Preparing for the Medical Exam

As part of applying for a marriage-based green card, you’re required to complete a medical examination with a government-authorized doctor. What should you expect?

While you might have heard stories about immigrants to the United States being quarantined for health reasons on Ellis Island, rest assured that immigration rules have changed a lot in the past 100 years. There are certainly no more government-mandated quarantines, but there are still some health-related reasons for denying a green card application. 

Specifically, the green card medical exam is required to make sure that the spouse seeking a green card doesn’t have any conditions that could make him or her inadmissible to the United States. It’s fairly rare to fail the medical exam, and even if you do have a condition that might complicate your green card application, you can often receive a waiver. Proper preparation can make the entire exam less stressful, and also head off any issues that could delay your green card application—or worse, cause a denial of your application. 

Here’s what to expect as you get ready for the green card medical exam. 

Before, During and After the Exam

Who’s the Doctor?

The medical exam must be performed by either a doctor designated by U.S. Citizenship and Immigration Services (USCIS), if you are applying for a green card from within the United States, or by a doctor authorized by the Department of State, if you are applying from outside the United States. 

The doctor will not give you a regular medical exam like you would get from your family doctor, nor will he or she give you a “pass or fail” based on a your general health. During the medical exam, the doctor is looking for specific illnesses or conditions that fall into three categories: communicable diseases, threats to society, and conditions that make it impossible for you to support yourself. The doctor is also checking to make sure you’ve had all the required vaccines. 

Scheduling the Exam

If you’re applying for a green card from abroad, the embassy where you’ll attend your green card interview has probably already given you a list of doctors authorized to perform a green card medical exam. If not, you can find an authorized doctor on the State Department’s medical exam information page. You’ll need to choose someone from this list—medical exams are only accepted if they are done by a doctor authorized by the State Department.

If you’re in the United States, you can use the USCIS “find a doctor” tool to locate a nearby doctor who is authorized to perform green card medical exams.

When you’re selecting a doctor, you can ask about fees for the medical exam, the doctor’s availability, and whether the doctor accepts your insurance. The price for the exam can vary by hundreds of dollars, but the exam will be the same regardless of how much it costs. 

What to Bring

Having all of your documents ready can help the medical exam go smoothly. Here’s what you should have:

  • Your vaccination records
  • A copy of your medical history
  • Copies of any chest X-rays, if you’ve had them
  • A letter from your regular doctor outlining the treatment plan for any health problems you may have
  • Photo identification, such as your passport

During the Exam

The doctor will review your immunization and medical history with you, and ask both general questions and specific questions based on your health. 

You’ll get a basic check-up as well as a skin test for tuberculosis, a blood test for syphilis, and a urine test for gonorrhea. You will have to return to the clinic 48-72 hours after the initial exam to get your tuberculosis skin test read, so it’s a good idea to schedule accordingly. 

If there are any required vaccines that you haven’t had, the doctor should be able to give you the vaccines during the visit. 

In addition to the tests and vaccines, the doctor will ask questions about any prescription drugs you take, as well as your past and present drug and alcohol use. 

After the Exam

When you come back to get your tuberculosis test read, the doctor will provide your medical exam form (technically, Form I-693) in a sealed envelope. You can ask the doctor to give you a copy for your records before he or she seals the envelope, because you must send the sealed, unopened envelope to USCIS (if applying from within the United States) or bring it to your visa interview (if applying from abroad). So if you want a record of your medical exam (which is always a good idea), you need to have the doctor make a copy before sealing the envelope. 

Health-Related Grounds for Inadmissibility

During the exam, the doctor’s job is to make sure that you don’t pose a threat to people in the United States. Here are the main reasons a person might be denied a green card for health reasons: 

  • Communicable diseases. If you have active, untreated, and infectious gonorrhea, leprosy, syphilis, or tuberculosis, you will be unable to get a green card until the disease has been treated and/or cured. 
  • Drug and alcohol abuse. If you have a history of drug abuse, you might be asked to take a drug test and/or certify that you have completed a drug treatment program. If you’re currently abusing prescription drugs, illegal drugs, or alcohol, you are not allowed to get a green card.
  • Mental illness with history or threat of violence. If you have a mental illness that has caused you to be violent in the past or is associated with violence, either against yourself or others, you may have trouble getting a green card. According to USCIS policy, drunk driving falls into this category. 
  • Inability to work. If your health is so poor that you won’t be able to support yourself financially, you could be denied a green card based on concern that you would become a public charge. This might be the case for people with serious degenerative or fatal diseases. 

You should NOT be denied a green card on medical grounds if you have a cold, you have a chronic but well-managed disease such as diabetes or heart disease, you are HIV-positive, or you have previously had one of the communicable diseases listed above (but you’ve since been cured). 

Here are some options for those with a health-related condition that could lead to the denial of a green card:

  • If you’ve tested positive for gonorrhea, syphilis, leprosy, or tuberculosis in the past, it’s important to show USCIS or the State Department that you have been successfully treated. Typically the best way to do that is to bring copies of your medical records showing the treatment you received and the results of that treatment, as well as a statement from your regular doctor confirming that your disease is either cured or being managed. 
  • If you have any history of drug abuse or mental illness, it’s also important to bring proof to the medical exam that your drug addiction has been treated or that your mental health is under control. 
  • If you have any other potentially serious disease, it’s good practice to get a letter from your regular doctor explaining how your disease is controlled and how your life is affected—including how your illness impacts your ability to work, if at all.
  • You can also apply for a “waiver of inadmissibility” if your green card application is denied for health reasons. USCIS will generally consult with the Centers for Disease Control (CDC) to determine if a waiver should be granted. USCIS can also attach conditions to the grant of a waiver as they see fit. For example, a condition of granting a waiver for an applicant with tuberculosis, could be that the applicant must agree to see a doctor immediately upon admission and make arrangements to receive treatment for tuberculosis. USCIS may deny a waiver if the applicant openly states that he or she is unwilling to obtain treatment for their medical condition. 

The medical exam is an important requirement on your way to getting a green card, but it doesn’t have to be stressful. With proper preparation, you can avoid unpleasant surprises and be one step closer to a green card. 

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