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Immigration Medical Exams

Overview​​

​​The immigration medical exam consists of four components: 

  1. ​Screening test(s) - you will go to the laboratory for blood test(s). Urine testing may also be needed for younger adult applicants. This part may be completed before your appointment.

  2. Vaccination/immunizations - you will need to complete all vaccination requirements deemed necessary by USCIS. Please send us your vaccination records using this secure link. This part may be completed before your appointment.​​

  3. Medical history - this is completed on the day of your immigration exam appointment.

  4. Physical examination - this is completed on the day of your immigration exam appointment.​​​​​​​​​​​​​​​​​​​​​​​​

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What do I need to bring?​

  • ​Please fill out the I-693 form parts 1 through 4 

  • Government-issued photo identification, such as a valid passport or driver’s license.

    • ​Those who are 14 years old or younger: bring identification that shows your name, date and place of birth, and parent’s full name. Possible forms of identification include your birth certificate (with an English translation) or an affidavit.

  • Vaccination/immunization records (please see the section on "which vaccines are required?")

    • You may send vaccination records securely for our civil surgeon to review before your immigration exam appointment.

  • Any past medical documents (labs, imaging, last note from primary care provider and specialists, list of chronic medical conditions, prior surgeries, hospitalizations.

  • All current medications.

  • If you are not fluent in English, you will need to bring an interpreter to your appointment. 

 

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​How much does it cost?​

  • Health insurance plans do not cover these immigration exams because they are considered administrative exams.

  • Per person, the cost of the immigration exam is $250. This includes:

    • Orders for screening lab tests that are required by USCIS. Please note: the screening tests must be ordered by a US Civil Surgeon. Results of testing that was ordered by an outside physician are not accepted for immigration purposes.

    • Immigration medical exam

    • Evaluation of immunizations​

    • Completion of the I-693 form by our physician

    • This does not include the cost of the lab tests or immunizations​​​​​​​​​​​​​​​​​​​​​​​​​​

​What to expect?​

  • ​​​​​​​​​You will need to go to Quest or TriCore to complete the required screening lab test(s).

    • This step may be completed before the immigration exam appointment for those who would like to expedite the process. However, based on the exam, there may be need for additional testing.

    • If this is not completed before the immigration exam, we will order the lab tests on the day of your exam. After your exam, you will go to have your blood drawn, and urine collected (if needed).

  • During your immigration exam appointment, we will gather information about your identity, vaccinations, and medical history.

  • We will also check your weight, height, vital signs, and perform a general physical exam.

  • If you are missing required vaccines, we will let you know which ones you need

    • We do not have vaccinations in our office. You can get vaccines at a nearby pharmacy or a local health department.​

    • After completing the required vaccinations, you may send us the record or receipts securely

  • If you have a chronic medical condition (such as hypertension or diabetes), you may need to get a supporting letter from your primary care doctor or specialist, and they may need to sign part of the I-693 (page 11). This can add extra time depending on how fast you can request this documentation from your doctor. It will help expedite the process if you bring all available records from your PCP with you to your appointment.

  • Lab results are usually available within 5-7 days. When we receive the results, we will review them and contact you if there are any concerns.

    • ​​If your screening tests are abnormal, you may need additional office visits for treatment and follow-up. ​There may be additional costs involved if you need additional treatment or testing. 

  • Once all of your labs results have been received (if normal), and you have received your required vaccinations, you will receive notification when your envelopes are ready for pick up at the office. 

    • You will receive a sealed envelope, and a copy of the completed I-693 form for your records.​​​​​​​​​​​​​​​​​​​​​​​

​How long does it take to get the completed I-693 form?​

  • ​If you complete all of your vaccinations on time, AND all of your lab results are normal, then the process typically takes one week.

  • If you have any abnormal test results or a chronic medical condition, or if you are missing vaccines, the process may take longer.

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Which lab tests are required?​

  • USCIS requires testing for the following:

    • Tuberculosis (blood test) for anyone 2 years and older

    • Syphilis (blood test) for adults ages 18-44

    • Gonorrhea (urine test) for adults ages 18-24

    • Additional labs may be required based on your history and physical exam and results of initial tests

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Which vaccines are required?​​​​​​​​​​​​​​​​​​​​​​​

vaccine requirements.jpg

Vaccination | Technical Instructions for Civil Surgeons | Immigrant and Refugee Health | CDC​

  • For most healthy adults under age 65, the following are required:

    • ​One dose of the Tetanus, Diptheria, and Pertussis (Tdap) vaccine within the last 10 years if you have received primary vaccination series for tetanus, dipthteria, and pertussis.

      • Those who have not completed the primary series will need the dose that is due at the time of the medical exam

        • 3 dose series: 1 dose Tdap, followed by 1 dose Td or Tdap at least 4 weeks later, and a third dose of Td or Tdap 6–12 months later.

    • ​3 doses of the Polio (OPV/IPV) vaccine

      • Adults who have not completed the primary vaccine series will need the dose that is due at the time of the medical exam

        • 3 dose series with at least 4 weeks between Dose 1 and 2 and 6 months between Dose 2 and 3).

      • The last dose of the polio series must be given at age 4 or older.​

  • 2 to 3 doses of the Hepatitis B vaccine. 

    • If you are unvaccinated against Hepatitis B, you will need the dose that is due at the time of the medical exam

      • ​2 dose series Heplisav-B

        • At least 4 weeks between Dose 1 and 2 

      • 3 dose series Engerix-B, PreHevbrio, or RecombivaxHB

        • At least 4 weeks between Dose 1 and 2, 8 weeks between Dose 2 and 3, and 16 weeks between Dose 1 and 3

      • 3 dose series HepA-HepB (Twinrix)

        • At least 4 weeks between Dose 1 and 2, 5 months between Dose 2 and 3, and 6 months between Dose 1 and 3

      • Heplisav-B and PreHevbrio are not recommended in pregnancy due to lack of safety data in pregnant persons

    • If you think you may have received Hep B vaccinations but don’t have your vaccine record, you can request an extra blood test to check for immunity against Hepatitis B (additional cost)

  • 1 dose of the Measles, Mumps, and Rubella (MMR) vaccine. 

    • If you are unvaccinated, you will need to get at least one dose in order to meet the requirement. 

      • If there is a chance you could be pregnant, take a pregnancy test before receiving the MMR vaccine because this is a live vaccine.

    • If you think you received these vaccines but don’t have your vaccine record, you can request an extra blood test to check for immunity against these (additional cost)

  • 2 doses of the varicella (chickenpox) vaccine OR a history of having chickenpox/varicella in the past. 

    • If you are uncertain whether you had chickenpox or got the vaccine, an extra blood test can be done to check for immunity (additional cost)

      • If there is a chance you could be pregnant, take a pregnancy test before receiving the varicella vaccine because this is a live vaccine.

    • If you never had chickenpox and are unvaccinated, you will need the dose that is due at the time of the medical exam

      • If you are over 50, you may be required to have the shingles vaccine, which is a particular version of the varicella vaccine for older adults.​​

  • One dose of the current seasonal influenza vaccine if it is flu season (Sept 1 - March 31).

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  • For adults 65 and older, or adults with chronic health conditions, additional vaccines may be required, including a pneumonia vaccine (PCV20).

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  • For children/teens, the list is much longer and may include vaccines depending on age: DTaP, Polio, Hib, PCV, Rotavirus, Hepatitis A, and Meningococcus.

What if I don’t have any vaccine records?

  • Extra blood tests can be ordered to check for immunity against certain diseases, including hepatitis B, measles, mumps, rubella, and varicella (chickenpox). The Hep B, varicella, and MMR titers

  • For all other vaccines, if you do not have documentation, you will have to receive at least one dose of each vaccine. For certain vaccines, if you do not have proof of completing the childhood vaccination series, you will need the dose that is due at the time of the immigration exam. Please discuss with Dr. Riniker

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What if my records are not in English?

  • For records in any language other than English, you need to pay a professional to provide a certified translated copy and bring this to your first appointment. You can search for these services online.

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Where can I get the vaccines I need?

  • Currently, we do not have vaccinations available in our office. You can get the vaccines at any pharmacy or the public health department.​

  • If you have insurance, most vaccines are covered. If not, you find information on free or discounted vaccines here. Prices range from $50-$200 per vaccine. 

  • ​Be sure to ask for a receipt that includes the name of the vaccine(s), the date of administration, etc.

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What if I object to vaccination?

  • You need to obtain a blanket vaccine waiver through USCIS. You can still complete the medical exam and get the completed I-693 form, but I must check the box: “Applicant will request an individual waiver based on religious or moral convictions.”

    • Whether your waiver is approved by USCIS or not is completely up to USCIS. If your waiver is declined, you may need to pay to complete the process again.​​​

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Cost of labs:

  • The below are approximate costs, and may change based on when you have your exam and which lab you go to as the prices are set by the lab.

  • Varies based on age, risk factors, immunization status. At a minimum the following will be required:

    • Adults ages 18-24: TB, gonorrhea, and syphilis: $160

    • Adults age 25+: TB and syphilis: $110

    • Children ages 2-17:  TB: $80

  • If you have health insurance, they may cover your screening lab tests. You can check with your insurance plan to see if they are covered. Here are the codes you will need:

    • TB Screening: Quantiferon: CPT code: 86480. Diagnosis code Z11.1​

    • Gonorrhea NAA: CPT code 87491, 87591. Diagnosis code Z11.3​

    • Syphilis: CPT code 86593, 86780. Diagnosis code Z11.3

  • If you do not have record of immunizations, you have the option to be tested for titers. Cost ranges from $25 to $300 depending on what immunizations are lacking. ​

    • If you have health insurance, they may cover your screening lab tests. You can check with your insurance plan to see if they are covered. Here are the codes you will need:

      • Hepatitis B titer: CPT code 86704 ; 86706 ; 87340. Diagnosis code: Z11.59

      • MMR titer: CPT codes 86735, 86762, and 86765. Diagnosis code z01.84

      • Varicella titer: CPT code 86787. Diagnosis code Z01.84

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