Keep the civil surgeon’s completed Form I-693 sealed when you mail it with your I-485 package. Open it only if USCIS directs you to, which happens when you file Form I-485 online and need to upload the contents yourself. In either case, hold onto the original sealed envelope: opening or altering it without that instruction can lead USCIS to reject or return the form.

TL;DR:

  • The envelope containing Form I-693 must remain fully sealed with tape and initials to be acceptable, especially when mailing the form to USCIS.
  • If filing online, applicants need to open the envelope themselves, scan, and upload the contents, but must keep the original sealed envelope for later proof.
  • Accepting an unsealed, damaged, or improperly sealed envelope from the civil surgeon can lead to rejection, Requests for Evidence, or delays.
  • USCIS updates have removed the expiration date rule for I-693 signed after November 1, 2023, but officers retain discretion to request a new exam if health status changes.
  • Most common mistakes involve mishandling the seal, using outdated forms, or failing to verify the seal during the appointment, which can be prevented with quick pre-mail checks.
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Table of Contents

Why USCIS requires the I-693 envelope to stay sealed

The sealed envelope exists to protect the civil surgeon’s signed findings from tampering between the exam room and the USCIS officer who reviews your case. Once a civil surgeon signs and seals Form I-693, that document is treated as an authenticated medical record, and USCIS needs assurance that nobody altered it after the fact.

If the envelope arrives opened, damaged, or without the required markings, USCIS will generally treat it as compromised. That usually means the agency returns the form, issues a Request for Evidence, or asks you to complete a brand new exam, any of which adds weeks or months to your case.

Before you leave the clinic, check these details:

  • The envelope is fully sealed with tape across the flap, not just tucked shut.
  • The civil surgeon’s initials appear on the back, visible under the tape.
  • The front carries the required “do not open” label addressed to USCIS.

Catching a problem at the clinic costs you five minutes. Catching it after USCIS opens your mail can cost you months.

How civil surgeons prepare and seal Form I-693

A properly sealed envelope follows a specific sequence, and you can watch for each step during your appointment. The Form I-693 instructions lay out exactly what the civil surgeon must do before handing you the envelope.

  1. The civil surgeon writes “DO NOT OPEN. FOR USCIS USE ONLY.” on the front of the envelope.
  2. The civil surgeon signs and initials across the back flap after placing the completed form inside.
  3. Clear tape goes over the flap, covering the initials so any later tampering would be obvious.
  4. The civil surgeon hands you the sealed envelope along with any supporting documents you’re meant to keep separately, such as vaccination records or lab reports not required inside the sealed packet.

Pro Tip: Ask the civil surgeon to seal the envelope while you’re still in the room, so you can confirm the initials and tape are in place before you leave.

Refuse the envelope if you notice missing initials, no tape, a flap that’s already open, or a form lacking the civil surgeon’s signature. A clinic following the correct procedure will re-seal or redo the packet on the spot rather than send you off with something USCIS is likely to reject.

Mail-in filing versus online filing: when to open the envelope

The single biggest point of confusion around Form I-693 is that the sealing rule isn’t absolute. It depends entirely on how you file your I-485.

  • If you’re mailing a paper I-485 package, submit the sealed envelope exactly as the civil surgeon gave it to you. Don’t open it, don’t peek inside, and don’t remove the tape.
  • If you’re filing I-485 online, USCIS instructs you to open the envelope yourself so you can scan and upload the I-693 contents as part of your digital filing.
  • After uploading, keep the original form and the envelope it came in. USCIS may ask to see them again at your interview or later in the process.
  • When in doubt about which filing mode applies to your case, confirm with your attorney or the civil surgeon’s office before touching the seal.

This split exists because paper filings rely on the physical seal as proof of authenticity, while online filings substitute a digital upload, but USCIS still wants the paper original available if a question comes up later.

Common mistakes applicants make with the sealed envelope

Most problems with Form I-693 trace back to a handful of repeated errors, and nearly all of them are avoidable with a quick check before you mail or upload anything.

  • Accepting an envelope from the civil surgeon that isn’t fully sealed, taped, or initialed.
  • Opening the envelope out of curiosity before a mail-in filing, which can trigger a rejection even if nothing inside was changed.
  • Filing online but forgetting to open the envelope and upload the contents, leaving USCIS without the medical evidence it needs.
  • Submitting an outdated form edition or one missing the civil surgeon’s signature entirely.
  • Failing to photocopy supporting documents before mailing the original package.

A short prevention habit solves most of this: verify the seal at the clinic, confirm your filing method before touching the envelope, and keep copies of everything you send.

If the envelope is opened, damaged, or returned

Mistakes happen, and USCIS has a path forward even when they do. The sequence below covers the most common scenarios.

  1. If you notice damage or an improper seal while still at the clinic, refuse the envelope and ask the civil surgeon to re-seal it or issue a fresh sealed copy.
  2. If USCIS returns your Form I-693 or issues a Request for Evidence, read the notice carefully, since it will specify whether you need a new exam or simply a corrected submission.
  3. Schedule a new exam promptly if required, and keep every piece of correspondence with USCIS, including the notice itself and your response.
  4. If the delay is creating a genuine hardship, such as an approaching interview date, document the timeline so you can reference it if you need to request expedited handling.

Civil surgeons who follow standard procedure will typically re-seal or re-issue the packet without hesitation. Keep that paper trail in case USCIS asks about the gap later.

What recent USCIS policy updates mean for your I-693

USCIS has changed the validity rules for Form I-693 twice in recent years, and both changes work in applicants’ favor. The agency removed the 60-day rule that used to tie the civil surgeon’s signature date to a strict submission window, cutting down on unnecessary Requests for Evidence tied to timing alone.

Building on that, USCIS announced guidance that a Form I-693 signed on or after November 1, 2023 does not expire, which removes a lot of the pressure applicants used to feel about submission deadlines.

  • The expiration relief doesn’t eliminate officer discretion.
  • An officer who has reason to believe your health status changed can still request a new exam.
  • Your practical move is the same regardless of policy updates: seal the form correctly, submit it with your application, and stay ready to get a new exam if asked.

Clinic best practices applicants should expect

Immigration physicals are a routine part of what we handle, and the sealing step is never treated as an afterthought. A compliant clinic seals the envelope correctly on the spot, gives you a patient copy of what you’re entitled to keep, and maintains its own records in case questions come up later.

Before you leave your appointment, ask your civil surgeon to confirm the seal is intact, ask what documents you should keep separately, and ask how the clinic handles a re-seal if something goes wrong in the mail.

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Getting your I-693 exam done right the first time

We run walk-in immigration physicals built around the exact sealing procedure USCIS expects, so you leave with a properly sealed envelope and necessary paperwork instead of a guessing game. Most visits wrap up quickly, and we hand you clear instructions on what to mail and what to keep.

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Bring a government-issued ID, your vaccination records if you have them, and any prior immigration paperwork related to your case. You can see our full list of immigration and occupational health services or read more about what to expect during the exam before you come in. When you’re ready, schedule your visit and we’ll get you a sealed, USCIS-ready Form I-693 the same day.

This article is general information, not a substitute for advice from a qualified doctor. Consult a qualified healthcare professional about your own circumstances before acting on anything here.

Getting your I-693 exam done right the first time — overview diagram

FAQ

Does the I-693 envelope need to be signed?

Yes. The civil surgeon signs Form I-693 itself before sealing it and also initials across the back flap of the envelope, with tape placed over those initials. A missing signature or missing initials is a red flag USCIS will likely act on.

What are the most common I-693 errors?

The most frequent problems are an improperly sealed envelope, opening it when filing by mail, forgetting to open and upload it when filing online, and submitting an outdated form edition. Keeping copies of everything before you mail or upload your package helps catch these mistakes early.

What envelope does a green card come in?

This question doesn’t apply to Form I-693, which is a medical exam record submitted as part of your application, not the card itself. The physical green card arrives separately from USCIS after your application is approved, through standard mail from the agency.

What are the new rules for form I-693?

USCIS removed the 60-day signature rule and later clarified that a Form I-693 signed on or after November 1, 2023 generally does not expire. Officers still retain discretion to request a new exam if they believe your health status has changed since the exam.