I-693 - Medical Exam and Vaccinations when applying for Green Card (I-485)

[gc0907]

Recently I had my medical examinations required by USCIS when applying for I-485.

Here is the detailed blog post where I talk about the general process, my personal experience and some general suggestions about this medical exams.

If you have different experience please share here so others in the same boat can prevent some of the hassel you have been through.

Oh, and if you like my post and want to say thank you leave Comment on my blog instead of this thread. We can keep this thread just to share personal experience and questions about the medical exams.

Updates(02/10/2012): Cases of RFE I came across regarding vaccinations:
1: Varicella Related
2: Flu shot was not taken / reported. So make sure you take flu-shot even if your CS doesn't mention or a record that says why you can't take flu shot.

Hope this helps.

[krishnav]

Hello Gurus,

Question more on the medical side...just wanted to see if anyone had a similar situation.
Our dates became current in the Nov bulletin and so we went to the doctor for the vaccinations and medical tests etc.
I had all the medical records and so I didnt get any vaccinations. My wife had to get a TDAP vaccine and thats all.

Now, we were planning on having kids and our doctor didnt tell us anything about how long we need to wait after vaccinations (except in the questionaire they asked if there was chances of my wife gettign pregnant in next 1 month).
Today one of my friend told me that one of the immigration doctors told his sister that one needs to wait for 6 months after vaccinations are done to plan on getting pregnant.
I was wondering if any of the people here had a similar situation or know more about this?

Our parents are killing us to have kids and telling them NOT FOR ANOTHER 6 MONTHS would be a tough task for us...haha.

Any thoughts would be appreciated.

[Stemcell]

Hello Gurus,

Question more on the medical side...just wanted to see if anyone had a similar situation.
Our dates became current in the Nov bulletin and so we went to the doctor for the vaccinations and medical tests etc.
I had all the medical records and so I didnt get any vaccinations. My wife had to get a TDAP vaccine and thats all.

Now, we were planning on having kids and our doctor didnt tell us anything about how long we need to wait after vaccinations (except in the questionaire they asked if there was chances of my wife gettign pregnant in next 1 month).

Today one of my friend told me that one of the immigration doctors told his sister that one needs to wait for 6 months after vaccinations are done to plan on getting pregnant.
I was wondering if any of the people here had a similar situation or know more about this?

Our parents are killing us to have kids and telling them NOT FOR ANOTHER 6 MONTHS would be a tough task for us...haha.

Any thoughts would be appreciated.

The only thing regarding your friends sister case that i can think of is may she tested positive with PPD and the doctor deciding to treat it for latent TB.In that case one needs to be cautious with pregnancy as she would be on Isoniazid ( drug for TB ) for 6-9 months or maybe she having tested positive for Syphilis.

In your case you should be fine.

[krishnav]

Thanks Stemcell.

The only thing regarding your friends sister case that i can think of is may she tested positive with PPD and the doctor deciding to treat it for latent TB.In that case one needs to be cautious with pregnancy as she would be on Isoniazid ( drug for TB ) for 6-9 months or maybe she having tested positive for Syphilis.

In your case you should be fine.

[gc0907]

You must consult your physician on this one. Shouldn't take any chance when it comes to health.

Hello Gurus,

Question more on the medical side...just wanted to see if anyone had a similar situation.
Our dates became current in the Nov bulletin and so we went to the doctor for the vaccinations and medical tests etc.
I had all the medical records and so I didnt get any vaccinations. My wife had to get a TDAP vaccine and thats all.

Now, we were planning on having kids and our doctor didnt tell us anything about how long we need to wait after vaccinations (except in the questionaire they asked if there was chances of my wife gettign pregnant in next 1 month).
Today one of my friend told me that one of the immigration doctors told his sister that one needs to wait for 6 months after vaccinations are done to plan on getting pregnant.
I was wondering if any of the people here had a similar situation or know more about this?

Our parents are killing us to have kids and telling them NOT FOR ANOTHER 6 MONTHS would be a tough task for us...haha.

Any thoughts would be appreciated.

[TeddyKoochu]

Hello Gurus,

Question more on the medical side...just wanted to see if anyone had a similar situation.
Our dates became current in the Nov bulletin and so we went to the doctor for the vaccinations and medical tests etc.
I had all the medical records and so I didnt get any vaccinations. My wife had to get a TDAP vaccine and thats all.

Now, we were planning on having kids and our doctor didnt tell us anything about how long we need to wait after vaccinations (except in the questionaire they asked if there was chances of my wife gettign pregnant in next 1 month).
Today one of my friend told me that one of the immigration doctors told his sister that one needs to wait for 6 months after vaccinations are done to plan on getting pregnant.
I was wondering if any of the people here had a similar situation or know more about this?

Our parents are killing us to have kids and telling them NOT FOR ANOTHER 6 MONTHS would be a tough task for us...haha.

Any thoughts would be appreciated.

As far as I have heard the TD shot is ok, the MMR vaccine is a bigger concern since its a live virus vaccine. Do consult your doctor / pcp.

[gc0907]

Guys,
I have updated my post to include how much my physician charged my insurnace for the vaccinations.

In case you don't have insurance or your insurance doesn't cover vaccinations, this might give you a rough estimate.

[kpt112107]

Hi,

Any idea about IGRA instead of TB skin test? Anybody applied with IGRA test results?


http://www.uscis.gov/portal/site/usc...00082ca60aRCRD

Q. What is initial testing with interferon gamma release assay (in place of TST)?

A. To fulfill the requirement of the initial TB testing, as of Nov. 1, 2009, civil surgeons may use interferon gamma release assay (IGRA), which are blood tests. The IGRAs that are currently acceptable to CDC are: the QuantiFERON ® TB Gold Test, the QuantiFERON® TB Gold in Tube Test, and the T-Spot ® TB Test. CDC may add additional tests. If it does, it will publish the inclusion of any test on its Web site. See the "CDC: Technical Instructions for Civil Surgeons" link to the right.
If you choose an IGRA (in place of a TST), the civil surgeon will take a blood sample from you during the medical examination. The blood is used to perform the TB initial screening test. Unlike with the TST, you will not have to return to the civil surgeon's office to have the test result read.
The results of the IGRA test are generally available within 24 hours of your office visit. If the result is negative, you probably will not need any further testing for TB. If the result is positive, you will be required to have a chest x-ray as a means of additional screening for TB. You may not have a TST or
other initial screening test; the administration of more than one initial screening test is a violation of the Technical Instructions.
There are certain exceptions to the IGRA testing requirement. For the civil surgeon to make the best determination of what is required, you should bring, at the time of your appointment with the civil surgeon, written documentation of any IGRA testing you previously had.

[kd2008]

http://www.uscis.gov/portal/site/usc...00082ca60aRCRD

Revised I-693 to be Introduced Nov. 1

On Nov. 1, 2011, USCIS will introduce a new, more user-friendly version of the form used to report results of medical examinations for those seeking certain immigration benefits, Report of a Medical Examination and Vaccination Record, Form I-693. Civil surgeons completing medical examinations between Nov. 1 and Dec. 31, 2011, should use the new form dated 10/11/11. However, USCIS will continue to accept the previous version, dated 7/20/10, for examinations completed between Nov. 1 and Dec. 31, 2011. Beginning Jan. 1, 2012, civil surgeons must use the new version of the form.

If… Then…
A medical examination completed before Nov. 1 Use the I-693 dated 7/20/10
A medical examination completed between Nov. 1 and Dec. 31, 2011 Use the I-693 dated 10/11/11, though USCIS will continue to accept the 7/20/10 version
A medical examination completed on or after Jan. 1, 2012 You must use the I-693 dated 10/11/11



If a medical examination completed on or after Jan. 1, 2012, is reported using an outdated form, USCIS will reject the form, requiring the applicant to return to the civil surgeon and resubmit the new form.

USCIS requires most applicants seeking to adjust to lawful permanent resident status to submit Form I-693 to report the results of a medical examination by a designated civil surgeon, confirming that an applicant is admissible to the United States on public health grounds.



Last updated:10/28/2011

[gc0907]

Thanks kd2008 for the info.

[Pundit Arjun]

Folks,

I dont have my immunization records. Hence I am planning to get the shots now. I have chosen Walgreens to get the shots (since the costs are low and they also update the PCP's office).

I have the following questions :

a) Is it fine, if I get a Varicella shot (though I have got chicken pox before). This is because I want to avoid the delay caused by the antibody titer test(when its time to file 485) ??

b) Also I believe I dont need to immunize for Polio, Rotavirus or Hib. Please confirm.

I am planning to take the following vaccines only :
Pneumococcal, Tdap, HepA, HepB, MMR, Varicella & Meningococcal.

I did take the list from cdc.gov. But Please let me know if I have missed any.

Thanks
Pundit.

[soggadu]

dude arjun...first of all you have to relax.... all these tests doesnt take much time... you know what the time killer is? the lawyers office...

Dont take varicella, you dont need it as you have chickened before...
all you have to take is MMR, flu shot and TD...rest all is not needed...

also.... as i said, talk to your lawyer first than getting these shots...these would be done in couple of days anyway and u have one whole month to prepare...

[Pundit Arjun]

Hi Soggadu,

Thanks for the reply.

Time wise, I actually have a lot. Mt PD is late 2009. But I have some FSA money left and thought of using it for this purpose rather than wasting the same

I will not take Varicella but take the rest : Pneumococcal, Tdap, HepA, HepB, MMR, Varicella & Meningococcal.

The attorney is not that gr8, bud. I will shop for an attorney soon.

Best,
Pundit

[soggadu]

once again, my doc gave me all the vaccines to fill the sheets... all she gave me are mmr,tdap and flu shot...dont get extra vaccines and become a Vaccine man like superman...also as you have much time...try getting these from county health center for free is possible

[gc0907]

It looks like it is varying from doctor to doctor. As I have listed, I was asked to take Tdap, HepA, HepB, MMR, Varicella and flushot.
Of which I went through titer for MMR(I took this earlier I knew it but did'nt have record) and Varicella(I got chickenpox ages back) because the surgeon won't sign the form without any record proof.
Other vaccines were marked as not age appropriate I think.

Hi Soggadu,

Thanks for the reply.

Time wise, I actually have a lot. Mt PD is late 2009. But I have some FSA money left and thought of using it for this purpose rather than wasting the same

I will not take Varicella but take the rest : Pneumococcal, Tdap, HepA, HepB, MMR, Varicella & Meningococcal.

The attorney is not that gr8, bud. I will shop for an attorney soon.

Best,
Pundit

[Pundit Arjun]

Thanks gc0907 and Soggadu.

FYI : The cost of vaccines from the county health center are the cost effective ones, but they are not free.

(Like you folks suggested) I spoke to my health insurance company and found out that the cost for all these Vaccines are covered and paid in full by insurance. This is because they fall under "Preventive Care" category.

I then called up my PCP and spoke to him about the shots. Since he always wanted me to catch up on the vaccines (and I was the one postponing it), he readily agreed and gave the prescriptions. Will be getting the shots on Monday.

Also found a doc who charges around $200 for immigration physicals and $40 for the TB skin test

Best,
Pundit

[nishant2200]

It looks like it is varying from doctor to doctor. As I have listed, I was asked to take Tdap, HepA, HepB, MMR, Varicella and flushot.
Of which I went through titer for MMR(I took this earlier I knew it but did'nt have record) and Varicella(I got chickenpox ages back) because the surgeon won't sign the form without any record proof.
Other vaccines were marked as not age appropriate I think.

Ouch... hepa , hepb, flu everything... I hope my doctor is kinder.

[gc0907]

Yep it was Ouch!.. in two days was poked 7 times (4 shots+2 blood samples + 1 TB).

Ouch... hepa , hepb, flu everything... I hope my doctor is kinder.

[tackle]

Here is a (not so) brief note on my experience

Background
1. Neither I nor my wife had any proof of vaccination
2. I checked with my Insurance and they said vaccination is covered 100%. But, titer tests (tests to check for antibodies from previous vaccination) are covered only 80% and that too only when we are over our deductible. We are well under our deductibles. So, we decided to not take the titer tests.

Examination
1. Made appointment with civil surgeon. The way it worked here is that we make 2 appointments that are 1 or 2 days apart. I made my 2 appointments with civil surgeon.
2. I then made an appointment with primary physician couple of hours after my first appointment with civil surgeon.
Appointment 1
1. Went to civil surgeon, filled out the forms they handed us. Told them we don't have any proof of vaccination
2. Met with the doctor, got physicals done (they check your genitals. So, be ready).
3. Got TB skin test and blood taken for Syphilis test.
4. Doctor advised us to get Tdap, MMR & Varicella vaccines. We could have got the vaccines at civil surgeon. But they don't work with insurance.
5. Went to primary physician and got Tdap, MMR & Varicella vaccines and got vaccination records. Didn't have to pay anything as insurance covers 100%.
Appointment 2
1. Went back to civil surgeon.
2. Doctor discussed the TB skin test results and Blood test results. He then described to us that all the vaccinations need booster shots and we need to take them after a month of first dosage. But he also said that it'll not prevent him from signing out I693 forms as there is a "waiver" option that he will chose on the forms. He filled out the I693 forms and signed them.
3. Waited a few minutes at the lobby to get the sealed envelopes and personal copies of I-693 forms.
4. Paid the $$ (the fees here is $210 per person. So, it was $420 in total)

After a couple of days, I filled out the required forms at work and got the $420 reimbursed. I didn't expect that my employer would pay for this. But I asked anyway and was surprised that they said they'll pay for it.

[ontheedge]

I read on some other thread that it is advisable to not mention to your PCP that you need the vaccines for immigration. Is that true? I checked with my insurance and they cover the listed vaccinations, but will they not cover if the bill comes to them any mention of immigration? What can we tell the PCP then? We just felt like getting shot one fine day?

[nagana]

Hi, I have question. When filling form I-693 what should we fill for "A-number" field? Where can we find it? Is it absolutely necessary to fill it? or Social security # is sufficient?

[nishant2200]

Hi, I have question. When filling form I-693 what should we fill for "A-number" field? Where can we find it? Is it absolutely necessary to fill it? or Social security # is sufficient?

My lawyer said its ok to leave it blank on the medical exam and not worry about it. What is important is the A number goes on the actual 485 application. The A number is taken from the 140 approval notice.

[gc0907]

I had the same doubt. I planned not to mention but the physician I went to said I don't need the Varicella shot since I had chickenpox in childhood. At that point I had to tell her that I need to get a written proof that I don't require the vaccine as it is for immigration purpose.
My insurance paid for it. So I doubt PCP mentioned that while filing claim or may be my insurance didn't care why I was taking the shots.

I read on some other thread that it is advisable to not mention to your PCP that you need the vaccines for immigration. Is that true? I checked with my insurance and they cover the listed vaccinations, but will they not cover if the bill comes to them any mention of immigration? What can we tell the PCP then? We just felt like getting shot one fine day?

[nishant2200]

Ok this is my experience. My civil surgeon is also a PCP, and accepted my Cigna PPO insurance also. 150 per person for medical exam, and all vaccines etc he will bill to insurance, he said.

First day, he gave me TB skin test first, then TDap. He sent me to lab to get blood drawn to test for immunity to MMR, Varicella, etc, all the vaccines which you need basically. The lab accepts my insurnance too. He in fact even added in blood tests for diabetes, cholesterol, anemia etc, as he said that he will help me as annual physical exam also, since I dont have a primary care doctor for myself anyways.

Two days later I went there, and for both me and wife, he gave copy of the lab test results, and indicated we already have all vaccines needed as well as we have no other problems. He just gave flu shots since it is flu season. Our TB test was negative, for both of us, you could hardly even see where TB test was made, forget any rash or swelling etc, totally negative.

He filled out the forms and gave in sealed envelope. Over.

[mygctracker]

My I-693 medicals Experience::

Anticipating forward VB date movement, I went to my PCP last month for Titers of MMR,Varicella. Took the TDAP shot, was sure we didn't get, coz it was introduced in recently (2004). Titers came positive, so we had antibodies for MMR & Varicella. Took the official letter from Doctor.

After looking at Dec bulletin, made Civil Surgeon appointment. Said they would charge $260 per person (doesn't include X-rays if needed). Had to choose because didn't want to drive too far.

On the day of appointment, there was no doctor in office. But thank god, the Nurse took Blood & Urine sample & also Gave TB PPD shot for skin test. She gave the I-693 forms and asked to fill. I gave her my vaccination confirmation and she delightfully said, great, no more vaccination needed.
So, we can come back 2 days later for TB skin test evaluation & Blood test results. Doctor checked skin and measured and said TB Positive! Go to next room for X-Ray (additional $65). Doctor also did some physical tests, then asked us to sign the forms.
2 days later I called Doctor's office and she said, papers are ready for pickup. Went in the evening and picked-up the sealed envelope.

One done from TO DO list. :-)