Do children need an immigration medical exam?

Yes, children generally need an immigration medical examination when they are applying for an immigration benefit that requires medical admissibility screening, including many applications for lawful permanent residence. There is no blanket exemption simply because the applicant is a baby, toddler, or minor.

For a child applying for adjustment of status from inside the United States, the examination must generally be performed by a physician whom U.S. Citizenship and Immigration Services has designated as a civil surgeon. A routine pediatrician’s physical cannot replace the immigration examination unless that physician is also an authorized civil surgeon.

Children completing immigrant visa processing outside the United States normally see a Department of State-designated panel physician instead. Those examinations follow the overseas process and are not ordinarily documented on Form I-693.

What happens during a child’s immigration medical exam?

A pediatric immigration medical exam is focused on the health-related requirements established by U.S. immigration law and the CDC Technical Instructions. It is not intended to replace your child’s regular preventive visits with a pediatrician.

Additional testing is not identical for every child. The child’s age, medical history, symptoms, vaccination documentation, and CDC requirements determine what is needed.

What should parents bring to the appointment?

Arriving with complete records can reduce repeat visits and help the civil surgeon determine whether your child is already up to date.

Vaccination requirements for children

Immigration vaccine requirements are age-specific. A civil surgeon uses the child’s age on the date of the medical evaluation, acceptable vaccination records, laboratory evidence of immunity when permitted, and the current CDC Technical Instructions to determine what is required.

The CDC’s immigration vaccination list includes vaccines protecting against diphtheria, tetanus, pertussis, polio, measles, mumps, rubella, rotavirus, Haemophilus influenzae type b, hepatitis A, hepatitis B, meningococcal disease, varicella, pneumococcal disease, and influenza. However, this does not mean every vaccine on that list is appropriate or required for every child.

Will my child need every immigration vaccine?

No. Required vaccines depend on the child’s age and vaccination history. Some vaccines are limited to infancy or early childhood, while others begin later. A child who has already received valid, age-appropriate doses may not need another dose at the immigration medical exam.

This table provides simplified examples, not an individualized vaccine prescription. Minimum ages, intervals, catch-up schedules, medical precautions, and the child’s documented history can change what is required at the appointment.

Does my child have to finish every multi-dose vaccine series immediately?

Usually not. Vaccine series often require minimum intervals and may take months to complete. If the child is due for a medically appropriate dose, the required dose is generally administered during the immigration medical process. When there is not enough time to complete the series because the next dose is not yet due, the civil surgeon can document the appropriate “insufficient time interval” blanket-waiver reason on Form I-693.

How does the seasonal influenza requirement work?

Influenza vaccination applies to applicants age 6 months and older when the vaccine is available in the United States. When influenza vaccine is unavailable because it is not flu vaccination season, the civil surgeon may document “not flu season” as the applicable blanket-waiver reason. Children younger than 6 months are not required to receive influenza vaccine because it is not age-appropriate.

What if a vaccine is medically contraindicated?

The civil surgeon reviews legitimate contraindications and precautions under current CDC and Advisory Committee on Immunization Practices guidance. When a vaccine should be deferred because of a recognized contraindication or precaution, the physician documents the medical reason on Form I-693. Parents should bring records describing serious vaccine reactions, immune-system conditions, or other relevant medical concerns.

What if my child is already fully vaccinated?

If your child has acceptable written documentation and is up to date for the immigration requirements that apply at their age, the CDC instructions state that no additional vaccine is required at the medical exam.

The civil surgeon must still review the records and transfer the acceptable vaccination history to Form I-693. Records should identify the vaccine and show the full date of administration. A personal vaccine record or a copy of a medical chart completed by a physician or other appropriate medical professional may be accepted if it appears valid and unaltered.

Vaccines received outside the United States may be accepted. The dates and vaccine schedule must be consistent with applicable recommendations, and parents are responsible for providing reliable English translations of non-English records.

What if my child has no vaccination records?

Do not panic, but begin looking for records before the appointment. Under CDC instructions, a parent’s recollection of vaccine doses is generally not enough. Self-reported vaccinations without acceptable written documentation cannot ordinarily be counted.

The child does not necessarily have to restart every vaccine series. The civil surgeon will consider any valid records that are available, determine which doses are currently due, and explain whether immunity testing is a reasonable option.

Can blood tests be used to show immunity?

Sometimes. According to the CDC’s current vaccination instructions for civil surgeons, acceptable laboratory evidence of immunity may be used for:

• Measles
• Mumps
• Rubella
• Hepatitis A
• Hepatitis B
• Polio, when the test documents immunity to all three poliovirus types
• Varicella

The laboratory test must use an acceptable FDA-approved or CLIA-certified method, and the civil surgeon must determine whether the result satisfies CDC requirements. Titers are not a universal substitute for every missing vaccine record.

A reliable history of varicella, commonly called chickenpox, may be accepted without a titer or additional varicella vaccination when it meets the CDC’s verification criteria. The civil surgeon will ask questions about the diagnosis, exposure, or any laboratory confirmation.

Does my child need a TB test?

Every immigration medical exam applicant age 2 years or older must receive an interferon-gamma release assay, commonly called an IGRA, under the current CDC Technical Instructions for civil surgeons. This requirement applies even to young children between ages 2 and 5, although different testing approaches may be used in other pediatric settings.

An IGRA is a blood test that measures the immune response to tuberculosis bacteria. The civil surgeon must use an FDA-approved IGRA. A prior tuberculosis skin test does not replace the required IGRA for an applicant age 2 or older.

A documented previous positive IGRA may be accepted instead of repeating the test when the documentation includes the test date, type of IGRA, results in standard units, interpretation, and identifying information and signature from the testing physician.

The civil surgeon will also ask about previous TB disease or treatment, prolonged cough, fever, night sweats, weight loss or poor growth, and household contact with someone who has or may have had tuberculosis.

What happens if my child’s TB blood test is positive?

A positive IGRA means the child’s immune system has reacted to tuberculosis antigens. It does not, by itself, prove that the child has contagious or active TB disease.

The next required step is a chest X-ray. The civil surgeon also evaluates the child for symptoms and relevant history.

Will my child need a chest X-ray?

No. A chest X-ray is not automatically required for every child receiving an immigration medical exam.

Under current CDC civil-surgeon instructions, a chest X-ray is required when an applicant:

• Has a positive IGRA;
• Has signs or symptoms of tuberculosis disease, regardless of the IGRA result;
• Has known HIV infection, regardless of the IGRA result; or
• Has extrapulmonary tuberculosis.

For children younger than 2, a chest X-ray is required when the child has symptoms suggestive of TB disease or known HIV infection, regardless of the TST or IGRA result.

When a chest X-ray is required, children younger than 10 receive a frontal view and a lateral view under the CDC instructions. Applicants age 10 and older generally receive a standard posteroanterior view, with additional views when clinically appropriate.

What happens during the physical examination?

The physical examination is generally straightforward and age-appropriate. A parent or guardian can help explain the child’s medical history and keep the child comfortable.

The CDC Technical Instructions direct the civil surgeon to perform an examination sufficient to identify relevant Class A or Class B conditions. Depending on the child’s age and circumstances, this may include:

This is not a school sports physical, and it is not designed to diagnose every possible pediatric condition. If the physician notices a health concern unrelated to immigration admissibility, the family may be advised to follow up with the child’s pediatrician or an appropriate specialist.

Can a medical condition cause my child to fail the immigration medical exam?

The immigration medical exam is not simply a general “pass or fail” physical. Its purpose is to identify specific health-related conditions defined by U.S. immigration law and the CDC Technical Instructions.

Health-related inadmissibility concerns can include certain communicable diseases of public health significance, failure to satisfy applicable vaccination requirements, a physical or mental disorder associated with harmful behavior, and drug abuse or addiction.

Ordinary childhood conditions—such as controlled asthma, eczema, food allergies, corrected vision problems, a stable heart condition, diabetes, or a developmental diagnosis—do not automatically make a child inadmissible. A condition may still be documented, classified, or referred for additional information when required, but a diagnosis alone should not be confused with an automatic denial.

How parents can help prevent delays

What happens after the child’s immigration medical exam?

The civil surgeon must wait until all required test results, vaccination determinations, and any necessary referrals are complete. The physician then completes and signs Form I-693, Report of Immigration Medical Examination and Vaccination Record.

The clinic should provide a copy of the completed Form I-693 for your records. CDC instructions also require the applicant to receive a copy of the completed vaccination record.

If you are filing Form I-485 on paper

The completed Form I-693 is normally placed in a sealed envelope. Do not open that envelope. USCIS may reject an unsealed Form I-693 submitted through the paper-filing process. Follow the current USCIS filing instructions and any instructions from your immigration attorney or accredited representative.

If you are filing Form I-485 online

USCIS’s current online-filing instructions state that the applicant must open the civil surgeon’s sealed envelope and upload the completed Form I-693 with the online application package. Keep the original Form I-693 and the envelope until USCIS makes a final decision, because USCIS may request the original or inspect it during an interview.

Under the USCIS policy announced in June 2025, a Form I-693 properly completed and signed by a civil surgeon on or after November 1, 2023, is generally valid only while the application with which it was submitted remains pending. If that application is withdrawn or denied, the medical form generally cannot be reused with a new application.

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