Medical Waivers for Green Card Applicants: How to Use Form I-693 to Bypass Vaccine Requirements

For many adjustment of status (I-485) applicants, the Form I-693 medical exam is a standard part of the green card process. However, those who are unable to receive certain vaccines—due to medical conditions such as allergies, pregnancy, or immunodeficiency—may qualify for a waiver of the vaccine requirement under the CDC’s and USCIS’s guidelines.

The Role of Form I-693 in Adjustment of Status

Form I-693, Report of Medical Examination and Vaccination Record, is required for most adjustment of status applicants. Its primary purpose is to confirm that the applicant is not inadmissible on public health grounds, including for communicable diseases or lack of required vaccinations.

USCIS requires that all vaccinations listed by the Centers for Disease Control and Prevention (CDC) be documented and up to date. Common required vaccines include:

• Measles, Mumps, and Rubella (MMR)

• Tetanus, Diphtheria, and Pertussis

• Varicella (Chickenpox)

• Hepatitis A and B

• Influenza (during flu season)

• Pneumococcal (based on age)

• COVID-19 (note recent policy change below)

Three Types of Vaccine Waivers

USCIS recognizes three general pathways to exemption from certain vaccine requirements:

1. Catch-Up Vaccination: The applicant receives the missing vaccines before the green card is approved, completing all required doses during processing.

2. Medical Waiver: The USCIS-authorized civil surgeon determines that a medical condition prevents safe vaccination. This is the most common and efficient route for those with documented medical contraindications.

3. Religious or Moral Objection Waiver: This must be filed as a separate, formal waiver application, and is generally more complex and less commonly used, especially among applicants without longstanding documented religious or moral objections.

   
   

Medical Waiver: Legal Basis and How It Works

A medical waiver is granted automatically when the civil surgeon certifies one of the following conditions on the I-693 form:

• The applicant’s age makes the vaccine inappropriate (e.g., adult applicants are not required to receive vaccines recommended only for children).

• The applicant has a medical contraindication, such as:

  • Documented severe allergy to a vaccine or its components

  • Pregnancy

  • Immunodeficiency or other condition where vaccination poses a health risk

• The applicant is unable to complete a vaccine series within the timeframe allowed for adjustment of status.

• The vaccine is not in season, such as the influenza vaccine outside of flu season.

No separate application or waiver form is required. The waiver becomes effective once the authorized physician indicates the exemption on the I-693.

Important Notes for Applicants

• If you have a documented allergy to vaccines or their ingredients, you may qualify for a medical waiver.

• You must see a USCIS-authorized civil surgeon—not a regular family doctor. The current list of approved physicians is available on the USCIS website.

• Proof of the medical condition—such as allergy testing records or letters from specialists—may be required by the civil surgeon to justify marking the waiver box.

Common Misconceptions

• Penicillin or general drug allergy does not automatically qualify for a vaccine exemption. There must be a direct allergy or contraindication related to the vaccine itself.

• Only USCIS-approved civil surgeons may complete and certify Form I-693. Documentation from other providers, even if medically valid, will not be accepted by USCIS.

COVID-19 Vaccination No Longer Required (Effective Jan. 22, 2025)

USCIS has announced that as of January 22, 2025, applicants are no longer required to show proof of COVID-19 vaccination when submitting Form I-693.

• COVID-19 vaccination will no longer be listed as a required vaccine.

• USCIS will not issue RFEs or Notices of Intent to Deny based solely on the absence of COVID-19 vaccination documentation.

• Adjustment of status applications will not be denied for lack of a COVID-19 vaccine.

How Our Office Can Help

We have successfully helped clients obtain medical waivers in a range of circumstances, including:

• Severe allergic reactions to multiple vaccines

• Pregnancy-related exemptions

• Time-limited gaps between multi-dose vaccines

• Conditions requiring individualized medical assessment

If you are preparing your green card application and are concerned about vaccine requirements, contact our office for a consultation. We can guide you through the I-693 process and help coordinate with USCIS-authorized physicians to ensure your application is complete and compliant.