Form I-693 - Report Of Medical Examination And Vaccination Record Page 13
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13Part 10. Additional Information
If you (the applicant or the civil surgeon) need extra space to provide any additional information within this form use the space below.
If you (the applicant or civil surgeon) need more space than what is provided, you may make copies of this page to complete and file
with this form or attach a separate sheet of paper. Type or print the applicant's name and A-Number (if any) at the top of each sheet;
indicate the Page Number, Part Number, and Item Number to which your answer refers; and sign and date each sheet.
1.
Family Name (Last Name)
Given Name (First Name)
Middle Name
A-
2.
A-Number (if any) ►
3.
A.
B. Part Number
C. Item Number
Page Number
D.
4.
A.
Page Number
B.
Part Number
C.
Item Number
D.
5.
A.
Page Number
B.
Part Number
C.
Item Number
D.
6.
A.
Page Number
B.
Part Number
C.
Item Number
D.
Form I-693 10/19/17 N
Page 13 of 13
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