Receiving a Request for Evidence (RFE) from U.S. Citizenship and Immigration Services (USCIS) often feels stressful when it’s related to your Form I-693 Report of Immigration Medical Examination and Vaccination Record when applying for your green card.
The good news is that an RFE is not a denial. In most cases, USCIS simply needs additional information, clarification, or a corrected medical examination before they can continue processing your application.
At Recharge Medical in San Francisco, we’ve completed thousands of I-693 immigration medical examinations since 2007. We’ve also been asked to help hundreds of patients whose original I-693 was completed incorrectly at another clinic or who received an RFE related to their immigration medical exam.
That experience has given us a good understanding of what is most likely to trigger an RFE, what can be prevented, and what simply happens despite everyone’s best efforts.
While some RFEs are unavoidable, many result from small clerical mistakes, incomplete documentation, or misunderstandings that could have been prevented. Let’s look at both the unavoidable and avoidable ones.
If you are reading this before you complete your I-693 exam, learn the 15 common mistakes that delay your I-693 process (and how to avoid them) and how to prepare for your I-693 immigration medical exam. These can help you or someone you know avoid future RFEs.
RFEs that can’t be prevented
Even when you, your attorney, and your civil surgeon do everything correctly, an RFE can still happen.
1. Processing delays at USCIS
Immigration cases often take months—or even years—to be reviewed. You may have completed your I-693 correctly and submitted it with your Form I-485 exactly as instructed.
However, by the time an immigration officer reviews your file, the USCIS forms, policies, or expiration rules may have changed.
USCIS policy instructs officers to evaluate your medical examination using the rules that were in effect when your exam was completed. Even so, processing delays and policy changes can occasionally result in an RFE requesting updated documentation.
While frustrating, these situations are outside the patient’s or civil surgeon’s control.
2. Your original immigration application was denied, withdrawn, or refiled
One of the most misunderstood aspects of Form I-693 is that it is generally considered a single-use document. If your adjustment of status application is approved, great! You’ll never need it again.
However, if your application is:
- Denied
- Withdrawn
- Administratively closed
- Refiled under a different application
then USCIS may require a new immigration medical examination.
This doesn’t mean anything was wrong with your original exam. It simply means the original I-693 can no longer be used.
3. Lost mail or administrative errors
Sometimes paperwork simply disappears. Occasionally USCIS may indicate they never received your I-693. Other times the form may have been delayed in the mail, misfiled, scanned incorrectly, or otherwise not associated with your case. While these situations are uncommon, they do happen. When they do, USCIS often issues an RFE asking for another copy or a new examination.
4. Human error
No system is perfect. Occasionally an immigration officer or administrative staff member may simply misread information. We once assisted a patient whose RFE stated that the physician’s signature was five years old. After reviewing our records, it was clear the examination and signature had actually been completed less than one month earlier. The dates had simply been misread. Fortunately, issues like this are usually straightforward to resolve once the documentation is reviewed.
RFEs that should not happen
Many RFEs are entirely preventable when patients present all the required information correctly and an experienced civil surgeon carefully completes the paperwork before it is submitted.
Some of the avoidable problems we’ve seen include:
- Misspelled patient names.
- Incorrect dates of birth.
- Using an outdated version of Form I-693 when a newer required version was available.
- Missing required vaccines.
- Administering the wrong vaccines because records were not reviewed carefully.
- Missing physician signatures.
- Missing patient signatures.
- Missing interpreter signatures.
- Signature dates that do not comply with USCIS requirements.
- Illegible handwriting.
- Sealed envelopes that have been broken or opened.
- Missing required chest X-ray documentation after a positive tuberculosis screening test.
- Missing follow-up laboratory documentation when required.
- Completing the medical examination before the applicant was eligible to move forward with adjustment of status.
Most of these problems can be prevented with careful attention to detail.
The most common preventable problem: vaccine issues
If we had to choose one issue that leads to more avoidable RFEs than any other, it would be vaccination documentation:
- Patients declining recommended vaccines.
- Vaccine records that aren’t reviewed carefully.
- Required vaccines that are accidentally omitted.
The challenge is that I-693 vaccine requirements are different for every patient based on:
- Age.
- Medical history.
- Previous vaccinations.
- CDC recommendations.
- Laboratory evidence of immunity.
This is why we encourage patients not to guess which vaccines they need before their appointment.
Bring every vaccination record you can find and let your civil surgeon determine exactly what is required.
What should you do if you receive an RFE?
Step 1: Don’t panic
An RFE does not mean your green card application has been denied. In most cases, USCIS simply needs additional information before continuing to process your application. Many I-693-related RFEs can be resolved relatively quickly.
Step 2: Don’t try to interpret the letter yourself
One of the biggest mistakes patients make is reading the first page of the RFE and assuming they understand exactly what USCIS is requesting. Most RFEs contain several paragraphs of standardized language that appear in almost every letter. For example, USCIS often reminds applicants to:
- Use a currently designated civil surgeon.
- Use the correct edition of Form I-693.
- Follow current filing instructions.
These statements do not necessarily mean that your original examination had those specific problems. The actual reason for the RFE is often found in one or two sentences buried later in the letter. Those sentences explain exactly what USCIS believes is missing or incorrect.
Step 3: Give the entire RFE to your attorney and civil surgeon
Don’t send only the first page. Provide every page of the RFE to your attorney and your civil surgeon. The additional pages often contain important details that determine exactly how the issue should be corrected.
Step 4: Work with an experienced civil surgeon
Sometimes the solution is simple. Your original civil surgeon might only need to:
- Provide additional documentation.
- Correct a clerical error.
- Complete missing information.
- Issue a corrected I-693.
Other situations require a completely new immigration medical examination. An experienced civil surgeon should be able to review the RFE, explain what USCIS is requesting, and help determine the most appropriate next step. If your original clinic isn’t willing to review the RFE with you or doesn’t seem familiar with the issue, consider seeking a second opinion from a civil surgeon with extensive immigration medical experience.
At Recharge Medical, we’re frequently asked to help patients understand and resolve RFEs after examinations completed at other clinics.
Step 5: Respond as soon as possible
Every RFE includes a response deadline. Don’t wait until the last week. Some corrections require:
- Additional vaccines.
- Laboratory testing.
- Chest X-rays.
- Medical records from previous physicians.
Starting early gives you time to gather everything USCIS is requesting before the deadline.
Experience matters
Every USCIS-designated civil surgeon is authorized to perform immigration medical examinations.
However, experience matters. A civil surgeon who performs immigration exams every day develops a deeper understanding of:
- USCIS documentation requirements.
- CDC technical instructions.
- Complex vaccination histories.
- Common paperwork mistakes.
- Laboratory interpretation.
- The issues most likely to trigger an RFE.
Receiving an RFE can feel discouraging, but it is usually a request for additional information—not a denial of your immigration application. The key is to:
- Stay calm.
- Read the entire notice carefully.
- Work with your immigration attorney.
- Share the entire RFE with your attorney and civil surgeon.
- Respond before the deadline listed by USCIS.
Most importantly, remember that many I-693-related RFEs can be resolved successfully with the right guidance and documentation.
At Recharge Medical in the San Francisco Bay Area, our goal is simple: to help every patient complete their immigration medical exam accurately, efficiently, and with as little stress as possible. Since 2007, we’ve performed thousands of I-693 immigration medical examinations and have helped hundreds of patients navigate RFEs or correct problems with exams completed elsewhere. While no civil surgeon can prevent every Request for Evidence, experience, careful attention to detail, and open communication can significantly reduce the risk of unnecessary delays.
Whether you’re preparing for your first I-693, responding to an RFE, or simply have questions about the immigration medical examination process, we’re committed to providing thorough, compassionate care and helping you move your immigration journey forward with confidence.
If you’re in the San Francisco Bay Area and need a green card medical examination or assistance with an I-693-related RFE from USCIS, we’d be honored to help. Contact us today.
Consult your immigration attorney
Every immigration case is unique, and USCIS policies and procedures may change over time. This article is intended to provide general educational information about the Form I-693 immigration medical examination and common issues we’ve encountered through decades of performing immigration medical exams. It is not legal advice and should not be relied upon as a substitute for advice from a qualified immigration attorney.
If you have questions about your eligibility to file Form I-485, how to respond to a Request for Evidence (RFE), or any other legal aspect of your immigration case, we encourage you to consult your immigration attorney. We’re always happy to work closely with you and your legal team to ensure the medical portion of your application is completed accurately and efficiently.