Dr. Gauthier has been designated as a Civil Surgeon by the U.S. Citizenship and Immigration Service (USCIS). There are essentially four steps to completing the I-693 form required for your immigration physical.
Please see the steps and forms below.
4 STEPS TO COMPLETE FORM I-693
1. Evaluating Whether Your Immunizations Are Up-To-Date:
Your vaccination history needs to be documented on Form I-693
Only immunizations documented appropriately (e.g., by a government entity or the clinic where they are received) are acceptable. The only exception is in the case of varicella (‘chickenpox’). In this case a verbal history of having had the ‘chickenpox’ is acceptable as documentation of immunity.
1. Tetanus immunization: A series of three immunizations
DTP/DTaP/DT - for those 2 months to 6 years of age
Td/Tdap - for those > 6 years of age
2. Polio(IPV) - a series of three immunizations given for those 2 months to 17 years of age
3. Rotavirus vaccine: A series of three immunizations given two months apart given orally to children 6 - 32 weeks of age.
4. Measles, mumps, and rubella (MMR): A series of two immunizations for those 12 months to 64 years of age
5. Hib - A series of two immunizations for those between 2 months and 4 years of age
6. Hepatitis A: A series of two immunizations given to children 12 - 23 months of age
7. Hepatitis B - a series of three immunizations for those from birth through 18 years of age
8. Varicella - a series of two immunizations for those 12 months or older for those with no history of having had
chickenpox or a negative varicella titer
9. Pneumococcal - for those 2-59 months of age (PCV) and those 65 years of age or older (PCV or PPSV)
10. Tetravalent meningococcal conjugate vaccine: Given to persons 11-18 years of age (MCV4)
11. Influenza: - for those 6 months of age or older (annually, each flu season.
For immigration purposes, the flu is: Oct 1 – Mar 31 annually.
2. Evaluating Whether You Have Tuberculosis:
Testing for tuberculosis is required for those 2 years of age or older (or < 2 years of age if there is evidence of contact with TB infection known or suspected) regardless of pregnancy or immunization with BCG vaccine previously. Possible exemptions to this include:
Written documentation (with specific testing details and a health care provider’s signature) of a prior TST
reaction of ≥mm or a positive IGRA; or
Written documentation of a history of a severe reaction with blistering to a previously performed TST.
A prior negative TST or IGRA (TB blood test) result from another doctor or clinic cannot be accepted since the civil surgeon must verify that the person applying for adjustment of status is the person appearing for the immigration medical exam. However, a positive TST or IGRA result may be accepted.
If the blood test is positive (> 5 mm) a chest x-ray will be required and the local Health Department notified.
Pregnant applicants, if a chest X-ray is required:
Applicants may defer the chest X-ray until after pregnancy.
If chest X-ray is deferred, the civil surgeon cannot complete the exam and sign Form I-693 until the chest x-ray is
performed and required treatment measures are taken (if needed).
An applicant will be referred to the TB Control Program of the local health department for TB when:
An applicant has an abnormal chest X-ray suggestive of active or inactive TB.
An applicant has clinical signs or symptoms suggestive of TB, regardless of cell-mediated immunity test or X-ray result.
An applicant appears very ill and in whom TB is suspected, requires immediate referral to avoid delay in treatment.
3. Evaluating Whether You Have Any Sexually Transmitted Diseases:
Laboratory studies for syphilis is required for those 15 years of age or older (or < 15 years of age if there is reason to suspect a syphilis infection).
Laboratory studies for gonnorrhea is required for those 15 years of age or older (or < 15 years of age if there is reason to suspect a gonorrhea infection).
4. The Performance Of The Physical Examination:
A civil surgeon cannot sign Form I-693 until all follow-up evaluations and required treatments for infectious diseases are completed
The physical exam will only be performed AFTER the above steps are completed
DOCTOR OFFICE VISITS
The process of completing an immigration physical exam requires two to three visits:
We require that you bring a valid, government-issued photo ID,
although it does not have to be issued by the United States.
Initial immigration physical exams are scheduled for Tuesday mornings. Payment for all three visits is due upfront. We require that you bring a valid, government-issued photo ID, although it does not have to be issued by the United States. Patients under 14 years of age may bring an alternative proof of identity so long as it lists the patient’s name, date and place of birth, and the full names of his or her parents. We also request that you bring any and all vaccine records so our medical professionals can determine if you require any immunizations, which will be administered in our clinic. Patients older than 2 years of age will receive a tuberculosis blood test, and patients 15 and older will be given a syphilis blood test and urine test for gonorrhea. For more detailed instructions, download our "instructions for patient’s".
You must return to Auburn Family Medicine for your second visit after 7 days of your initial visit. At this appointment, you will receive results from any tests performed during your initial visit and whether further testing or treatments are required. For many (but not all) applicants, Dr. Gauthier will perform your official immigration physical exam. You’ll then receive completed and sealed I-693 paperwork that will be ready to submit to USCIS. You’ll also be given a copy to keep for your records.
Third Visit (if necessary)
For those individuals who require further testing or treatment, a third and final visit will be scheduled. An immigration physical will be performed. You’ll receive completed and sealed I-693 paperwork that will be ready to submit to USCIS. You’ll also be given a copy to keep for your records.
Examination - $200
TDAP - $40
MMR - $65
Varicella - $100
Injection Fee - $15-$30
Flu Shot (Oct 1 - March 31) - $25
Chest X-ray (Charge determined by radiologist)
RPR, Gonorrhea tests – Determined by the lab