Common Medical Examination (Form I-693) Concerns
Those seeking to adjust status and become a permanent resident must, for the most part, submit a medical examination along with their adjustment application. The medical exam, done on Form I-693, is to ensure that you have no inadmissible related health conditions. This mainly refers to infectious diseases that are of public health concern. Often, USCIS is ensuring that you have been vaccinated for such diseases—so that you are less likely to spread them. With the COVID-19 pandemic, this has become even more of a concern.
There are also timing rules when it comes to Form I-693 medical exams, which may be complicated by the timing of filing your adjustment application. Below, find some of the most common questions clients have been asking us regarding their medical examinations.
Medical Exam Validity
Medical examinations must generally be signed by the physician no more than 60 days before the corresponding application is received by USCIS. After that, medical evaluations remain valid for two years after the date they are signed by the doctor – even if the exams are submitted after the application is already filed and pending with USCIS.
The Form I-693 must be completed in its entirety on the most recent version of the form and properly signed or would risk rejection from USCIS. Moreover, the doctor that signs your form must be an authorized Civil Surgeon, which requires the doctor to keep his/her information up-to-date with USCIS as well.
Re-Using Old Medical Exams
Applicants often find themselves in situations where they are wanting to submit medical exams completed some time in the past. As of December 9, 2021, USCIS has waived the requirement that the doctor sign the Form I-693 within 60 days of submitting the application to USCIS.
Accordingly, it may be possible for an applicant to submit an older version of his/her medical exams in the new application – so long as the exams are still within the 2-year validity period and are completed on the latest version of the form. Keep in mind, however, that if your application remains pending with USCIS beyond your medical exam’s 2-year validity period, the government will require you to submit an updated form before your green card can be issued.
COVID-19 Vaccine Requirements
On September 14, 2021, USCIS announced that applicants who are required to submit a medical evaluation with their petitions or applications must complete the COVID-19 vaccine series before their doctor can complete and sign their Form I-693, Report of Medical Examination and Vaccination Record. This requirement went into effect on October 1, 2021, meaning any medical evaluations signed on or after that date must include proof of full COVID-19 vaccination status.
USCIS does allow for COVID-19 vaccine requirement waivers if the vaccine is deemed not age-appropriate, contraindicated due to a medical condition, not routinely available where the doctor practices, or the vaccines are in limited supply and would cause significant delay for the applicant to receive the vaccination.
Individual Vaccine Waivers
Vaccination documentation is a required part of the medical examination process for USCIS. USCIS requires vaccinations for many different diseases, but also includes a requirement for any other vaccine that the CDC Advisory Committee for Immunization Practices (ACIP) deems necessary. Right now, the COVID-19 is a required vaccination, as deemed by ACIP.
So, this means that unless you have an authorized excuse, as outlined by USCIS, or an approved Form I-601 Waiver, you are required to be fully vaccinated against COVID-19 if your application requires you to submit medical examinations to USCIS.
Religious Belief/Moral Objection Vaccination Waiver
USCIS does allow applicants to apply for individual waivers based on sincerely held religious beliefs or moral convictions. To do so, individuals must apply for the waiver using the Form I-601, Application for Waiver of Grounds of Inadmissibility. Applying for the waiver does not guarantee it will be granted.
When deciding whether to grant a religious objection waiver, there are some guidelines they follow. When considering whether an objection is based on religious belief or moral conviction, they are to handle it with sensitivity. USCIS has been instructed to balance the individual’s beliefs with the public health of society.
It is common for some religions to object to vaccinations. However, the federal government must balance one’s freedom to worship as they choose with public health. Therefore, if you apply for a religious exemption waiver, it is important that you outline religious beliefs or moral convictions, and why they are important to you. It is especially important to outline these beliefs if your objection to vaccinations has changed over time.
When assessing your religious beliefs or moral convictions, USCIS generally requires that the applicant demonstrate that he or she opposes vaccinations in all forms – the applicant cannot “pick and choose” between vaccinations.
However, an applicant’s past vaccination history is not automatic grounds for denial of the waiver – the USCIS officer must consider the reasons for having received those vaccines (for example, the applicant was vaccinated as a child when in the custody of a parent). Although past vaccination records may make your waiver more difficult, you may still be able to show USCIS that your beliefs have changed since you were last vaccinated. If you have other religious/moral reasons for not objecting to vaccinations in the past, and now objecting to them, be ready to document those reasons to USCIS and their officers.
Further, the objection to vaccination must be based on sincerely held religious beliefs or moral convictions. Objections based on scientific evidence (or lack thereof) or political principles would not qualify for the waiver.
Waivers are at the discretion of individual USCIS officers, within the boundaries of the policy outlined above. If USCIS does not grant a waiver, you must get vaccinated or your green card application would be denied as you would be rendered inadmissible to the United States.
Evidence that can be submitted with your waiver application includes sworn statements regarding your sincerely held religious beliefs/moral convictions, as well as affidavits from other members of your congregation regarding your sincerely held beliefs, and any other evidence that exemplifies the sincerity of your beliefs.
Applicants often need to move forward with filing their adjustment of status applications even without their medical examinations ready for a variety of reasons. No matter the reason, filing your medical examinations after filing your adjustment application is an option. Filing your medicals after submitting your application is frequently called medical interfiling.
If you are sending your medical exam before an RFE for it has been issued, consider keeping two copies of the medical exam, just in case USCIS still issues an RFE (and for your records).
While you are required to send medical exams within sixty days of their signature if filing them along with your adjustment application, that is not the case if filing a medical interfiling. If interfiling the form into a pending application, your medical exam will be valid for two years after the date it was signed.
Medical Reasons for Inadmissibility
Certain physical or mental disorders can also render individuals inadmissible to the United States. Individuals with current physical or mental disorders and that have behavior associated with that disorder that has or may pose a threat to property, safety, and welfare of themselves or others may be deemed inadmissible. In addition, if an individual has had such a disorder in the past and the recurrence of the associated behavior is likely to occur, USCIS may deem them individual based on the likelihood of recurrence. It is important to note that each case is highly fact specific, and the occurrence of a certain disorder alone will often not lead to inadmissibility.
Physical or Mental Disorder Defined
The Department of State defines physical disorders, mental disorders, and harmful behavior. Physical disorders are clinically diagnosed medical conditions that manifest physically. Mental disorders are conditions that are characterized by alterations in thinking, mood, or behavior. For both physical and mental disorders, they must also be listed in the World Health Organization’s Manual of International Classification of Diseases.
Finally, the presence of a physical or mental disorder alone is not enough to render one inadmissible. There must also be harmful behavior tied to the disorder. Harmful behavior is defined as an action that is associated with a disorder that is or has caused serious psychological or physical injury to the person or others, serious threat to the health and safety of themselves or others, and major property damage.
Things like a history of institutionalization tied to a disorder, or criminal history related to the disorder are relevant factors when USCIS considers whether the disorder warrants inadmissibility.
Drug Addiction or Drug Abuse
Drug use or alcohol addiction, while not on its own a disorder rendering one inadmissible, can be associated with harmful behavior that may render one inadmissible. However, drug abuse (the non-medical use of controlled substances) may deem one inadmissible. Examining physicians must be able to document a pattern of substance use in addition to effects associated with stopping such drug or alcohol use. Therefore, if you can establish that do not have a pattern of substance abuse, USCIS will still issue you a green card.
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