Change in Medical Exam Requirements Leads to RFEs

As of August 1, 2016, any civil surgeon completing a report of medical examination and vaccination record (form I-693) for an applicant who is 15 years of age or older, must test the applicant for gonorrhea. This policy change came with virtually no notice to the public. It has resulted in many requests for evidence (RFEs) issued by the U.S. Citizenship and Immigration Services (USCIS), asking for updated I-693s, to the surprise of I-485 applicants.

Background on Civil Surgeons and Update to I-693 Requirements

Civil surgeons are physicians who have been authorized by the USCIS to provide the medical examinations required by nearly all I-485 applicants. The purpose of these medical exams is to ensure that the applicant does not have any medical condition that would make her/him inadmissible to the United States, including certain communicable diseases.

Gonorrhea Added to Technical Instructions for Civil Surgeons

The Center for Disease Control (CDC) is responsible for maintaining the Technical Instructions for Civil Surgeons, which guides civil surgeons on the purpose of this type of medical screening, details the medical conditions for which individuals must be tested, and provides other related instructions on the I-693 process. Included in this document is a list of communicable diseases for which applicants must be tested.

An update was posted on the CDC website to advise civil surgeons that, as of August 1, 2016, a test for gonorrhea is required. The USCIS, however, did not announce that this policy change was being implemented. And, based on the reports of RFEs being issued on pending I-485s since the I-693 requirements were changed, it appears many civil surgeons were unaware that this test was now mandatory.

Gonorrhea Annotation Required on I-693s Completed Since Aug 1, 2016

As mentioned above, since August 1, 2016, civil surgeons have been required to test for gonorrhea when completing an I-693 for any applicant who is 15 or older. The I-693 form, however, has not yet been updated to include gonorrhea under the section for communicable diseases of public health significance. Civil surgeons, therefore, are instructed to annotate the results of the gonorrhea test in the remarks section of the form. If the USCIS finds that no annotation has been made, the applicant should expect to receive an RFE for updated medicals.


While it is the civil surgeon’s responsibility to fully complete the I-693, it is prudent for the foreign national applicant to be familiar with the testing requirements to help ensure that all the proper tests are performed. Applicants should make sure that they receive a copy of the I-693 to review. It would also be helpful for the USCIS to be more proactive in announcing such changes, rather than using the expensive and time-consuming avenue of RFE issuance to disseminate information regarding a new requirement on these medical forms.


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Disclaimer: The information provided here is of a general nature and may not apply to any specific or particular circumstance. It is not to be construed as legal advice nor presumed indefinitely up to date.