What Every Attorney Should Know About the Immigration Medical Exam

Posted: Mar 15th, 2019 at 03:41PM - by Jonathan Baktari MD/President & CEO

What Every Attorney Should Know About the Immigration Medical Exam

Immigration Attorney’s help their clients in many ways during the application process. One aspect of that process is the Medical Exam required by USCIS. As you already know, there is a feature on USCIS.gov to find a civil surgeon by zip code to refer your client to. But if your clients ask you specific questions about the exam and the process, are you knowledgeable enough to confidently answer their questions? I am going to discuss what every Immigration Attorney should know regarding the Medical Exam.

How to Help Your Clients Prepare for the Exam

If it could be so simple as to tell your clients to just find a civil surgeon, that would be nice! Unfortunately, it isn’t that simple. But if you just give them a few more pieces of advice, trust me, it may pay off big time. You will find key points in each.

1) What your client should expect during the medical exam:

The medical exam for Immigration consists of the physical examination, laboratory tests, and vaccinations.

During the physical examination, the Clinician will review the applicant’s medical history and physically examine the patient. The exam has a focus of looking for physical or mental disorders and communicable diseases.

The laboratory tests include tests for Tuberculosis, Syphilis, and Gonorrhea.

The Tuberculosis Test

There are two types of Tuberculosis tests that Immigration will accept. There is a blood test for Tuberculosis and a TB skin test. When looking for a Civil Surgeon to refer your clients to, it is beneficial to find one that offers the blood test for Tuberculosis.

    • The TB skin test is a small injection into the applicant’s arm of a pure protein derivative. If the patient has been exposed to Tuberculosis, the skin will develop a reaction in most cases. The applicant must return to have the arm checked specifically 48-72 hours after the injection was administered.
    • Quantiferon (also known as IGRA test) is a blood test for Tuberculosis. The benefit of this test for your applicants is that it does not require the applicant to return to the office in 48-72 hours like the skin test dose. The other benefit of this test is that it is not affected by a common vaccination given in countries outside of the USA called BCG. That vaccination can cause the skin test to be abnormal-resulting in the applicant then needing a follow-up chest x-ray. If an applicant has a Quantiferon blood test instead, it will reduce their chances of needing a chest x-ray and the additional cost and delay of results.

If either the TB skin test or Quantiferon is abnormal, a chest x-ray is required by immigration. This is to check for signs of active contagious Tuberculosis in the lungs.

KEY POINT: I recommend finding a civil surgeon that has the option for the Quantiferon tuberculosis test.

The Syphilis Test

Syphilis is a bacterial infection that is spread sexually and is still a major public health threat. It is tested through a blood test. If an applicant tests positive for Syphilis, they must complete treatment with antibiotics prior to completing the I-693 exam or else will be considered inadmissible. Immigration does not accept rapid (finger stick) syphilis tests that give immediate results. They only accept a sample that is processed by a laboratory.

KEY POINT: Be leery of a Civil Surgeon office that promises exam results same or next day (the acceptable syphilis test is not that instantaneous)

The Gonorrhea Test

Gonorrhea is also a sexually transmitted bacterial infection. Immigration recommends civil surgeons use the most minimally invasive test to detect if this disease is present. This disease can be detected through a urine test or a swab of the genitalia.

KEY POINT: When referring your patients to a Civil Surgeon, recommend they use a Civil Surgeon who does the urine Gonorrhea test so that your clients have the least invasive test.


Immigration requires applicants be up to date with vaccinations based on their age, health information, and previous vaccination records. Many applicants who are unable to obtain vaccination records may also be interested in a Civil Surgeon that can draw a lab test called a Titer. A titer test can check if an applicant is immune from previous vaccination or infection in lieu of the vaccine.

KEY POINT: Recommend your client find a Civil Surgeon that carries the vaccinations in the office and can also do titer testing to check for immunity.

2) Find a Civil Surgeon Location That Does it All

There are several civil surgeons to choose from. What makes one better or different than the other?

One key aspect of that is the convenience to be able to complete all the components of the medical exam at one location. Tell your clients to ask when calling a Civil Surgeon office if they are going to be able to have everything done at that one location. If not, they may end up with a long drawn out process of going from one clinic to another to complete the lab tests, physical examination, vaccinations, etc. The longer and more complex this process gets, the less happy your clients will be.

KEY POINT: Tell your clients to ask when they call a Civil Surgeon office the following questions:

      • Do you do the laboratory tests at your location or send me to another place?
      • Do you carry all the vaccinations that Immigration requires at your office or send me somewhere else?

Prepare records and forms for the medical exam.

Applicants may ask you what type of records or forms they should prepare to have for their medical exam. It is helpful for the applicants to have the following:

      • Government Issued Photo ID: such as a license, passport or other government-issued ID that includes a photo. This should be valid and non-expired. This ID is brought to their medical exam appointment for the Civil Surgeon to ensure the identity is correct of the patient.
      • Vaccination records: To help minimize the vaccinations required for applicants, it is useful to have a previous vaccination record. Sometimes, this is difficult to obtain and if it cannot be obtained that is okay. If one does have a vaccination record, it must be in English. If it is in a foreign language, your client may have that translated by an Official Translator before their medical exam appointment before it can be used.
      • I-693 Form: This is the form that Immigration requires for the medical examination. It is 13 pages in length. If the applicant would like to fill it out before their appointment, make sure to tell them to either type it or use all capital letters and black ink so that it is legible. The applicant should not sign or date the form until the Civil Surgeon directs them to.

Other records that may apply:

      • Proof of treatment of diseases that Immigration tests for if the applicant has tested positive and had treatment in the past. This would include if someone was treated for Syphilis or for Tuberculosis.
      • Proof of pregnancy if the applicant is currently pregnant

KEY POINT: Make sure the most current edition of the I-693 form is used. It can be found on uscis.gov under the forms section.