USCIS Medical Exam and Vaccination when applying for Green Card
I got done my medical examination required by USCIS when applying for I-485. I am going to share the general process, experience about my examination and some general suggestions.
Disclaimer(10-Oct-2011): This is my personal experience and, the information and process may change in future. So always check with USCIS website and/or immigration attorney for the latest information/guidelines. Also my medical experience (Adult-M) shouldn’t be taken as medical advice.
Visit USCIS Website:
Go to the USCIS website for current requirements on medical exams. Or Search for USCIS Medical Exams to get the latest link, in case the above link is broken.
Find a Medical Doctor (Civil Surgeon):
First thing you would need to do is to find a doctor approved by USCIS who can perform the required medical exam. These are the only doctors who are authorized to sign the I-693 form. So make sure you go to one of the doctor found on the USCIS website.
Make an appointment:
Call one of the doctors in the list and make an appointment. You might have to call couple doctors to get an appointment as early as possible. I called like 4 doctors. I got a next day appointment with a doctor who was at U.S. HealthWorks (I got that doctor’s contact information from USCIS’s website).
When you call for an appointment make sure you are making appointment with right doctor and mention that it is for immigration medical examination and ask what all you need to bring with you. When I asked them, they informed to bring all the forms and health records. So one thing was clear that they were aware of the process.
Important: Mostly immigration medical exams are not covered by health insurance plans and you will end up paying it from your pocket. Ask for their fees when you call to make an appointment. Vaccines might be covered by insurance if the doctor you are visiting accepts insurance. Read further about my experience for more information.
Fill form I-693
Important Update(10/31/2011): New I693 effective Nov 1st, 2011
On the USCIS website you will find the Form I-693 along with instructions. Download the form and fill the information in Part-1. Do not sign or date the form. Follow the instructions. It is just basic information. Print the form. Possibly take it with you in a USB drive.
What to take with you at the time of appointment
- Form I-693
- Govt. issued Photo ID (Driver’s License or Passport)
- Vaccination Records (Immunization Card / Records from doctor in your country, etc.)
- Any other medical records you think might be helpful to prove your health condition
It is good to carry stuff with you instead of going back to resubmit them. Doctor will not sign the form unless he/she is able to fill necessary details and has proof of vaccinations.
So far it was just general information and boring. Here comes fun part of this post, my story.
At Civil Surgeon’s office (Day 1):
Went to the civil surgeon’s office. As usual, since it was my first visit in that office I had to fill few forms – personal info and medical history, allergies, etc. Since these exams are not covered by health insurance plans, I had to pay $120. Then the lady helping me asked for form I-693 and my Immunization Card (I was like what’s that?). I said I don’t have one but I had a couple years old letter from my doctor in India that stated that I was vaccinated for Tetanus(Dose1) and Hepatitis-B(Dose1) on so and so date and next doses are due on so and so date. She took the photocopy and returned me the original. Again waiting…
Immunization Card: That’s the card that carries the records about when, where and what vaccinations you got. Search the web if you want more information.
A nurse called my name and I followed her (NO not on twitter). First was eye examination. Asked me to read some letters on wall from a distance and on a machine. Then asked me to recognize colors(red,green,yellow and blue). It sounded like I was in kindergarten. First read some alphabets and then colors. Then came height and weight, and urine sample. Yes, keep some stock in your bladder. Don’t empty everything in advance but again you won’t need a gallon. Then came blood pressure. Again wait….
Then came another nurse and gave me TB test injection. If you don’t know what it’s like then for your information, you will see a boil at the place where you were injected. It will go down in sometime. Nurse informed me that I need to come back a day after, so they can see the results. No appointment needed. Again wait…. – “doctor will come and see you.”
Then comes the doctor. Looked at my file. Deep breathe in-out, check my ears and tongue. Asked to take out the my shirt and pants and lie on the bed. He poked me on side of my stomach and then hit with small hammer or my knees. Stand up and then bend down and back up. Then tested for hernia. Touched the testicles and asked to cough. Put my clothes on. Ok all testing done.
Then he looked at my vaccination record and told me I only had my first dose of tetanus and Hep-B and don’t have record for any other required vaccines. So I need to get those. I told him I got MMR but don’t have a record but he still asked me to get following shots and then only he can sign my form:
- Tdap (tetanus, diphtheria, and acellular pertussis)
- MMR (Measels, Mumps and Rubella)
- Flu shot
He said their office doesn’t accept insurance and I will have to pay out-of-pocket if I want to get those shots right there and then. Or I can go to my primary doctor or any other doctor who is approved by my insurance and get those shots. Then bring back my Immunization Card so he can verify and complete the I693 form.
Then he asked me to sign and date in the Part1 of form I-693. Remember, my message in red above.
Then came another nurse who took my blood sample. Not sure for what. Ok that was it. I took down all the required vaccine names and left the office. Remember I have to come back for my TB thing a day after.
Note: On I693 Part-2 #5-Vaccinations section has list of required vaccines. You might not need all of them depending on your age and/or if you were vaccinated in past. It will depend on your personal medical history.
Called Health Insurance:
So I come out of the surgeon’s office and I called my health insurance to confirm they will cover the cost of the vaccination. The agent took time to find each vaccine and told they fall under “Preventive Medical Care” and should be covered. If they ask why you want them, tell your physician recommended.
Make appointment for vaccination
Then started looking for physicians on my insurance’s website. Found few nearby and started calling them. First one didn’t have any appointment for a week. Second one had an appointment but said they weren’t carrying 2 of the required vaccines. I was shocked hearing that response. Anyway, the third call got me a next day appointment and I confirmed they had all the vaccines I need. All set.
Going for Vaccination (Day 2):
As usual all form filling, paying co-pay, height,weight,blood pressure, etc. Then comes the doctor and asked what all vaccinations are needed and why. I told all the six and told I need it for immigration purpose. She asked me when I had my tetanus vaccine. I told here the date and told I had only one dose. Same for HepB. Never had HepA. So she told I then need Tdap, HepA and HepB. Then asked if I had Chickenpox in childhood. Oh, hell yes. Who can forget that experience. She said then I don’t need Varicella because my body will be now naturally immune to chickenpox. But I said, no I need the proof so I need it. Then she goest that she recommends first antibody titer, i.e. lab test to determine immunity against chickenpox. Then I asked what about MMR, I need that too. I had it few years back but don’t have a record. Then she said that she will ask for MMR check as well in the antibody titer test. Then if I need it she will give that shot. At the end she said, I should come back after 6 months to get my remaining doses of HepA and HepB.
Then the nurse comes and I got four out of the six shots that day (Tdap, HepA/B and flushot), two on each hand. Then she hands me two papers. One had my information and what tests are needed and the another paper was list of lab locations. I can go to any of those lab and give my blood sample. She also gave me my Immunization Card (Ahhh.. now I know what it looks like). It has information about the shots I got.
Cool… now head over to the labs.
Lab test for antibody titer:
Called the nearest lab location from the list I got and they said I can come anytime. I said, be there in 10 mins. Went there and they took my blood sample. They also took my insurance card copy. Paid nothing there, no copay. The nurse told that the report will be sent to my doctor(where I got vaccination) in 3-4 days. I wasn’t happy to wait for that long, but had no choice.
Back to Civil Surgeon for TB results(Day 3):
On third day of my medical exam journey, I was back to civil surgeon’s office. This time no appointment was needed and was the first one – early morning. The nurse got me in. Looked at my arm where I was injected for TB and it was all clear. She opened my file and did something.
Then I showed her my Immunization Card and she took a photocopy. I told what the physician told me about MMR and Varicella. She said, I need to submit the lab report once it’s in or in case I have to take those shots, will need to present the Immunization Card with those updated records. She also told me it won’t take 3-4 days for that test.
Lab reports(Day 4):
Next day I got call from a nurse at the physicians office that my lab report is in and I am immune to those two diseases and won’t need the other two vaccines. She said, she will mail me a copy but I said I will pick it up. I went to the office, picked up my lab report and headed straight to civil surgeon’s office.
The nurse took my report and asked to wait for doctor to complete I-693.
Important Note: Doctor will sign and seal the form I-693 in an envelop. Do not accept if the form is NOT in a sealed envelop. Don’t forget to ask them that you need a copy of everything. This way you have it for your record and also make sure there weren’t any mistakes.
Yeah, so that was it. Happy ending.
These are some of the suggestions based on my experience. Don’t take it as legal or medical advice.
1: Check the list of vaccinations on I-693. See what records you have. Just take it to your physician on you regular visit and get all the shots that applies to you. Most of those are valid for years or may need once per lifetime.
2: If possible/feasible, try to get an appointment with a USCIS approved doctor that is also an in-network doctor for your insurance. That way, if you need any vaccination, you can get it right there and then.
3: In case you have to go to a separate physician to get vaccines, confirm with them that they are carrying those vaccines. You don’t want to go there and end up with getting no shots.
Vaccination Cost (Updated – 10/26/2011)
I looked at my insurance claims and here’s what the physician charged for vaccinations and what the lab charged for antibody titer. My insurance covered all vaccination related costs and I just paid my office visit of $25. But for those who don’t have insurance or the insurance that doesn’t cover immunization this might be helpful.
Office visit: $90 – I paid $25 and insurance paid $40.
Vaccines: $330 – I paid $0 and insurance paid $250
Here’s the breakdown where the first amount is the actual cost of the vaccine and second amount I think is the doctor’s charge for administering them.
Vaccine1: $65 + $30
Vaccine2: $95 + $15
Vaccine3: $70 + $15
Flu shot: $25 + $15
Vaccines administered were HepA, HepB and Tdap but my insurance statement doesn’t list out the names and so I don’t know what amount correlates to each of them.
Lab for antibody titer:
The lab charged $450 for test for MMR and Varicella (chicken pox) to my insurance. They actually charged about $110+ for each test, total of 4. I paid $0 and my insurance paid $33 (isn’t it shocking?).
I just came across other bolg that people do get RFE if they didn’t get the flushot, if they were filing during the flu season(Oct-March).
Ending the story
Hope this helps. Feel free to share your experience or suggestions in the comments below.
Thanks for reading.
Q’s Immigration Blog –Vaccinations (You can post your questions related to vaccinations here)