One of the most common sources of anxiety about the immigration medical exam is the blood test. Many applicants worry about what the blood is tested for, whether they need to fast, and what happens if a result comes back positive. The blood tests required for your Form I-693 (Green Card medical exam) or visa physical are specifically designed to screen for a limited set of communicable diseases that are considered public health concerns by the CDC. They are not comprehensive health panels, and they do not test for drugs, cholesterol, or general wellness markers. The rules are slightly different depending on whether you are in the U.S. seeing a USCIS-designated civil surgeon or abroad seeing a Department of State-authorized panel physician. This guide breaks down exactly what blood tests are required, why they are needed, how to get them done, and what to expect if a test comes back positive.
Key Rule: Blood tests for the immigration medical exam are mandatory for specific age groups and are not optional. They screen for syphilis (applicants aged 15–44) and tuberculosis (TB) via an IGRA blood test (applicants aged 2 and older). HIV testing is not routinely required for U.S. immigration medical exams. You do not need to fast before these blood tests.
Which Blood Tests Are Required for the I-693 Exam?
If you are applying for a Green Card from inside the United States through adjustment of status, your exam will be performed by a USCIS-designated civil surgeon and documented on Form I-693. The required blood tests are strictly defined by the CDC's Technical Instructions for Civil Surgeons. Here is exactly what is tested:
- Syphilis (Serologic Test): A blood test for syphilis is required for all applicants aged 15 to 44. If you are under 15 or over 44, the test is only required if the civil surgeon has reason to suspect infection. The test is typically an RPR (Rapid Plasma Reagin) or VDRL (Venereal Disease Research Laboratory) test. If the test is positive, a second confirmatory test (treponemal test) is performed on the same blood sample.
- Tuberculosis (TB) Screening: A TB screening test is required for all applicants aged 2 and older. While this can be a tuberculin skin test (TST), many civil surgeons now use a blood test called an Interferon Gamma Release Assay (IGRA), such as QuantiFERON-TB Gold or T-SPOT.TB. The IGRA blood test is preferred because it does not require a return visit for reading and is not affected by previous BCG vaccination.
- Gonorrhea (Urine Test, Not Blood): While not a blood test, it is worth noting that a urine test for gonorrhea is required for applicants aged 15 and older.
Importantly, HIV testing is not routinely required for U.S. immigration medical exams. This is a common misconception, as HIV testing is required for some other countries' immigration processes (like Canada). For the U.S. I-693, HIV is only tested if clinically indicated. Additionally, blood tests for the I-693 do not screen for drugs, alcohol, or general health markers like cholesterol or blood sugar.
Blood Tests for the Visa Physical (Panel Physician Exam)
If you are applying for an immigrant visa from outside the United States, your medical exam will be performed by a Department of State-authorized panel physician. The required blood tests are similar but may have slight variations based on the CDC's Technical Instructions for Panel Physicians and the specific country's requirements.
The standard blood tests for the visa physical include:
- Syphilis screening – required for applicants aged 18 to 44.
- Tuberculosis (TB) screening – typically an IGRA blood test or chest X-ray, depending on age and country-specific guidelines.
In some countries, panel physicians may also test for HIV or hepatitis B and C if required by local health regulations or if clinically indicated. Always check with your specific panel physician or the U.S. embassy's website for the exact requirements in your location.
Step-by-Step Process for Getting Your Blood Test Done
The blood test is not a separate appointment—it is integrated into your immigration medical exam. Here is the complete workflow:
- Schedule your appointment with a USCIS-designated civil surgeon (if in the U.S.) or a Department of State-authorized panel physician (if abroad).
- Bring your documents: government-issued photo ID, vaccination records, and any relevant medical history. Do not sign Form I-693 until instructed.
- Complete the medical history and physical exam – The civil surgeon will review your history and perform a physical examination.
- Blood draw – The civil surgeon or their staff will draw blood for the required tests. This is a standard blood draw, typically from a vein in your arm.
- Urine sample – For gonorrhea screening (if you are 15 or older), you will provide a urine sample.
- Lab processing – The blood and urine samples are sent to a lab for analysis. Results typically take 2 to 5 business days to return.
- Follow-up (if needed) – If any test results are positive or require further evaluation, the civil surgeon will contact you for additional testing or treatment.
- Receive your sealed envelope – Once all tests are cleared, the civil surgeon will complete Form I-693, sign it, and place it in a sealed envelope for you to submit with your Form I-485.
The blood draw itself takes only a few minutes. The overall exam appointment typically lasts 30 to 60 minutes.
What Happens If a Blood Test Comes Back Positive?
A positive test result does not mean your application is automatically denied. The immigration medical exam is a screening process, not a final determination of inadmissibility. Here is what happens for each positive result:
- Positive Syphilis Test: If the initial screening test is positive, the civil surgeon will order a confirmatory test on the same blood sample. If confirmed, you will need to undergo treatment (typically with penicillin) and provide proof of treatment to the civil surgeon. Once treated, you are generally considered admissible.
- Positive IGRA (TB Blood Test): A positive IGRA indicates that you have been exposed to the bacteria that causes tuberculosis. It does not mean you have active, contagious TB. If the IGRA is positive, the civil surgeon will order a chest X-ray to determine if you have active TB disease. If the chest X-ray is clear, you are considered to have latent TB infection (LTBI) and are not inadmissible. If the chest X-ray shows active TB, you will need to undergo treatment before your application can be approved.
In both cases, the civil surgeon will guide you through the next steps. Treatment and follow-up may add time and cost to your process, but they will not necessarily prevent you from getting your Green Card.
Costs of Blood Tests for the Immigration Medical Exam
The blood tests are typically included in the civil surgeon's base exam fee, but some clinics bill them separately. The total cost of the I-693 exam (including blood tests) ranges from $200 to $500 on average, with some clinics charging up to $1,000 depending on location and additional services.
| Test | Typical Cost (if billed separately) | Notes |
|---|---|---|
| IGRA (TB Blood Test) | $100 – $190 | Often the most expensive single test |
| Syphilis Blood Test | $50 – $100 | Required for applicants aged 15–44 |
| Gonorrhea Urine Test | $50 – $100 | Required for applicants aged 15 and older |
Many civil surgeons offer package prices that include all required tests. When calling to schedule, ask for the total cost including all lab work and vaccines. Some clinics accept health insurance for the lab tests and vaccines, but the exam fee itself is often not covered.
Common Mistakes to Avoid
To ensure your blood tests are processed correctly and your I-693 is accepted, avoid these common errors:
- Going to an outside lab without the civil surgeon's order. The tests must be ordered by the civil surgeon as part of the exam.
- Fasting unnecessarily. You do not need to fast for the required tests. If you fast when not needed, it won't hurt, but it may make you uncomfortable.
- Not bringing vaccination records. While not a blood test issue, missing vaccination records can lead to additional vaccines and costs.
- Opening the sealed envelope. Once the civil surgeon seals your I-693, do not open it (unless filing online, in which case you must open it to upload).
- Assuming a positive test means denial. Positive results for syphilis or TB are treatable and do not automatically make you inadmissible.
Frequently Asked Questions
Q: Do I need to fast before the immigration medical exam blood test?
A: No. The required blood tests for syphilis and TB (IGRA) are not affected by food intake. You do not need to fast.
Q: Does the immigration medical exam blood test test for drugs?
A: No. The blood tests for the I-693 do not screen for drugs, alcohol, or illegal substances. They only test for syphilis and TB (and gonorrhea via urine).
Q: Does the immigration medical exam test for HIV?
A: HIV testing is not routinely required for U.S. immigration medical exams. It is only tested if clinically indicated. This is a common misconception, as HIV testing is required for some other countries.
Q: How long does it take to get blood test results for the I-693?
A: Blood test results typically take 2 to 5 business days to process. The civil surgeon will not complete your Form I-693 until all results are available.
Q: What happens if my syphilis test is positive?
A: A positive syphilis test requires a confirmatory test on the same blood sample. If confirmed, you will need to undergo treatment (usually with penicillin) and provide proof of treatment to the civil surgeon. Once treated, you are generally considered admissible.
Q: What happens if my TB blood test (IGRA) is positive?
A: A positive IGRA means you have been exposed to TB bacteria. The civil surgeon will order a chest X-ray to check for active TB disease. If the X-ray is clear, you are not inadmissible. If active TB is found, you will need treatment before your application can be approved.
Q: Can I get the blood tests done at my own doctor's office?
A: No. The blood tests must be ordered and reviewed by the USCIS-designated civil surgeon (for I-693) or the panel physician (for visa physical). Tests done outside of their office are generally not accepted.
Q: How much do the blood tests cost for the immigration medical exam?
A: The blood tests are typically included in the civil surgeon's base exam fee, which ranges from $200 to $500 on average. If billed separately, the IGRA test can cost $100–$190 and the syphilis test $50–$100.