--- title: "Immigration Medical Exam: Which Lab Tests to Expect (and What You Can Check First)" type: guide url: "https://www.test-well.com/guides/immigration-medical-exam-tests" date_published: 2026-07-23 --- # Immigration Medical Exam: Which Lab Tests to Expect (and What You Can Check First) *What the civil surgeon tests for at your green-card medical, what it costs, and how pre-screening the same markers keeps a surprise result from delaying your application.* > The immigration medical exam (Form I-693) must be performed by a USCIS-designated civil surgeon — your own lab results can't substitute. It includes a TB blood test (IGRA, ages 2+), syphilis screening (ages 18–44), gonorrhea screening (ages 18–24), and a vaccination-record review. You can pre-screen the same markers first so a surprise positive doesn't stall your application; TestWell's Immigration Exam Prep Panel covers all three for $159.99. ## Recommended tests | Recommended | Type | Price | Why | | --- | --- | --- | --- | | [Immigration Exam Prep Panel](https://www.test-well.com/tests/immigration-exam-prep-panel) | Panel (3 tests) | $159.99 | All three exam markers in one order | | [Tuberculosis (TB) Blood Test](https://www.test-well.com/tests/tuberculosis-blood-test) | Test | $91.99 | The make-or-break marker — test it first | | [Syphilis Test with Confirmation](https://www.test-well.com/tests/syphilis-test) | Test | $39.99 | Screened at the exam for ages 18–44 | | [Chlamydia & Gonorrhea (RNA, Urine)](https://www.test-well.com/tests/chlamydia-gonorrhea) | Test | $52.99 | Gonorrhea is screened for ages 18–24 | | [Hepatitis Panel (A, B, C)](https://www.test-well.com/tests/hepatitis-panel) | Test | $69.99 | Not exam-required, but smart to know | | [MMR Immunity Test (Measles, Mumps, Rubella)](https://www.test-well.com/tests/mmr-immunity-test) | Test | $289.99 | Prove vaccinations without records | All prices are cash-pay plus one $6 lab processing fee per order; physician authorization is included. ## How the Immigration Medical Exam Actually Works 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. ## Why Pre-Screening Before the Exam Is Worth It 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. ## The TB Test: What BCG-Vaccinated Applicants Need to Know 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 two methods are compared in depth in [TB blood test vs. skin test](https://www.test-well.com/guides/tb-blood-test-vs-skin-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. ## Vaccination Records: The Other Half of the Exam 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](https://www.test-well.com/guides/titer-tests-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. ## Frequently asked questions ### Can I use my own lab results for the I-693 immigration medical exam? No. The civil surgeon must order the required tests under their own direction as part of the exam — that's a USCIS/CDC requirement, not a TestWell limitation. Self-ordered results are for your own knowledge and preparation: they tell you in advance what the civil surgeon's tests will find, and you can share them at your appointment so your history is documented. ### What happens if I test positive for TB at the immigration exam? A positive IGRA blood test triggers a chest X-ray to look for signs of active TB. If the X-ray is clear, the likely conclusion is latent TB infection — not contagious, not disqualifying, but the civil surgeon documents it and may require you to complete or begin treatment depending on the findings. The practical cost is time: weeks to months of follow-up in the middle of your application. That delay is exactly what pre-screening lets you avoid. ### How much does the immigration medical exam cost in 2026? Civil surgeons set their own fees — typically $200–$500, sometimes more in large metros, and usually excluding follow-up tests, X-rays, or vaccines. Pre-screening the three lab markers with TestWell is $159.99, and knowing your results first helps you avoid paying for a second civil-surgeon visit after a surprise finding. ### I had the BCG vaccine — will it make my immigration TB test positive? No. The IGRA blood test (QuantiFERON) used for immigration screening is not affected by BCG vaccination. If you've previously had a positive TB skin test, that was likely a BCG-related false positive — the blood test is how you find out your true status. ### Do I need syphilis and gonorrhea testing for a green card? It depends on your age at the time of the exam: syphilis screening is required for applicants 18–44, and gonorrhea screening for applicants 18–24. Both are treatable with antibiotics, and a treated infection doesn't make you inadmissible — but an active untreated one found at the exam means treatment and re-documentation before your I-693 can be completed. ### Can TestWell do my vaccinations too? We don't administer vaccines — we do the lab side: titer tests that prove existing immunity (MMR, varicella, hepatitis B) so you may not need to be revaccinated at all. If a titer shows you're not immune, any pharmacy or clinic can administer the vaccine, and the civil surgeon documents it. ## Sources - [USCIS — Form I-693, Report of Immigration Medical Examination and Vaccination Record](https://www.uscis.gov/i-693) - [CDC — Technical Instructions for Civil Surgeons](https://www.cdc.gov/immigrant-refugee-health/hcp/civil-surgeons/index.html) - [CDC — Testing for Tuberculosis](https://www.cdc.gov/tb/testing/index.html) --- Canonical page: https://www.test-well.com/guides/immigration-medical-exam-tests Machine-readable catalog: https://www.test-well.com/api/catalog.json · MCP server: https://www.test-well.com/mcp · Overview for agents: https://www.test-well.com/llms.txt Prices are cash-pay, in USD, and include physician authorization; every order adds one flat $6 lab processing fee. Educational content is not a diagnosis — discuss results with a clinician.