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

Five I-693 rules have moved since 2025. The sealed envelope stays closed only if you file your I-485 by mail. File online and you open it and upload the form. Only the 01/20/25 edition is accepted. Each I-693 belongs to one application and must be filed with your I-485. A new public charge rule starts September 18, 2026.

The video above was recorded in July 2025. Almost everything Dr. Gurpreet Singh Padda, MD, MBA, MHP explains about how the exam works is still exactly right. But a handful of the rules around it have moved since. One of them has flipped outright. This article puts the current rules next to the video, so you do not act on a year-old instruction.

Why a pain physician performs immigration exams

Dr. Padda came to the United States from India as a child in the 1970s. His family went through the whole immigration process themselves. Back then it was much harder than it is now. That is where this practice comes from. It is not a line of business added to a clinic. It is work done by someone who sat on the other side of it.

His point in the video is worth repeating: today’s pathways are algorithmic. The rules are written down. Meet them and you move ahead. Miss one and you do not. That is frustrating. But it is also good news, because it means preparation is the whole game.

Is the I-693 medical exam a general physical?

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

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

What has changed on the I-693 since 2025?

These are the current requirements. You can check each one at the source. The links go to USCIS and the Federal Register, not to a summary.

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

In the video Dr. Padda is firm: 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. If you file online, you must open the envelope and upload the completed I-693 yourself. 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 no longer applies to everyone. It depends on how you file. Check which path applies to you before you break a seal. That is 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. Does the I-693 expire? It is now tied to one application

USCIS policy took effect June 11, 2025. Under it, 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 paper 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. It applies to adjustment applications postmarked or electronically submitted on or after that date. It gives officers back broader discretion 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. USCIS defers to the civil surgeon’s I-693 on medical questions. In practice, it means accurate, complete, well-documented records matter more now, not less. Want the difference 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. CDC updated the Technical Instructions for Civil Surgeons on March 11, 2025.

Why does the civil surgeon need proof for every item?

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 red-tape caution. Say a civil surgeon records something without documentation. That exposes you to a finding of fraud later, and USCIS can revisit a file. You can recover from a rejection today. A misrepresentation in your immigration record is a different kind of problem.

In practice, only about 5 to 10 percent of applicants arrive with a complete package. That means 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. That is why a follow-up visit is a separate, published fee rather than a surprise.

Related reading: TB Testing for the Green Card Exam · May 2026 USCIS Memo and the Green Card Medical Exam · Anxiety and Your I-693 Exam Results

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. Policy took effect June 11, 2025. Under it, an I-693 signed on or after November 1, 2023 is valid only for the application it came with. 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 you. Also 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. With Regular, you pay nothing at booking and the full $390 at the visit. With Document Verified, you pay a $100 non-refundable 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. That is 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?

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

What are the most common reasons for I-693 rejection?

Four stand out under the current rules. The form is an outdated edition. Only the 01/20/25 edition is accepted for signatures on or after July 3, 2025. The envelope was opened or looks tampered with on a mail filing. The I-693 was left out of the I-485 package, which lets USCIS reject the I-485 outright. Or an item had no documentary proof, so the civil surgeon could not record it.

Which edition of Form I-693 does USCIS accept?

Only the 01/20/25 edition, for any I-693 a civil surgeon signs on or after July 3, 2025. The edition date is printed at the bottom of the form. An outdated edition is grounds for rejection. It is one of the five rules that moved after the July 2025 video was recorded. So an older guide may still show the previous edition.

When do I submit Form I-693?

With your Form I-485. Since December 2, 2024, USCIS requires the I-693, or a partial I-693 such as the vaccination record, in the same filing as the I-485. Without it, USCIS may reject the I-485 outright. How you file then decides the envelope. Mail filings keep it sealed. Online filings open it and upload the form, keeping the original and the envelope until USCIS decides.

Key takeaways

• The video is from July 2025. The exam process is unchanged, but five rules around it 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.

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.

Medically reviewed by Dr. 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 October 2026.