Medical Exam Requirements and Questions When Applying for a Green Card

By Elizabeth M. Klarin

February 8, 2023 | Immigration Blog

To immigrate to the U.S., an essential requirement is that would-be immigrants have received a series of vaccines in order to qualify for permanent residence. 
What vaccines are required for U.S. immigration?
This issue has become a hot-button one lately, after USCIS added the COVID-19 shot to the list of required vaccines for U.S. immigration eligibility in 2021. Other vaccines required for immigration include Hepatitis A, Hepatitis B, Influenza, Influenza type b (Hib), Measles, Meningococcal, Mumps, Pneumococcal pneumonia, Pertussis, Polio, Rotavirus, Rubella, Tetanus and diphtheria toxoids, and Varicella.
Can I get a waiver of vaccination requirements?
In certain cases, vaccines may be determined to be “not medically appropriate;” where this is the case, a blanket waiver of inadmissibility is granted. Conditions where vaccines are considered “not medically appropriate” include where vaccines are not age appropriate; cannot be administered because of a medical contraindication (life-threatening condition or issue if the vaccine is given); administered as a series in intervals, but there is insufficient time to complete the entire vaccination series at the time of the medical examination; and in the case of the influenza vaccine, where it is not the flu season, or if the vaccine for the specific flu strain missing is no longer available. Pregnancy or having an immune-compromised condition can also result in a blanket waiver from certain vaccine requirements. A blanket waiver may also be granted where a vaccine is not routinely available, or there is a nationwide shortage or limited supply of a certain vaccine at the time of the medical exam.
A civil surgeon or U.S-approved panel physician will assess at the time of an individual’s required medical exam for immigration purposes whether a vaccine is not medically appropriate, and U.S. government agencies have been instructed to accept this assessment from the medical doctor “unless that finding is clearly wrong.”
What if I did not get the COVID-19 vaccine, or do not want to get it?
The COVID-19 vaccine is, like the other vaccines listed above, required to qualify for U.S. permanent residence. The only way around this is to submit a request for an exemption from this requirement. In this case, you would need to clearly demonstrate that you are opposed to vaccinations in any form, and your objection is based on sincerely held religious beliefs or moral convictions. In cases where objection to all vaccination has come later in life, this may be more difficult to show than for someone who has never received any vaccines. 
What if I don’t have my vaccine records, or cannot obtain them?
You should bring whatever records you do have with you to your medical exam. If you cannot obtain records of some or all of your prior vaccinations, your private healthcare provider may be able to test to see whether you are immune to one or more vaccine-preventable diseases. If you have written evidence of immunity, you should take this documentation to your civil surgeon or panel physician at the time of your medical exam for immigration purposes. This will enable the civil surgeon or panel physician to determine which vaccines you need to receive.
If you refuse to receive the vaccines required for immigration purposes, and do not qualify for a waiver of the vaccination requirement, your application for legal permanent resident status may be denied.
When should I obtain a medical exam?
Over the past few years, many Green Card applicants have chosen not to have their medical exam done at or immediately preceding the time of filing for adjustment of status, since USCIS and Department of State processing is taking so long that they feared their medical exam results might not be valid by the time their case is processed. 
Form I-693 is only valid for 2 years from the date of the civil surgeon's or panel physician’s signature attesting to an individual’s medical history and eligibility for permanent residence; if the Green Card application is not completed within the completed I-693’s 2-year validity, applicants are required to submit a new Form I-693 (Report of Medical Examination and Vaccination Record). This takes additional time and also costs an additional fee for the applicant (or applicants, if there are multiple related family members). For this reason, many applicants have been waiting to receive a request for the medical exam results from USCIS, indicating that USCIS is actively in the process of adjudicating their case, before completing this step. Applicants appearing for immigrant visa interviews at a U.S. Consulate or Embassy also have chosen to wait until their interview date is confirmed before obtaining the required medical exam.
However, for those applying to adjust their status to permanent resident from within the U.S., USCIS has stated that it is expanding potential interview waivers in family-based adjustment of status applications—and that approval might come quicker and/or without an interview for applicants whose medical exam results are already on file when their application for adjustment of status is being adjudicated. For this reason, many applicants for adjustment of status are obtaining their medical exam result to submit with their initial application.
What other issues and concerns are coming up with medical exams?
For more information on this topic, please contact Elizabeth Klarin; (, 716.853.5100, ext. 1288) or a member of the Lippes Mathias Immigration practice team.

This article was originally published by The Lawyer’s Daily (, part of LexisNexis Canada Inc.

Disclaimer: The information in this post is provided for general informational purposes only, and may not reflect the current law in your jurisdiction. No information contained in this post should be construed as legal advice from our firm or the individual author, nor is it intended to be a substitute for legal counsel on any subject matter. No reader of this post should act or refrain from acting on the basis of any information included in, or accessible through, this post without seeking the appropriate legal or other professional advice on the particular facts and circumstances at issue from a lawyer licensed in the recipient’s state, country or other appropriate licensing jurisdiction.

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