As a test of whether you fall into a health-related ground of inadmissibility, any application for U.S. permanent residency (meaning an immigrant visa through a U.S. consulate overseas or a green card through adjustment of status in the U.S.) or for a fiancé visa will include a medical exam by a doctor approved by the U.S. consulate or U.S. Citizenship and Immigration Services (USCIS).
This requirement applies to both adult and child applicants, though the exam doctor will take age into account for purposes of things like deciding which vaccines are necessary.
Your own doctor cannot do the exam unless he or she happens to be on the government’s list of approved doctors. You will need to pay the fee for the exam. The U.S. government does not control how much the doctor can charge.
This is not like a regular physical exam or check-up, where you bring up health issues that you are experiencing, and receive wide-ranging medical advice. It is more of a screening exam, to see whether it is safe to allow you into the United States. You don't have to be in perfect health, but you must not have any serious or communicable diseases, mental disorders, or drug problems that would make you inadmissible to the U.S. (ineligible for a visa or green card).
See Inadmissibility: When the U.S. Can Keep You Out for more on this topic.
The first thing the doctor's office will do is check your passport or other identity document, to make sure that you are really you, and haven’t sent a healthier person in your place.
The doctor will also make sure that you have had all the required vaccinations. The doctor will not, however, give you a general physical exam or tell you whether you have any health conditions beyond the ones of interest to U.S. immigration authorities.
If you’re applying to adjust status in the U.S., the diseases that can make you inadmissible (as of 2020) are gonorrhea, infectious leprosy (Hansen's disease), infectious stage syphilis, and active tuberculosis.
If you’re seeking an immigrant visa at a U.S. consulate, two more types of disease can make you inadmissible:
See Chapter 6 of the USCIS Policy Manual for details and updates.
If you have an illness that causes you trouble but will not infect or injure others, such as heart disease, cancer, or certain mental illnesses, you will not be inadmissible on medical grounds. However, it's possible you could be found inadmissible as a likely public charge—that is, someone likely to require need-based government assistance (often referred to as welfare)—if you will not be able to work in the U.S. and don’t have medical insurance.
A further requirement of getting a U.S. green card is that you have had certain vaccinations. The list of those vaccinations is below. If you are entering the U.S. on a fiancé visa, however, you have the choice of either getting these vaccines as part of the medical exam you get for your fiancé visa, or as part of the medical exam you get when you later apply for your green card.
Refugees and people granted asylum in the U.S. do not need the vaccinations until they apply for a green card.
In 2020, the required vaccinations included the ones listed below. Some of these are required only for people in certain age groups. If other diseases later become preventable by vaccines, they may be added to this list.
Bring a copy of any past vaccination reports; the doctor will not be able to accept your word for the fact that you've had them done. If the vaccination reports are not in English, you will also need to bring a written, full English translation.
If you haven't had certain vaccines, the doctor will administer them (or at least the first dose) during this exam. However, the physician will not simply give the same set of vaccines to everyone. The exact nature of the requirement depends on which vaccines are considered age-appropriate, in the judgment of the Advisory Committee on Immunization Practices (ACIP).
You can view a chart of which vaccines are considered medically appropriate at various ages in the U.S. Citizenship and Immigration Services (USCIS) Policy Manual under Chapter 9, Vaccination Requirement.
As you'll see, infants five weeks old and younger are required only to have the Hepatitis B vaccination. A child who has reached seven weeks of age must also have the rotavirus vaccine.
The doctor or a member of the doctor’s professional staff will ask you for your medical history. The doctor will review all the times you have ever been in the hospital, any time you had to be put in an institution for a chronic physical or mental condition, and all the times you’ve ever been sick or disabled so seriously that it resulted in a “substantial departure from a normal state of well-being or level of functioning.”
The doctor will ask specific questions about psychoactive drug and alcohol use, any history of harmful behavior, and any history of psychiatric illness not documented in the medical records. The doctor will also review chest X-rays and treatment records to see if you have or ever had tuberculosis.
The doctor will review any other records, such as police, military, school, or employment records, that may help to determine a history of harmful behavior related to a physical or mental disorder. These records also may show whether you have any illnesses or disabilities that result in a substantial departure from a normal state of well-being or level of functioning.
The doctor will ask specifically about symptoms that suggest cardiovascular, pulmonary, musculoskeletal, and neuropsychiatric disorders, and will look for symptoms that you are infected with any of the diseases that would make you inadmissible.
The doctor will then give you a physical examination, which will include looking at your eyes, ears, nose and throat, extremities, heart, lungs, abdomen, lymph nodes, skin, and external genitalia. The doctor will also perform a mental status examination, assessing your intelligence, thought, comprehension, judgment, affect, mood, and behavior.
The doctor will do any test necessary to diagnose—or confirm a suspected diagnosis of—diseases that could make you inadmissible. A blood draw and chest X-rays are usually part of the testing. You do not need to fast (refrain from eating) in preparation for the blood draw.
If you’re too sick at the time of the medical exam for the doctor to perform all the necessary tests, you’ll be referred to your own doctor to get better, and told to come back for the immigration medical exam later.
If your case is unusual and the doctor can’t say for sure whether you can pass the medical exam, the doctor can refer you to another doctor to perform further testing.
When the examination is done, the doctor will prepare a form with results and findings. The doctor will give you the form in a sealed envelope for you to give the consulate or to USCIS (don’t open the envelope!). In some cases when you are applying for a visa overseas, the doctor will send the results directly to the consulate.