Form I-693 Instructions 03/09/23 Page 5 of 12
A. Refer the applicant to the local health department if a chest X-ray suggests TB or other circumstances described
in the CDC’s Technical Instructions for Civil Surgeons.
(1) Abnormal chest X-ray ndings suggestive of TB that require health department referral include inltrate
or consolidation, reticular markings suggestive of brosis, cavitary lesion, nodule(s) or mass with poorly
dened margins (such as tuberculoma), pleural eusion, hilar/mediastinal adenopathy, miliary ndings,
discrete linear opacity, discrete nodule(s) without calcication, volume loss or retraction, irregular thick
pleural reaction, or other.
(2) Chest X-ray ndings that do not require referral to the health department include smooth pleural
thickening (if at costophrenic angle, must conrm that it is not an eusion by doing lateral or decubitus
radiograph or ultrasound), diaphragmatic tenting, single or scattered calcied pulmonary nodule(s), and
calcied lymph node(s).
B. Ensure that any applicant diagnosed with syphilis is treated with the standard treatment regimen described in the
CDC’s Technical Instructions for Civil Surgeons.
C. Ensure that the applicant is tested for gonorrhea and given appropriate therapy, if applicable.
D. Refer the applicant to a Hansen’s disease specialist for evaluation to conrm a suspected diagnosis of Hansen’s
disease (leprosy).
E. File a case report with the appropriate public health authorities if a case report is required by local laws or
regulations. You must also advise the applicant that a case report is being led.
How Do I, as a Civil Surgeon, Fill Out My Portion of This Form I-693?
You, as the civil surgeon, are responsible for ensuring that Form I-693 is completed and signed as follows.
1. Part 5. Applicant’s Identication Information. You are responsible for verifying the identity of the applicant and
noting in Part 5. Applicant’s Identication Information, Item Numbers 1. - 2., the form of identication that the
applicant presents to you and the identication number, if applicable. You are also required to check the top of each
page of Form I-693 to make sure the name and A-Number (if any) are correct. Finally, you must require the applicant
to sign the Applicant’s Certication in Part 2. in your presence. The applicant should sign at the beginning of the
immigration medical examination, following the completion of Parts 1. through 5.
2. Part 6. Summary of Medical Examination. After the medical examination and any required follow-up visits or
examinations, summarize the results in Part 6. When completing Item Number 2., be sure to use the date that you
obtained the applicant’s permission to conduct the immigration medical examination and any required testing or labs
(by obtaining their signature in Part 2.).
3. Part 7. Civil Surgeon’s Contact Information, Certication, and Signature. You must sign the certication after
the medical examination is complete. Fill out your identifying information in this part before referring an applicant
for further tests or evaluation. Do not sign and date this part until the referral or follow-up evaluation (if required) is
completed and the applicant is medically cleared. Your signature must be original. Stamped signatures or typewritten
names are not acceptable (except for blanket-designated health department or military physicians as described below).
You must also enter your Civil Surgeon Identication Number (CSID), unless you are preforming the examination
under a health department or military blanket designation. You can locate your CSID on the initial designation
approval letter sent to you by USCIS, National Benets Center. If you cannot locate your CSID, send an email to
In signing the Form I-693 in this part, you certify under penalty of perjury that you have a valid, unrestricted license
in the jurisdiction in the United States in which you are conducting immigration medical examinations. You also
certify under penalty of perjury that no other jurisdiction in the United States in which you conduct immigration
related medical examinations has revoked or placed restrictions on your license to practice medicine in that
jurisdiction.