Immigration Exams

The last step of the immigration process for those seeking a Green Card is the medical examination. It is required for all members of a family seeking a family-based Green Card. The exam can only be completed by a government-authorized doctor, approved by the Office of Homeland Security, and there are several parts of the exam. These include:

• Medical history and immunization records review
• Physical and mental evaluation
• Screening for drug and alcohol
• A variety of diseases and illnesses tests

The results of the Green Card medical exam are to assess whether or not the person (or relative) seeking the Green Card is admissible, or inadmissible to the United States based on a set of requirements. If the person fails the green card medical exam, then they’re not eligible to receive the green card.

It is advisable to learn about the medical exam process in order to know what to expect and to be better prepared. This will help to avoid delays and reduce the risk of denial. We know that the entire green card process for immigrants can be quite stressful. Preparation helps to eliminate the unknown and therefore reduce the stress associated with the process.

We have prepared a guide to help you become informed about each stage of the green card medical exam process, including before, during, and after.

Before the Exam

What doctor can I use in New York City (also inquire about Florida?

Dr. Marina  Gafanovich’s medical practice is civil surgeon designated by U.S. Citizenship and Immigration Services, so we can only schedule appoints for those physically in the United States, more specifically in New York City

• If you’re applying from abroad, you will see a panel physician authorized by the U.S. Department of State.

When and how do I schedule the exam?

Simply click on the SCHEDULE A CONSULTATION 

IF YOU’RE APPLYING FROM WITHIN THE UNITED STATES

When to schedule: You have two options as far as when to schedule your appointment:

1. Schedule it before you begin the green card application process. In this case, you would submit your medical exam results with your application package (including all government forms and supporting documents). This process is known as “concurrent filing.” You are not required to do it this way.

IMPORTANT: If you choose to include the medical exam results with your green card application, the medical exam results form, I-693 (more information about this form below) must be signed by a civil surgeon no more than 60 days before the green card application (Form I-485) is submitted. If the doctor signed the form more than 60 days before you submitted your green card application, then you should rather hold on to it and send it after you’ve filed the green card application or bring it to the interview. That way, you wouldn’t have to repeat the medical exam. The medical results form is valid for two years, so an applicant should make sure to send it or bring it to the interview before the two-year expiration.

2. Schedule it after filing your green card application package. In this case, you can either send your medical exam results to USCIS soon after submitting your green card application (Form I-485) or bring the results with you to your green card interview. If choosing this option, the results are valid for four years from when the doctor signed the form. Note the validity period is usually two years, but USCIS has temporarily extended the validity to four years to account for COVID-19 processing delays.

IF YOU’RE APPLYING FOR A GREEN CARD FROM ABROAD

When to schedule: You may schedule your medical exam only once you’ve received your green card interview appointment letter from the National Visa Center (NVC), which is part of the State Department that processes green card applications for relatives living abroad. The State Department explicitly instructs family members seeking a green card from abroad not to schedule their medical exam until they’re notified of their green card interview date.

How to schedule: Far in advance of receiving your appointment letter, search for your U.S. embassy or consulate, which provides instructions for the medical exam, as well as contact information on authorized doctors in each country. You will need to select a doctor yourself (the NVC will not assign one to you). It’s generally best to set up your appointment as soon as you receive an interview appointment date from the NVC.

When you schedule your appointment, make sure to let the doctor’s office know that you seek a medical exam to immigrate to the United States.

The exam results will be valid for six months (unless the relative seeking a green card has certain medical conditions, in which case the exam results could expire in three months).

What should I bring to my exam?

To ensure that the medical exam goes smoothly, it is suggested that you have all your documents gathered before the appointment, and bring the following:

• Bring a copy of your medical history
• Bring a copy of any previous  chest X-rays
• Bring your immunization or vaccination records
• Bring a letter from your doctor for any medical treatment plan you follow
• A government-issued photo ID; this can be your passport, driver’s license, state ID, a travel or work permit
• Payment for the medical exam
• Bring Form I-693 (Report of Medica Examination and Vaccination Record)
• (if you do not have it, we can provide one at the office, but prefer you bring it with your portion completed)

During the Exam

The green card medical exam or immigration physical is an evaluation by the civil surgeon accredited physician to determine if an applicant poses a public health risk. The doctor will inquire about your health, both general and specific questions, as well as review your medical and immunization records.

The exam shall also include the doctor screening for specific conditions within these categories :

• Communicable diseases (tuberculosis, syphilis, and gonorrhea, for example)
• Drug abuse and/or addiction
• Disorders (physical or mental) that are associated with harmful behavior

To accomplish the above, here is a list of the test to be conducted:

Tuberculosis test

Civil surgeons in the United States and panel physicians abroad follow different tuberculosis testing guidelines from the Centers for Disease Control and Prevention (CDC):

IF YOU’RE APPLYING FROM WITHIN THE UNITED STATES

Dr. Marina Gafanovich, M.D. uses the Tuberculosis Technical Instructions for Civil Surgeons. Currently, this requires a test called the “interferon gamma release assay” (IGRA) for all green card applicants aged 2 and older. You will not have to return to the doctor’s office to obtain the IGRA results unless your IGRA results reveal tuberculosis signs or symptoms. IN such case,  you’ll be required to return  to get a chest X-ray and undergo further testing. (Dr. Gafanovich doesn’t provide exams abroad, only within the United States, at her office in New York City).

IMPORTANT: As of October 1, 2018, the IGRA is the only acceptable tuberculosis test for all green card applicants within the United States. Dr. Gafanovich complies with the  CDC’s updated guidance to ensure you receive the right kind of tuberculosis test.

Blood and urine tests

Dr. Gafanovich is required to perform a blood test for syphilis and a urine test for gonorrhea on all green card applicants aged 15 and older.

Vaccination screening

In case your lost your immunity, Dr. Gafanovich will offer you the missing vaccination necessary to complete the requirements for an additional fee associated with each vaccine. We encourage you to have an updated vaccination record including the date of your last Td or TDAP vaccine and COVID card.

Dr. Gafanovich makes sure that you’ve received all required vaccines. If you’re missing any, you’ll be required to obtain these before you attend your green card interview, but the doctor will offer you the missing vaccination necessary to complete the requirements (for an additional fee associated with each vaccine). during your medical exam, which includes:

• MMR
• Hepatitis B
• Varicella
• Hepatitis A
• Mumps
• Measles
• Rubella
• Polio
• Tetanus and Diphtheria Toxoids
• Pertussis
• Haemophilus influenza type B
• Seasonal flu vaccine (only if your appointment is during the yearly flu season of October 1 to March 31)
• COVID-19

IMPORTANT: USCIS now requires green card applicants to show proof of a COVID-19 vaccination for the medical exam.

Drug and alcohol screening

During the exam, you will need to provide a urine sample, which would be sent out to the laboratory to be screened for the presence of drugs and alcohol. The average turnaround time to complete the form and receive the required blood and urine tests are within 7 business days.

During the first visit, the patient will be evaluated by the doctor and submit all necessary documents as well as blood and urine tests. If no further vaccination is necessary, the office will contact the patient to pick up the completed form in the sealed envelope within a week.

If any further vaccination is necessary, the office will contact the patient and offer the missing vaccination and complete the form and give the sealed envelope at the time of the second patient visit.

Post Exam

You’ll be required to sign the form once the exam is complete. USCIS will not accept unsigned forms. The doctor will provide your medical exam results in a sealed envelope within 7 days (do not break the seal or open the envelope) unless you’re instructed to return to the doctor’s office for additional vaccinations. A copy of the results will be provided for you to review, and retain for your own records.

Important Information for Women

Female applicants must complete the medical exam even if they are having a menstrual period. Any woman who is pregnant may also be required to have a chest X-ray, However, you must provide prior consent to the doctor so that additional protection can be provided during the procedure. If you’re pregnant, you can postpone the X-ray until after birth. However, the X-ray must be performed before the green card application (I-485) can be completed.

Reasons for Health-Related Denial

It is the responsibility of Dr. Gafanovich that the applicant doesn’t pose any health threat to United States residents.  Denial of the applicant’s medical approval can include:

• Communicable diseases: If you have gonorrhea, leprosy, syphilis, or tuberculosis, that is active, untreated, and infectious you will be unable to get a green card until the disease has been treated and/or cured.
• Drug and alcohol abuse: You might be asked to take a drug test and/or certify that you have completed a drug treatment program if you have a history of drug abuse, You will not be allowed to get a green card if you’re currently abusing prescription drugs, illegal drugs, or alcohol.
• Mental illness with history or threat of violence: You may have trouble getting a green card if you have a mental illness that has caused you to be violent in the past or is associated with violence, either against yourself or others, Drunk driving is considered within this category according to USCIS policy.
• Inability to work: Poor health that inhibits or prevents you from supporting yourself financially, if determined that likelihood of becoming a “public charge,” may result in denial of a green card.

The U.S. Department of Homeland Security (DHS), however, has proposed changes to the “Public Charge” rule that could potentially expand the scope of the medical exam and tighten the standards for scrutinizing green card, visa, and U.S. citizenship applicants with medical conditions.

Preventing or Challenging Health-Related Denial

Health-related denials would not be a result of:

• Common cold during the medical exam.
• A well-managed disease, such as diabetes or heart disease, even if chronic
• HIV-positivity, and/or,
• Been cured of a previous  communicable diseases

It’s important to show USCIS or the State Department that you’ve been treated and cured, or have a health issue under control if 

• you’ve tested positive for gonorrhea, syphilis, leprosy, or tuberculosis in the past:  
• have any history of drug abuse or mental illness and that your drug addiction has been treated or that your mental health is under control.
• how your disease is controlled and how your life is affected — including how your illness impacts your ability to work if at all f you have any other potentially serious disease.

NOTE: If you’re denied for health-related reasons, you can apply for a “waiver of inadmissibility” (basically, “forgiveness” from the U.S. government in order to enter the United States). In such an instance, the USCIS will generally consult with the CDC to determine if a waiver should be granted, and if so, what conditions, if any,  should be attached to said waiver.