I-485 Medical Exam Rules: File Form I-693 Up Front or Risk Rejection

The immigration medical exam is no longer the piece of an adjustment-of-status case you can hand in later. USCIS now requires Form I-693, the Report of Immigration Medical Examination and Vaccination Record, to be filed at the same time as Form I-485 — and a package submitted without it can be rejected at intake before any officer looks at the merits.

Brian Burke, an attorney at Shihab Burke, LLC, in Dublin, Ohio, walked through the rule in a June 2026 broadcast on the firm’s channel titled “Employment-Based Adjustment of Status: A Survival Guide.”

For years, applicants routinely filed the I-485 first and supplied the I-693 in response to a Request for Evidence months later. USCIS ended that on December 2, 2024, mandating concurrent filing for nearly every adjustment applicant. The stated goal was to cut the RFE backlog the missing exams were generating. The practical effect is that the civil surgeon appointment now sits on the critical path to filing, not after it.

The exam’s shelf life has moved twice in the other direction. A Form I-693 signed by a civil surgeon on or after November 1, 2023 was, under an April 2024 policy, valid indefinitely and reusable across future benefit applications. USCIS reversed course on June 11, 2025, deciding that the indefinite-reuse rule was overly broad and a potential public-health risk. Under the current policy, a properly signed I-693 is valid only while the specific application it was filed with is pending.

That distinction matters more now than it did a few years ago, because adjustment denials are more common. The May 21, 2026 USCIS discretion memo reframed adjustment as an “extraordinary” benefit officers can decline, and a denial does not just end the case — it burns the medical exam attached to it. An applicant who has to refile starts over with a fresh civil surgeon appointment.

Where the rule reduces to a single sequence:

• A Form I-693 signed on or after November 1, 2023 must be filed with the I-485, not after it.
• It remains valid as long as that I-485 is pending — no separate expiration clock.
• If the I-485 is withdrawn or denied, the exam is dead. A future filing needs a new I-693.

None of this means the RFE has disappeared. Officers are still issuing medical exam RFEs on cases filed under the older rules and on filings with vaccination or signature gaps, so a concurrently filed exam is not a guarantee the question will never come up.

One operational note for anyone using the online I-485: USCIS asks filers to open the sealed civil surgeon envelope to upload the exam, but the original sealed copy should be kept and brought to the interview. With nearly every adjustment applicant now interviewed, the originals are still part of the file the officer expects to see — and with cases running long, the smart move is to schedule the exam early, file it inside the package, and keep the paperwork intact until the green card is in hand.