On June 11, 2025, USCIS declared that any Form I-693 medical exam signed on or after November 1, 2023, is valid only for the single immigration case it supports, ending last year’s policy of indefinite reuse.
Framed as a public-health measure, the change requires Green Card applicants who withdraw, are denied or refile to obtain fresh exams, impacting adjustment of status application planning.
Change to medical examination rules
On June 11, 2025, USCIS published revised guidance on the Form I-693, the “Report of Immigration Medical Examination and Vaccination Record.”
Under the new policy, a medical exam signed by a civil surgeon on or after November 1, 2023, remains valid only while the immigration benefit application it accompanies, most commonly Form I-485 for adjustment of status, is pending. If that underlying application is withdrawn or denied, the medical report expires automatically and cannot be recycled in any future filing.
The change reverses course on an earlier update issued on April 4, 2024, which had allowed exams signed on or after November 1, 2023, to be reused indefinitely, even if the related I-485 was later abandoned.
USCIS now states that the broader, open-ended approach “could potentially threaten public health” because it would allow applicants to rely on medical data that might no longer be current by the time a new case is filed. Returning to a single-use model, the agency says, ensures that physicians screen applicants close to the date of adjudication and that communicable disease information reaches the Centers for Disease Control and local public-health departments in real time.
The revised rule applies immediately to every application that was pending on or filed after June 11, 2025. Applicants whose I-693 was signed before November 1, 2023, continue to benefit from the long-standing two-year validity counted from the surgeon’s signature date. Those filings are unaffected unless an officer sees reason to doubt the completeness or accuracy of the older report.
USCIS also retains discretion to demand a fresh I-693 whenever there is evidence, such as a change in medical condition, that could render the earlier exam unreliable.
Impact of the changes
From a practical standpoint, the most affected cohort are adjustment of status applicants who obtained a medical exam after the November 2023 cut-off and subsequently withdrew, were denied or intend to re-file their case. They must now schedule a new examination even if the prior document was completed only months ago.
Routine refile plans, which are popular with employment-based applicants seeking to port to a new job or restart a delayed case, will need to account for the new medical requirement to avoid Requests for Evidence and attendant delays.
Because civil surgeon fees vary widely and appointment slots can be scarce in some regions, applicants should budget additional time and cost into any refiling strategy.
Employers should likewise reassess filing timelines. It may no longer be prudent to obtain a medical exam far in advance of a planned I-485 package. Instead, coordinating the exam so that the surgeon signs shortly before submission will maximize the utility of the report.
Where a long adjudication is expected, some filers may prefer to hold the I-693 until requested, so that its “single-use” shelf life is consumed only once USCIS is actively reviewing the case.
Finally, applicants should note two ancillary developments. First, USCIS will accept only the 01/20/25 edition of Form I-693 for signatures dated on or after July 3, 2025, so any re-examination scheduled this summer must use the correct version.
Second, while rejected forms no longer trigger a need for a fresh medical, an officer may still insist on a new exam if the refusal reason suggests the applicant’s health or vaccination history might have changed.
Author
Founder & Principal Attorney Nita Nicole Upadhye is a recognized leader in the field of US business immigration law, (The Legal 500, Chambers & Partners, Who's Who Legal and AILA) and an experienced and trusted advisor to large multinational corporates through to SMEs. She provides strategic immigration advice and specialist application support to corporations and professionals, entrepreneurs, investors, artists, actors and athletes from across the globe to meet their US-bound talent mobility needs.
Nita is an active public speaker, thought leader, immigration commentator, and immigration policy contributor and regularly hosts training sessions for employers and HR professionals.
