WE LIVE IN USA
That sealed I-693 envelope: never open it on paper, always open it online
There's a rule about Form I-693, the immigration medical exam, that almost every Chinese-language source online gets half right, and the half they get wrong will either void your exam or stall your case.
Two filing methods, opposite rules
Filing by mail
The envelope the doctor sealed must never be opened. Open it and it's void. You redo the exam and pay the $200–$500 again.
Filing online
USCIS, in their own words:
"If you file Form I-485 online, you must open the sealed envelope from the civil surgeon and upload the completed Form I-693"
You have to open it, scan it, and upload it.
But the same passage adds a condition: you keep the original and the envelope yourself until the case has a final decision. You may be asked to produce them at the interview.
Source: USCIS Form I-485 (that page shows a last update of 2026-07-24).
Getting it backwards hurts either way
- Filing online but not daring to open it → you can't upload the I-693 and your case is incomplete
- Filing by mail but opening it → the exam is void, redo it
So decide how you're filing first, then decide whether to open the envelope. That order can't be reversed.
Who can do the exam
It must be a USCIS-designated civil surgeon (your regular family doctor doesn't count.) The directory is on the USCIS website.
Typically $200 to $500, and most insurance won't cover itThis is part of an immigration process, not a medical need, so insurance companies generally won't cover it.
What to bring
- Vaccination recordsTaiwan's yellow card counts too, butbring an English translation
- Your passport
- Form I-693
The exam covers catch-up vaccinations, a tuberculosis test, and screening for syphilis and other communicable diseases.
Missing vaccinations can add 1–2 months
This is the most underestimated time cost. If you're missing certain vaccines, you'll have to get them on the spot, andsome vaccines require spacing between doses, meaning the second shot is weeks away.
In other words, the exam isn't necessarily a one-visit affair. People coming from Taiwan hit this particularly often, because the Taiwanese and American vaccination schedules don't fully align.
The fix: dig out your Taiwanese vaccination records early, get them translated, and show them to the civil surgeon in advance so he can tell you what's missing, rather than finding out on exam day.
Validity period
The rules on how long an I-693 stays valid do changeConfirm your filing timing with an attorney or check current USCIS guidelines, and don't plan your schedule around a blog post from a few years ago.
In one line
Decide your filing method before you decide about the envelope; and get your vaccination records in front of the doctor early, so dose spacing doesn't wreck your timeline.