 vaccination is no longer part of that list. Where an applicant lacks documentation, a blood titer test showing existing immunity is an accepted alternative for several vaccines, including polio, MMR, varicella, and hepatitis B — sparing the applicant an unnecessary re-vaccination if they can show they’re already protected.

The hepatitis B vaccine is roughly 90 to 95 percent effective with a full series and provides long-lasting protection, according to the immunization data civil surgeons rely on when reviewing an applicant’s history.

None of this testing happens in isolation from the broader public health system. When a civil surgeon identifies a Class A condition, current guidance requires a referral to a local health department for evaluation and treatment before Form I-693 can be signed — a step that ties an individual applicant’s exam back into the same surveillance and treatment infrastructure used for the general population.