Medical examination and vaccination requirements vary depending on the immigration benefit the person is seeking.
Most applicants subject to medical grounds of inadmissibility must undergo a medical examination to determine their admissibility. Some applicants, however, do not need to undergo a medical examination unless there is a specific concern. Nonimmigrants, for example, are in this category.
Even if the applicant is not subject to health-related grounds of inadmissibility, the officer may still order a medical examination as a matter of discretion if the evidence indicates that there may be a public health concern. [1] This could apply, for example, when an officer adjudicates a request for parole. [2]
In general, an immigration officer may order a medical examination of an applicant at any time, if the officer is concerned that the applicant may be medically inadmissible. [3] This rule applies regardless of the type of immigration benefit sought, or whether the applicant is applying for a visa, seeking entry at a U.S. port-of-entry, or already in the United States.
A civil surgeon in the United States can only perform a medical examination for purposes of a benefits application processed within the United States. Similarly, a panel physician abroad can generally only perform a medical examination for purposes of a visa application processed outside the United States. There are limited exceptions where an applicant seeking a benefit application inside the United States does not have to repeat a medical examination performed by a panel physician. The following chart highlights the benefits that require a medical examination and vaccinations, and whether a civil surgeon or panel physician should conduct the medical examination. [4]
Panel Physician or Civil Surgeon
Immigrant visa applicants, applying with U.S. Department of State (DOS)
Adjustment applicants (other than exceptions noted elsewhere in this table)
Nonimmigrant visa applicants, applying with DOS; and nonimmigrants seeking change/extension of status while in the United States [5]
No (with some exceptions) [6]
Temporary Protected Status (TPS) applicants [7]
No (with some exceptions) [8]
K or V visa applicants, applying with DOS [9]
Nonimmigrant seeking change of status to V status [10]
K or V nonimmigrants applying for adjustment of status in the United States [11]
May be required [12]
Panel physician and/or civil surgeon
Refugee applicants, including principal and derivative applicants overseas [13]
Applicants seeking derivative refugee or derivative asylee status while in the United States [14]
Principal asylum applicants in the United States [15]
Applicants seeking derivative asylee status with DOS [16]
Refugee-based adjustment applicants [17]
May be required [18]
Civil surgeon [19]
Asylees applying for adjustment of status [20]
May be required [21]
Kurdish asylees paroled under Operation Pacific Haven applying for adjustment of status
Panel physician or civil surgeon
North American Indians entering the United States [22]
Children of returning residents entering the United States [23] or children of U.S. nationals
Internationally adopted orphans [24]
In general, nonimmigrant visa applicants, nonimmigrants seeking change or extension of status, and Temporary Protected Status (TPS) applicants are only medically examined if the consular officer or immigration officer has concerns as to the applicant’s inadmissibility on health-related grounds. Customs and Border Protection (CBP) officers at ports-of-entry may also require a nonimmigrant arriving with or without a visa to submit to a medical examination to determine whether a medical ground of inadmissibility applies.
While the consular officer may encourage compliance, the consular officer cannot deny a K or V visa for lack of compliance with the vaccination requirements.
Some panel physicians may perform the vaccination assessment in anticipation of the applicant’s later adjustment of status application.
For nonimmigrants applying for change of status to V status, the civil surgeon may perform the vaccination assessment in anticipation of the applicant’s later adjustment of status application.
K and V nonimmigrants applying for adjustment of status are not required to repeat the medical examination if the application was filed within one year of the date of the original medical examination, and:
If a new medical examination is required and reveals a Class A medical condition, a new waiver application will also be required. In such cases, the officer should determine whether the applicant complied with the terms and conditions of the first waiver, if applicable. Such determination should be given considerable weight in the adjudication of a subsequent waiver application. [29]
Even if a new medical examination is not required, applicants must still comply with the vaccination requirements if the vaccination record was not included as part of the original medical examination report. If the vaccination report was properly completed at the time of the overseas examination, the officer may accept the vaccination assessment completed by the panel physician.
An applicant’s overseas medical examination report completed by a panel physician should already be in the applicant’s A-file. If it is not in the A-file, the officer should request the medical examination report through a Request for Evidence (RFE).
If the applicant was granted a change of status to V in the United States, [30] the medical examination report completed by the civil surgeon should be in the A-file created at the time that the change of status was initially granted.
By regulation, refugees applying for adjustment of status generally do not need to repeat the entire medical examination if the applicant was already examined by a panel physician for purposes of admission to the United States. [32] Refugees must undergo an additional medical examination only if the original examination by the panel physician revealed a Class A medical condition.
Family members granted refugee status in the United States must submit to a medical examination at the time they seek to adjust their status.
All refugees must comply with the vaccination requirements at the time of adjustment of status by submitting the relevant parts of the Report of Immigration Medical Examination and Vaccination Record (Form I-693) completed by a designated civil surgeon. A prior vaccination assessment performed by the panel physician cannot be used for purposes of the adjustment of status application. [33]
USCIS granted a blanket civil surgeon designation to state and local health department physicians for the limited purpose of completing the vaccination record for refugees applying for adjustment of status.
All asylees are required to undergo an immigration medical exam, including vaccination assessment, at time of adjustment. [34]
However, according to USCIS policy developed in consultation with the Centers for Disease Control and Prevention, an asylee dependent who had a medical examination conducted overseas is not required to undergo a new medical exam when applying for adjustment of status if:
Even if an asylee dependent may use the result of the previous examination, he or she must still establish compliance with the vaccination requirements and submit the vaccination assessment with his or her adjustment of status application. This requirement applies even if the applicant had a vaccination assessment completed overseas by a panel physician. To comply with the requirement, the applicant must have the relevant parts of Form I-693 completed by the civil surgeon.
Afghan nationals who arrived in the United States under Operation Allies Welcome (OAW) [35] and completed an immigration medical examination abroad are not required to repeat the immigration medical examination when applying for adjustment of status if:
For children of returning residents entering the United States, as long as the parent’s visa is valid or the parent is a U.S. resident or U.S. national, there are no medical examination or vaccination requirements.
Children of returning residents entering the United States are:
Children 10 years of age or younger who are classified as orphans and who are applying for IR-3 and IR-4 (orphans) and IH-3 and IH-4 (Hague Convention adoptees) visas are not required to comply with the vaccination requirements before admission to the United States. [38]
[^ 1] Based on the conditions listed in INA 212(a)(1).
[^ 4] Special considerations that apply to certain benefit types are noted in Section B, Special Considerations [8 USCIS-PM B.3(B)].
[^ 6] See Section B, Special Considerations [8 USCIS-PM B.3(B)].
[^ 8] See Section B, Special Considerations [8 USCIS-PM B.3(B)].
[^ 12] See Section B, Special Considerations [8 USCIS-PM B.3(B)].
[^ 18] See Section B, Special Considerations [8 USCIS-PM B.3(B)].
[^ 19] Including state or local health department physicians, who are blanket designated by USCIS as civil surgeons for purposes of completing the vaccination record for refugees adjusting status only.
[^ 21] See Section B, Special Considerations [8 USCIS-PM B.3(B)].
[^ 22] See 8 CFR 289.1 and 8 CFR 289.2. American Indians born in Canada who meet the regulatory requirements may be regarded as having been admitted for lawful permanent residence. Because neither an immigrant visa nor an adjustment of status application is required, the applicant is not required to comply with the medical examination and vaccination requirements.
[^ 24] See INA 101(b)(1)(F), including Hague Convention adoptees.
[^25] On August 29, 2021, President Biden directed DHS to lead implementation of ongoing efforts across the federal government to support vulnerable Afghan nationals, including those who worked alongside the U.S. Government in Afghanistan for the past 2 decades, as they safely resettled in the United States. These coordinated efforts were initially referred to as Operation Allies Refuge, and the operation has since been renamed Operation Allies Welcome (OAW). See the DHS OAW webpage.
[^ 26] See INA 214. See 8 CFR 214.2(k) and 8 CFR 214.15. See 9 FAM 302.2-3(A), Medical Examinations – Medical Examination for Fiancé(e)s.
[^ 29] See Volume 9, Waivers and Other Forms of Reliefs, Part D, Health-Related Grounds of Inadmissibility [9 USCIS-PM D] for more information on medical waivers.
[^35] On August 29, 2021, President Biden directed DHS to lead implementation of ongoing efforts across the federal government to support vulnerable Afghan nationals, including those who worked alongside the U.S. Government in Afghanistan for the past 2 decades, as they safely resettled in the United States. These coordinated efforts were initially referred to as Operation Allies Refuge, and the operation has since been renamed Operation Allies Welcome (OAW). See the DHS OAW webpage.
[^ 37] See INA 101(b)(1)(F). See Chapter 9, Vaccination Requirement, Section G, Exception for Certain Adopted Children [8 USCIS-PM B.9(G)] for more on this exception.
[^ 38] See INA 212(a)(1)(C), as amended by Section 2 of the International Adoption Simplification Act, Pub. L. 111-287 (PDF), 124 Stat. 3058, 3058 (November 30, 2010).