Immigration Medical Exam: Which Lab Tests to Expect (and What You Can Check First)

If you're applying for a green card from inside the US (adjustment of status), USCIS requires a medical examination documented on Form I-693. Only a civil surgeon — a physician specifically designated by USCIS — can perform it. If you're applying from abroad, a panel physician approved by the US embassy does the equivalent exam in your country.

This matters because of what it means for lab testing: you cannot walk in with your own results and have them count as the exam. The civil surgeon orders the required tests under their own direction, and the lab reports results back to them. Any company suggesting you can buy an "official immigration test package" that replaces this is misleading you.

What the civil surgeon evaluates, per the CDC's Technical Instructions:

• Tuberculosis — an IGRA blood test (QuantiFERON or T-SPOT) for every applicant age 2 and older. A positive result triggers a chest X-ray and possible latent-TB evaluation.
• Syphilis — blood screening for applicants 18–44, with confirmatory testing if reactive.
• Gonorrhea — urine screening for applicants 18–24.
• Vaccination records — proof of age-appropriate vaccines (MMR, Tdap, varicella, hepatitis B, flu in season, and others). Missing proof means getting revaccinated or documenting immunity with a blood titer.
• A physical exam and review of your medical history, including mental health and substance-use questions.

The exam typically costs $200–$500+ depending on the civil surgeon (USCIS doesn't regulate the fee), and that usually doesn't include follow-up testing if something comes back positive.

Here's the scenario pre-screening prevents. You've booked your civil surgeon appointment, your I-485 timeline is moving, and the TB blood test comes back positive — something you had no idea about. Now you need a chest X-ray, possibly a latent-TB treatment plan, a follow-up visit, and your I-693 sits unfinished for weeks or months. None of this was avoidable at that point — but knowing in advance would have let you handle it on your own schedule, before it could block anything.

That scenario is far more common than most applicants expect. Roughly a quarter of the world's population carries latent tuberculosis — often acquired in childhood, with zero symptoms — and prevalence is highest in many of the countries green-card applicants come from. A positive result doesn't mean you're sick or contagious, and it doesn't make you inadmissible; latent TB is treatable and civil surgeons handle it routinely. It just takes time — which is exactly what you don't want to discover you need mid-application.

Pre-screening the same three lab markers costs $159.99, takes one lab visit, and gives you CLIA-certified results in 3–5 business days. If everything is negative, you walk into your exam with confidence. If something is positive, you and your doctor address it first — and you can share your results with the civil surgeon so nothing about your history is a surprise.

To be completely clear: our pre-screening panel does not replace the I-693 exam, and the civil surgeon will run their own tests. What you're buying is information and time — the two things that protect an immigration timeline.

Tuberculosis screening is where most exam surprises happen, and it's also where the most confusion lives — especially for the majority of immigrants who received the BCG vaccine as children.

If you were BCG-vaccinated and ever took the old TB skin test (PPD/Mantoux) in the US, there's a good chance it read "positive" — not because you had TB, but because BCG frequently causes false positives on skin tests. This is exactly why immigration screening uses the IGRA blood test (QuantiFERON-TB Gold Plus) instead: it is not affected by BCG vaccination. Many applicants who spent years believing they "test positive for TB" get a clean negative on the blood test.

The blood test also requires just one visit (the skin test requires a return visit 48–72 hours later to be read), and results arrive in 3–5 business days.

If your blood test does come back positive: don't panic. It indicates TB exposure, not active disease. The next steps are a chest X-ray to rule out active TB and a conversation with a doctor about latent-TB treatment, which is typically a course of antibiotics over 3–4 months. Completing (or documenting) that process before your civil surgeon visit turns a timeline-killer into a checkbox.

The second-most-common exam surprise isn't a disease — it's paperwork. The civil surgeon must verify age-appropriate vaccinations (MMR, Tdap, varicella, hepatitis B, and others). If your records are in another country, another language, or lost entirely, you have two options:

• Get revaccinated — safe, but it can mean multiple shots and sometimes multi-dose series spread over weeks.
• Prove immunity with a titer test — a blood test measuring your existing antibodies. If you're immune (most adults who were vaccinated as children are), the titer is your proof, and no shots are needed.

Titers are especially worth it for MMR and varicella, where childhood vaccination or infection makes lasting immunity likely. See our full guide to titer tests and proof of immunity for how each one works, and bring the quantitative results to your civil surgeon appointment.

One honest caveat: for some vaccines (like Tdap), there's no accepted titer substitute and a booster is simply required — a titer won't save you a shot there. Your civil surgeon has the final say on what satisfies the vaccination table.