Are My Medical Exams Correct?

Angelica Rice • May 4, 2023

      As part of the Form I-485, Adjustment of Status application process, or the Immigrant Visa process if the Applicant is applying from abroad, USCIS requires that all Applicants be properly vaccinated and have a properly filled out Form I-693, Medical Examination form prepared by a USCIS authorized Civil Surgeon or Panel Physician and submitted to USCIS in a sealed envelope. 


      Unfortunately, many Applicants and immigration Practioners often run into situations where the authorized surgeon or physician has not properly completed the medical exam and it has led to detrimental consequences for their Adjustment process, including denial of their Form I-485 application or Immigrant Visa application. 


      First, the Civil Surgeon or Panel Physician should provide the Applicant with a copy of the medical examination results that are being sealed and provided to USCIS. This way the Applicant and/or their immigration attorney can view and check the results before sending the sealed envelope to USCIS. This will prevent erroneously completed medicals from being sent to USCIS and will reduce the chances that their Form I-485 is denied or otherwise negatively impacted by a deficient medical exam.


      Second, the Applicant or their immigration attorney (if they have one), should review the copy of the medical exam they are given and make sure that they are completed in accordance with the USCIS and CDC vaccination requirements. These requirements can be found on the following websites:


https://www.uscis.gov/tools/designated-civil-surgeons/vaccination-requirements

https://www.cdc.gov/immigrantrefugeehealth/civil-surgeons/vaccinations.html


The Immigration and Nationality Act (INA)¹ specifies the following vaccinations must be administered or completed as part of the medical exam:


  • Mumps, measles, rubella;
  • Polio;
  • Tetanus and diphtheria toxoids;²
  • Pertussis;
  • Haemophilius influenza type B; and
  • Hepatitis B.
  • CDC requires the following additional vaccines for immigration purposes:
  • Varicella;
  • Influenza;
  • Pneumococcal pneumonia;
  • Rotavirus;
  • Hepatitis A;
  • Meningococcal; and
  • COVID-19.


      If the applicant has not received any of the listed vaccinations and the vaccinations are age appropriate and medically appropriate, the applicant has a Class A condition and is inadmissible. Generally, all age-appropriate vaccine rows of the vaccination assessment must have at least one entry before the assessment can be considered to have been properly completed. However, the COVID-19 vaccination (required as of October 1, 2021) differs in that the applicant must complete the entire vaccine series (one or two doses depending on formulation).³


      In order to determine which vaccines are “age appropriate” the Civil Surgeon or Panel Physician, should be referencing the vaccine requirements chart contained in the CDC Vaccination Technical Instructions. See this chart below⁴:


      If you have questions about USCIS required medical examinations or if your Form

I-693 was properly completed, please contact our office for assistance today! 


¹ See INA 212(a)(1)(A)(ii).

² Applicants who have completed the initial DTP/DTaP/DT or Td/Tdap series should receive a Td/Tdap booster shot every 10 years. If the last dose was received more than 10 years ago, the applicant is required to have the booster shot, otherwise the applicant is inadmissible under INA 212(a)(1)(A)(ii).

³ For more information, including current dosage requirements for the immigration medical examination, see the CDC Requirements for Immigrant Medical Examinations: COVID-19 Technical Instructions for Civil Surgeons webpage.

⁴ https://www.cdc.gov/immigrantrefugeehealth/civil-surgeons/vaccinations.html


This blog is not intended to be legal advice and nothing here should be construed as establishing an attorney client relationship. Please schedule a consultation with an immigration attorney before acting on any information read here.

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Angelica Rice

USCIS Changes H-1B Lottery to Wage-Based Selection

By Kris Quadros-Ragar • January 15, 2026
U.S. Citizenship and Immigration Services (USCIS) has announced a major change to the H-1B cap selection process. Under a final rule issued on December 29, 2025, USCIS will replace the long-standing random H-1B lottery with a wage-weighted selection system that favors higher-paid and more complex positions. The rule is scheduled to take effect on February 27, 2026 , just ahead of the fiscal year 2027 H-1B cap registration season, unless delayed by legal challenges. If implemented, USCIS is expected to release additional guidance explaining how employers must submit registrations under the revised process. This change marks one of the most significant reforms to the H-1B program in recent years. Up until 2025, all registrations were treated equally once the annual cap was reached. Under the new system, selection odds will be tied to wage levels based on the U.S. Department of Labor’s Occupational Employment and Wage Statistics data. All H-1B registrations will still be placed into a single selection pool, but registrations tied to higher wage levels will receive multiple entries into that pool, increasing their likelihood of selection. Lower wage levels will receive fewer entries, making selection less likely but not impossible. H-1B wage levels are not determined solely by salary. Each wage level reflects the complexity of the job, the level of responsibility involved, and the education and experience required . Entry-level positions involving routine duties and close supervision are generally classified at the lowest wage level, while positions requiring independent judgment, advanced skills, and significant responsibility fall into higher wage levels. The highest wage level is reserved for roles that involve expert knowledge, strategic decision-making, and substantial leadership or technical authority. USCIS is expected to closely scrutinize selected petitions to ensure that the wage level claimed during registration is supported by the job duties and salary offered in the petition. Any discrepancies between the registration and the petition may result in requests for evidence, denials, or enforcement action. With the elimination of the purely random lottery, employers should begin preparing early by carefully evaluating job descriptions, wage levels, and overall H-1B strategy. Accurate classification and thoughtful planning will be essential under this new wage-based selection system. If you are an employer considering H-1B sponsorship, or a foreign professional wondering whether your position may qualify under the new wage-based system, consulting with experienced immigration counsel is more important than ever. Santos Lloyd Law is actively advising clients on H-1B cap registrations and strategy under the new rules. To discuss your options or determine whether you may qualify, contact our office to schedule a consultation.

Increase in issuance of EB-1A RFEs

By April Perez • January 9, 2026
During the recent administration there has been an increase in issuance of Requests for Evidence for EB-1A petitions for those of Extraordinary Ability. A Request for Evidence is a request that is made by USCIS that should explain how the evidence is deficient in proving the criteria argued and what additional evidence needs to be provided by the applicant to meet the criteria. EB-1A petitions are already normally subject to higher scrutiny because their approval is the first step needed to apply for Lawful Permanent Residence or a green card. USCIS normally requires not just evidence but that the evidence be provided with context and information to show why it matters in a particular field. For example, if you were providing evidence of your membership in an organization that requires outstanding achievements of its members, just providing evidence of the membership is not enough. You must explain what that membership is and provide background information on the organization granting the membership. You also need to provide evidence on the criteria that is used to select the members, information on those who select the members to show that they are recognized experts, other documentation such as articles about the membership organization to show its importance, and any other relevant evidence and background information to show that the criteria is met. A request for evidence being issued prior to the current administration was not uncommon, but in the current climate it is more surprising to not receive a request for evidence for this type of case. It is important to remember that a request for evidence is not a denial. Depending on the validity of the information in the request and the substance some Requests for Evidence can be overcome, and the case be approved. It is important to carefully review the request and note if there are any errors in the content and application of the regulations by USCIS. If you have an attorney, you should work with them and make sure that you provide any evidence you think may be helpful. Although there is a deadline by which a response must be submitted, attention to detail and patience will go a long way when dealing with having to respond to a request for evidence.  If you believe you may qualify for this type of visa, please feel free to contact our office.
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