Instructions For Report Of Medical Examination And Vaccination Record (Page 6 of 12) in pdf

5. Part 8. Referral Evaluation. If you refer the applicant to a local health department or to another physician or clinic,

you must also fill out Item Number 5. Required Referral to Health Department or Other Doctor in Part 7. Civil

Surgeon Worksheet in Form I-693. The health care professional receiving the referral must fill out and sign Part 8.

Referral Evaluation. Do not complete Item Number 5. in Part 7. if the referral is recommended and not required.

How Do I Complete Form I-693 If I Need to Make a Required Referral?

Advise applicants that they must complete all health-related follow-up requirements before you can certify Form I-693.

You must fill out Item Number 5. Required Referral to Health Department or Other Doctor in Part 7. Civil Surgeon

Worksheet with the contact information of the physician or public health facility that will conduct further evaluation or

provide treatment. You should also specify the type of examination and additional tests or treatment that the applicant

should receive in the Remarks section of Item Number 5. The health care professional receiving the referral must fill

out and sign Part 8. Referral Evaluation. Do not complete Item Number 5. in Part 7. if the referral is recommended

and not required. Complete your identifying information in Part 6., but do not sign or date the form. Make a copy of

the Form I-693 for your records and give the original to the applicant in a sealed envelope. (See the next section for

additional instructions for sealing the envelope.)

What Should I Do After the Medical Examination and Health-Related Follow-Up Requirements (If

Required) Are Completed?

After the medical examination and any health-related required follow-up is complete, summarize the results in Part 5. of

Form I-693. Do not sign Form I-693 until the applicant has met all health-related follow-up requirements. After that,

sign the civil surgeon’s certification in Part 6., Item Number 8.

Make two copies of the completed and signed Form I-693 and any supporting documents. Keep one copy for your

records. Give the other copy to the applicant. The vaccination portion of Form I-693 will serve as the applicant’s official

vaccination record for future use (for example, school or employment purposes.)

Prepare the original of the completed and signed Form I-693 for submission to USCIS.

Follow these steps:

1. Place the Form I-693 and any supporting documentation into an envelope.

2. Seal the envelope.

3. On the front, write in capital letters: “DO NOT OPEN. FOR USCIS USE ONLY.”

4. On the back, write your initials across the seal where the flap meets the envelope.

5. Seal the entire flap with clear tape. Make sure the tape covers your initials as well as the flap.

6. Give the sealed envelope to the applicant.

The applicant must submit the sealed envelope to USCIS.

IMPORTANT: USCIS will not accept Form I-693 unless it is in a sealed envelope that is not opened or altered in

any way.

Return to the applicant all supporting medical documents that you were not required to include in the sealed

envelope.

Form I-693 Instructions 02/07/17 N

Page 6 of 12

Instructions For Report Of Medical Examination And Vaccination Record Page 6