The short answer is no, a routine drug screen is not part of the standard Form I-693 process. The exam does include blood and, for certain age groups, urine testing, but those screen for specific infectious diseases, not controlled substances. The civil surgeon will, however, ask about your substance use history and may order additional testing if clinical concerns arise. The Jamaica, Queens immigration medical exam providers at Rock Medical PC help applicants prepare so there are no surprises on exam day.
What the Immigration Medical Exam Actually Tests For
The immigration medical exam required for Form I-693 focuses on identifying communicable diseases of public health significance, verifying vaccination status, and evaluating physical and mental health. It is not designed as a drug screening. The lab work included in the exam targets specific infectious diseases rather than controlled substances.
Per current CDC Technical Instructions for Civil Surgeons, applicants aged 18 to under 45 must be tested for syphilis using both a nontreponemal test (such as RPR) and a treponemal test. Younger or older applicants are tested only if there is reason to suspect infection.
Applicants aged 18 to 24 must also be tested for gonorrhea using a nucleic acid amplification test (NAAT), which can be performed on a urine sample or a swab. Applicants outside that age range are tested if clinically indicated.
Every applicant aged two and older receives a tuberculosis blood test called an interferon-gamma release assay (IGRA), which has replaced the older skin test for immigration purposes.
The civil surgeon also reviews your vaccination records and may administer any immunizations you need to meet current CDC requirements. Required age-appropriate vaccines typically include, but are not limited to:
- MMR
- Varicella
- Tdap
- Polio (IPV)
- Hepatitis B
- Influenza during flu season
USCIS waived the COVID-19 vaccine requirement on January 22, 2025. The CDC formally removed COVID-19 from the required vaccine list on March 11, 2025, so it is no longer part of the immigration exam process.
How the Civil Surgeon Evaluates Substance Use
While there is no standard drug test, the civil surgeon is required to assess your substance use history as part of the mental health evaluation. This assessment follows CDC Technical Instructions and uses uniform diagnostic criteria consistent with the DSM-5-TR, the diagnostic manual published by the American Psychiatric Association.
During the exam, the civil surgeon will ask questions about past and current use of alcohol and controlled substances. They will also review your medical records for any history of substance use treatment and observe your physical appearance and behavior for signs that may indicate active substance use. These signs can include changes in motor ability, skin appearance, or evidence of intoxication during the appointment.
If the civil surgeon identifies clinical concerns based on your answers, records, or observations, they have the authority to order additional testing, including a drug screen. They may also refer you to a mental health specialist for further evaluation if they cannot reach a clear determination on their own.
What Happens If Drug Use Is Identified
Under federal immigration law, a determination that an applicant is a drug abuser or addict makes them inadmissible under INA Section 212(a)(1)(A)(iv). This means the civil surgeon’s assessment carries real weight in the green card process, even without a formal drug test.
Under current CDC guidance, an applicant must meet at least two of the eleven DSM-5-TR criteria for a substance use disorder to receive a clinical diagnosis. Whether that diagnosis results in an inadmissibility finding depends on the substance involved. A substance use disorder involving a controlled substance listed in the federal Controlled Substances Act is automatically inadmissible. A substance use disorder involving a non-controlled substance, such as alcohol, is only inadmissible if the civil surgeon also identifies associated harmful behavior.
Therefore, a single positive urine drug test or an admission of occasional use, on its own, may not establish inadmissibility. The eleven criteria are grouped into four categories: impaired control, social impairment, risky use, and physical dependence.
For most green card applicants, no waiver is available if a civil surgeon finds a current substance use disorder involving a controlled substance. Inadmissibility can only be overcome by demonstrating that the disorder is in sustained remission, which requires at least 12 consecutive months meeting no DSM criteria and verified abstinence. Waiver options exist for limited immigrant categories such as refugees and asylees, but are generally unavailable for standard adjustment of status applicants.
If you have concerns about how your history might affect your application, consulting with an immigration attorney before your medical exam is strongly recommended.
How to Prepare for Your Immigration Medical Exam in Jamaica, Queens
Knowing what to expect removes much of the stress from the Form I-693 process. Bring your vaccination records, a valid government-issued photo ID, and any relevant medical documentation. If you take prescription medications, bring a list of current prescriptions along with the prescribing physician’s information.
Be honest and straightforward during the substance use assessment. The civil surgeon’s role is to conduct a medical evaluation, not to act as an immigration enforcement officer. Accurate information helps ensure your Form I-693 is completed correctly, which reduces the risk of delays or requests for additional evidence from USCIS.
Schedule Your Immigration Medical Exam at Rock Medical PC
Rock Medical PC in Jamaica, Queens provides USCIS-designated civil surgeon services for Form I-693 immigration medical exams. Dr. Farid Shahkoohi, board certified by the American Board of Internal Medicine, brings over 30 years of medical experience to each evaluation. Our bilingual (English and Spanish) staff guides you through each step of the Form I-693 process so you can move forward with your application confidently. Contact Rock Medical PC to schedule your appointment or book your appointment online.
