I-693 Deficiency Notice

If you've received an I-693 Deficiency Notice, there is nothing to worry about. This article covers what these notices mean, and how to respond to them.
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An I-693 Deficiency Notice is very common – most of our clients who are applying for adjustment of status to permanent resident (green card) receive this letter.

This notice informs the applicant that a medical exam has not been received by USCIS, and that one must be presented at the interview.

A medical exam may be submitted at the time of filing the I-485 Adjustment of Status application, or at the interview.

9.5 times out of 10, we advise our clients to wait until the interview notice is received to complete the medical exam so that they may bring it to the interview.

Why didn’t we do the exam at the time of filing?

Once you complete the medical exam, it must reach a USCIS officer within 60 days. Also, the medical exam is valid for two years once it is signed by the doctor.

In our experience, we have seen USCIS lose documents that are submitted with the application package. The medical exam is delivered in a sealed envelope.

At one time, we submitted a client’s medical exam with the initial application. USCIS sent a Deficiency Notice, informing us that a medical exam was not received. Our client was forced to obtain another medical exam before the interview, and had to pay an additional $500 for it (the doctor must certify that a blood test was performed at the time of signing, and during flu season the doctor is required to administered a flu shot).

Our client arrived at the USCIS interview with the new medical exam, only to learn that the original exam was in the file.

Although this is a clear USCIS error, the client was not able to recover the cost of the second exam.

For this reason, we advise our clients to avoid this situation by bringing the sealed medical exam to the interview. That way we can ensure the envelope is handed directly to a USCIS officer.

Should I do the medical exam now, and mail it in?


When an application is submitted to USCIS, it first arrives at a “Lockbox,” which is a facility that does the initial processing to determine if the forms are signed and processes payment. The file then moves to a service center that determines whether all of the initial evidence is included. The service center dispatches the I-693 Deficiency Notice.

At some point, the file is then transferred to the local USCIS Field Office where the final review and interview will take place.

There is a high risk that evidence mailed in at this time, including the medical exam, will be lost or never make it to the file. It’s not worth the risk.

So when should I do the medical exam?

The medical exam must reach a USCIS officer within 60 days of being signed by the doctor. Therefore, we advise you to wait until the interview notice is received.

Usually the interview takes place between 3 and 5 weeks after the notice is sent.

Usually, a USCIS-certified civil surgeon (doctor) will be able to schedule an appointment within just a couple of days. After the appointment, it usually takes about 1 week to get the results from the blood tests, and to certify the form, giving you enough time to pick it up and bring it with you to the interview.

Wait until the interview notice arrives, and then we’ll guide you through the medical exam process.

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