Applying for a marriage-based green card involves a lot of paperwork, interviews, and waiting. But there is one crucial step that involves needles and a doctor’s visit: the immigration medical exam.
If you are adjusting your status in the United States, you must prove that you don’t pose a health risk to the general public. A major part of this is showing that you have received specific immunizations.
Many applicants get confused about the I-485 vaccinations required by USCIS. Which ones do you need? What if you lost your childhood records? What if you are pregnant?
This comprehensive guide will break down the vaccination requirements for 2026, explain the role of Form I-693, and help you prepare for your appointment so your green card application doesn’t get delayed.
Key Takeaways
- Not Just Any Doctor: You must visit a USCIS-designated “Civil Surgeon” for your exam. Your family doctor usually cannot do this.
- The Form: The doctor records your results on Form I-693.
- The List: Requirements include Mumps, Measles, Rubella, Polio, Tetanus, Hepatitis B, COVID-19, and others depending on your age.
- Missing Records: If you don’t have records, you can get a blood test (titer) or get the shots again.
- Validity: As of current 2026 guidelines, Form I-693 forms signed by a civil surgeon on or after Nov. 1, 2023, do not expire, but must be filed correctly.
Why Are Vaccinations Required for the Green Card?
Under U.S. immigration law, the government wants to ensure that new residents do not carry communicable diseases of “public health significance.”
When you submit your I-485 form (Application to Register Permanent Residence or Adjust Status), USCIS checks for “inadmissibility grounds.” One ground for inadmissibility is health-related. If you refuse required vaccinations without a valid waiver, your green card application will likely be denied.
The list of required vaccines isn’t random. It is determined by the Advisory Committee on Immunization Practices (ACIP) and the Centers for Disease Control and Prevention (CDC).
The Medical Exam and Form I-693
You cannot simply mail in a copy of your vaccination card from your home country. You must undergo a formal medical examination by a designated Civil Surgeon.
What happens at the exam?
- Review of History: The doctor looks at your vaccination records.
- Physical Exam: A basic check-up (eyes, ears, throat, heart, lungs).
- Blood and Urine Tests: Checking for syphilis, gonorrhea, and tuberculosis (TB).
- Vaccinations: If you are missing any I-485 vaccinations required, the doctor will administer them during the visit (for an extra fee) or ask you to get them at a pharmacy and return with proof.
Once the exam is complete, the doctor will fill out Form I-693 (Report of Immigration Medical Examination and Vaccination Record), sign it, seal it in an envelope, and give it to you.
Crucial Rule: DO NOT open the envelope. If the seal is broken, USCIS will reject it.
I-485 Medical Exam - Complete Guide
I-485 Vaccinations Required: The Complete List
The specific vaccines you need depend on your age. However, for most adults applying for a green card, the following vaccinations are standard requirements as of 2026.
According to the CDC and USCIS guidelines, here is the full list:
1. COVID-19
You must be fully vaccinated against COVID-19 with a vaccine authorized for use in the United States or listed for emergency use by the World Health Organization (WHO). This is a mandatory requirement for all eligible applicants.
2. Mumps, Measles, and Rubella (MMR)
Usually given as a combined shot. If you had these as a child, you need proof. If not, you will need the vaccine.
- Note: This is generally not given to pregnant women.
3. Polio (IPV/OPV)
Required for applicants aged 2 months to 17 years. While most adults completed this series as children, the doctor will check your history.
4. Tetanus and Diphtheria Toxoids (Td or Tdap)
You generally need a booster if you haven’t had one in the last 10 years.
5. Pertussis (Whooping Cough)
Usually part of the Tdap shot.
6. Haemophilus influenzae type b (Hib)
Generally required for children up to age 5.
7. Hepatitis B
Required for all applicants from birth through 59 years of age. If you are 60 or older, you may be exempt unless you are at risk.
8. Varicella (Chickenpox)
You need the vaccine unless you have documentation showing you already had it, or if you have a history of varicella disease that the doctor can verify (often through a blood test).
9. Influenza (Flu Shot)
Seasonal Requirement: You are only required to get the flu shot if your medical exam happens during flu season, which is traditionally October 1 through March 31.
- Tip: If you have your exam in July, you don’t need this shot!
10. Pneumococcal Disease
Required for adults 65 and older, and younger adults with certain medical conditions.
11. Rotavirus
Required for infants (6 weeks to 8 months).
12. Hepatitis A
Required for children aged 12 months to 18 years.
13. Meningococcal
Required for applicants aged 11 through 23 years.
Feeling Overwhelmed by the Requirements?
Between finding a Civil Surgeon and gathering documents, the green card process is stressful. Greenbroad makes it simple. We help you organize your entire application package, providing you with a customized document checklist so you know exactly what to bring to your appointment.
What If You Don’t Have Your Vaccination Records?
This is the most common problem our clients face. Perhaps you moved a lot as a child, or records in your home country were lost.
Scenario: Juan grew up in a rural town in Colombia. He knows he got shots as a kid, but the clinic closed years ago. He has no paper records.
If you are like Juan, you have two options:
Option 1: The Titer Test (Antibody Test)
You can ask a doctor to run a blood test called a “titer.” This test measures the level of antibodies in your blood.
- Positive Result: Means you are immune (you had the vaccine or the disease in the past). You do not need the shot.
- Negative Result: Means you are not immune. You must get the vaccine.
Option 2: Get Vaccinated Again
It is generally safe to receive vaccines again if you aren’t sure. Many applicants find it faster and sometimes cheaper to simply get the required shots at a local pharmacy (like CVS or Walgreens) using their health insurance before going to the Civil Surgeon.
Pro Tip: Civil Surgeons often charge high prices for vaccines. Get your shots covered by insurance at a pharmacy first, and bring that proof to your exam.
Special Considerations
Pregnancy
If you are pregnant, you are still required to undergo the medical exam. However, you will not receive “live” vaccines (like MMR or Varicella) as they can harm the baby. The Civil Surgeon will mark these as “Not Medically Appropriate” on your form. You may need to take them after the pregnancy to complete your adjustment of status, though often the waiver for pregnancy is sufficient for the I-485 approval.
Religious or Moral Objections
Can you say no to the I-485 vaccinations required? Technically, yes, but it is extremely difficult. You must file Form I-601 (Application for Waiver of Grounds of Inadmissibility). You have to prove that you are opposed to all vaccinations in any form (not just one specific vaccine) based on sincere religious beliefs or moral convictions.
- Warning: USCIS scrutinizes these waivers heavily. If you plan to refuse vaccines, you should absolutely consult an immigration attorney. Greenbroad does not handle I-601 waivers.
The Ultimate Guide: 35+ Marriage Green Card Interview Tips for 2026
How to Fill I-485: The Medical Exam Section
When you look at an i-485 guide or the form itself, you will see questions about your health. Specifically, Part 8 of the I-485 asks about inadmissibility.
- Question: “Have you ever been… determined to have a communicable disease of public health significance?”
- Answer: For most people, this is “No.”
You do not fill out the medical results on the I-485 form yourself. The I-485 is just your application. The Form I-693 (the sealed envelope) is the proof that you passed the health check.
You have two options for submitting the medical exam:
- Concurrent Filing: Send the sealed I-693 envelope in the same package as your I-485. (Recommended to avoid delays).
- Bring to Interview: Submit the I-485 first, then bring the sealed envelope to your interview.
2026 Costs and Processing
Budgeting for your green card is important. Here is what you can expect regarding the medical exam in 2026.
Civil Surgeon Fees
USCIS does not regulate what doctors charge.
- Average Cost: $200 to $500 for the exam itself.
- Vaccine Costs: Can add another $100–$400 if you don’t use your own insurance at a pharmacy beforehand.
- Lab Tests: Sometimes charged separately.
- Shop Around: Call 3 or 4 doctors from the USCIS “Find a Doctor” list to compare prices.
I-485 Fees
As of 2026, the government filing fee for Form I-485 is generally $1,440. This does not include the cost of the medical exam or the Greenbroad service fee.
Common Mistakes to Avoid
- Going to the Wrong Doctor: We cannot stress this enough—your family doctor (PCP) cannot sign Form I-693 unless they are on the USCIS Civil Surgeon list.
- Opening the Envelope: If you open the envelope the doctor gives you, you just threw away $300+. You must give it to USCIS sealed.
- Forgetting the Flu Shot: If you file in January, you must have a flu shot (or a doctor’s note saying why you can’t).
- Incomplete Records: Don’t assume the doctor “won’t notice” a missing Tetanus shot. They are required to check.
Conclusion
Ensuring you have all the I-485 vaccinations required is a vital step in your journey to becoming a permanent resident. While the list may look long, most adults have already received the majority of these shots.
The key is preparation: locate your old records, get any missing shots at a pharmacy with your insurance, and choose an authorized Civil Surgeon to sign off on your health.
Don’t let a missing Tetanus shot or a broken envelope seal delay your life together in the United States.
Ready to start your Green Card journey with confidence?
At Greenbroad, we specialize in helping couples navigate the complex immigration system. For a flat fee of $749, we prepare your complete application package, including your I-485, I-130, and work permit forms. We provide you with a personalized checklist—including exactly how to handle your medical exam—so you never have to guess what to do next.
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Disclaimer: This article provides general information and is not legal advice. Immigration rules, fees, and vaccination requirements are subject to change. For complex medical waiver cases or legal inadmissibility issues, we recommend consulting with a qualified immigration attorney.