On December 2, 2024, USCIS updated the Form I-693 Report of Immigration Medical Examination and Vaccination Record instructions. The update states that most* Adjustment of Status applicants must now submit the completed medical exam at the same time as their Form I-485.  

Previously, USCIS has encouraged the medical exam to be filed with the Form I-485 but allowed it to be submitted at a later date.

This update comes after an April 2024 decision was made to change the Form I-693’s validity period from two years from time of signature to an indefinite validity.  

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*   Not all Adjustment of Status applicants are required to complete a Form I-693, Report of Immigration Medical Examination and Vaccination Record. Visit https://www.uscis.gov/policy-manual/volume-8-part-b-chapter-3 to confirm whether a medical exam is required for your Adjustment of Status application.