What Changed on the I-693 Since 2025 — Including the Sealed Envelope Rule

The video above was recorded in July 2025. Almost everything Dr. Padda explains about how the exam works is still exactly right — but a handful of the rules around it have moved since, and one of them has reversed outright. This article carries the current rule set alongside the video, so you are not acting on a year-old instruction.

Why a pain physician performs immigration exams

Dr. Gurpreet Singh Padda came to the United States from India as a child in the 1970s. His family went through the entire immigration process themselves, at a time when it was substantially harder than it is now. That is the origin of this practice — not a line of business added to a clinic, but work done by someone who sat on the other side of it.

His observation in the video is worth repeating: today’s pathways are algorithmic. The criteria are written down. Meet them and you proceed; miss one and you do not. That is frustrating, but it is also good news, because it means preparation is the whole game.

The I-693 is not a general physical

This trips up more applicants than any other misunderstanding. The I-693 is not a check-up. It is not looking for high blood pressure or diabetes. It exists to establish that you are not inadmissible on health-related grounds — principally communicable disease of public health significance, plus the vaccination record.

We cover that distinction in depth in Your USCIS Medical Exam Is Not a Physical. The short version: identity, communicable disease, and vaccination are the three things a civil surgeon must establish, and each one needs documentary proof.

What has changed since this video was recorded

These are the current requirements. Each is verifiable at the source, and the links go to USCIS and the Federal Register rather than to a summary.

1. The sealed envelope rule now has an exception — this one reversed

In the video Dr. Padda is emphatic: never open the sealed envelope. If it looks tampered with, it is rejected and you start over.

That is still correct if you file Form I-485 by mail. But USCIS now offers online I-485 filing for certain applicants, and if you file online you must open the envelope and upload the completed I-693 yourself. You then keep the original form and the envelope until USCIS makes a final decision on your case — they may ask for it at interview or as evidence.

So the instruction is no longer universal. It depends on how you file. Check which path applies to you before you break a seal, because the two rules point in opposite directions.

2. Only the 01/20/25 edition is accepted

For any Form I-693 a civil surgeon signs on or after July 3, 2025, USCIS accepts only the 01/20/25 edition. An outdated edition is grounds for rejection. The edition date is printed at the bottom of the form.

3. Your I-693 is tied to one application

Under USCIS policy effective June 11, 2025, an I-693 signed on or after November 1, 2023 is valid only while the application it was filed with is still pending. If that application is denied or withdrawn, the form dies with it — a future filing needs a new exam.

This is a real change in kind. The form is no longer a document with a shelf life you can reuse; it belongs to one case.

4. The I-693 must be filed with your I-485

Since December 2, 2024, you must submit the I-693 — or a partial I-693, such as the vaccination record — together with your Form I-485. Otherwise USCIS may reject the I-485 outright.

5. A new public charge rule takes effect September 18, 2026

DHS has rescinded the 2022 public charge regulations. The final rule was published July 20, 2026 and takes effect September 18, 2026, applying to adjustment applications postmarked or electronically submitted on or after that date. It restores broader discretion to officers to weigh all pertinent facts.

To be clear about what this does and does not mean: it does not change what the medical exam tests for. Health has always been one of the statutory factors in the public charge analysis, and USCIS defers to the civil surgeon’s I-693 on medical questions. What it means practically is that accurate, complete, well-documented records matter more now, not less. If you want the distinction between medical inadmissibility and public charge, we wrote it up separately in Does a Medical Condition Make You a ‘Public Charge’?.

6. COVID-19 vaccination is not required

The video states this correctly and it has not changed. USCIS waived the requirement effective January 22, 2025, and CDC updated the Technical Instructions for Civil Surgeons on March 11, 2025.

Why your civil surgeon cannot simply write it down

Dr. Padda is blunt about this in the video, and it is the part applicants push back on most: “I have to have proof on every single item.”

That is not bureaucratic caution. A civil surgeon who records something without documentation exposes you to a finding of fraud later — and USCIS can revisit a file. A rejection today is recoverable. A misrepresentation in your immigration record is a different category of problem.

In practice, only about 5 to 10 percent of applicants arrive with a complete package: identity documents, prior test results, and translated vaccination records. That figure is this practice’s own experience, not a published statistic. Everyone else needs a second step — which is why a follow-up visit exists as a separate, published fee rather than a surprise.

Frequently Asked Questions

Do I open the sealed I-693 envelope or not?

It depends on how you file. If you file Form I-485 by mail, do not open it — submit it sealed. If you file the I-485 online, you must open it and upload the form, then keep the original and the envelope until USCIS decides your case. Confirm your filing path before breaking the seal. Background on what the exam covers: Your USCIS Medical Exam Is Not a Physical.

My I-693 was signed last year. Can I reuse it for a new application?

Generally no. Under policy effective June 11, 2025, an I-693 signed on or after November 1, 2023 is valid only for the application it accompanied. If that case was denied or withdrawn, you need a new exam. See what every applicant should know before booking.

Does the new public charge rule change my medical exam?

No. The exam’s scope is unchanged. The rule affects how adjudicators weigh public charge factors on applications filed on or after September 18, 2026. Ask a licensed immigration attorney how it applies to your circumstances, and read Does a Medical Condition Make You a ‘Public Charge’?.

How much does the exam cost, and what is not included?

The I-693 examination is $390 — a $100 non-refundable scheduling fee at booking plus $290 at the visit. A follow-up visit, if one is needed, is $190. Laboratory testing and a chest X-ray are quoted at your visit, because which tests are required depends on your age and history and some applicants need fewer of them. If you use your own insurance for lab or imaging, you pay your insurer’s negotiated rate. Full breakdown on fees and processing timeline.

What should I bring so I only need one visit?

Photo identification or passport, any prior tuberculosis testing or chest X-ray reports, and your complete vaccination records with a certified English translation. See what counts as an acceptable vaccination record.

Key takeaways

• The video is from July 2025; the exam process is unchanged but five surrounding rules have moved.
• The sealed envelope instruction now depends on whether you file by mail or online — the two rules are opposite.
• Only the 01/20/25 form edition is accepted for signatures on or after July 3, 2025.
• An I-693 belongs to one application; a denial or withdrawal voids it.
• Bring documentary proof of everything, or expect a second visit.

Watch the full video above, and explore the rest of the series on our YouTube channel.

Medically reviewed by Gurpreet Singh Padda, MD, MBA, MHP — USCIS-designated civil surgeon (CSID 111051), board certified in Anesthesiology, Pain Medicine, Interventional Pain Management, Addiction Medicine, and Obesity Medicine. Last reviewed August 2026.

References

1. U.S. Citizenship and Immigration Services. I-693, Report of Immigration Medical Examination and Vaccination Record. https://www.uscis.gov/i-693
2. U.S. Citizenship and Immigration Services. Validity of Report of Immigration Medical Examination and Vaccination Record (Form I-693), policy update, June 11, 2025.
3. Department of Homeland Security. Public Charge Ground of Inadmissibility, final rule, 91 FR 45324, published July 20, 2026; effective September 18, 2026.
4. Centers for Disease Control and Prevention. Technical Instructions for Civil Surgeons, vaccination component, updated March 11, 2025.

This article is educational information about the immigration medical examination process. It is not legal advice and does not create a physician–patient relationship. For legal questions about your case, consult a licensed immigration attorney.