All About the Green Card Medical Exam Drug Test


Green Card applicants are required to complete a medical exam with an authorized civil surgeon. The standard exam does not include a drug test, but it involves urine and blood screenings that are known to catch certain drugs in your system. Generally speaking, urine tests are known to pick up “soft” drug usage within the previous two weeks, while blood tests may pick up hard drugs (though they rarely do in practice).

In addition to these standard screenings, the doctor will also ask for relevant health information, which may include drug use. If the doctor suspects that you have used illicit drugs based on your history, behavior, or physical appearance, the doctor may order a random drug screening at their discretion. The doctor can issue as little as 24 – 48 hours’ notice for a random drug screening, so they are extremely difficult to anticipate or prepare for.

Whether drugs come up in a test or through your verbal health history, the use of illicit drugs may be detrimental to your Green Card petition, even if you live in a city or state that permits recreational and/or medicinal drug use. Light (non-habitual) marijuana usage rarely carries negative penalties, but any other type of illegal drug use may make you inadmissible to the United States and consequently ineligible for a Green Card.

If drug usage is a potential issue, you should schedule a confidential consultation with an immigration attorney to discuss your case. Attorneys are bound to strict client confidentiality standards, so you do not need to be concerned about the attorney turning you in to local police or immigration authorities. An experienced immigration attorney will be able to advise you on how to best address your drug usage within the Green Card application process.

How to Find an Authorized Doctor

A Green Card medical exam must be performed by a doctor who is authorized by USCIS—otherwise referred to as an authorized civil surgeon. Military physicians are also authorized to perform a Green Card medical exam at a military treatment facility within the US, providing the applicant is a US veteran, member of the US armed forces, or a designated dependent of active or retired military members. 

Applicants who are outside of the United States must complete the Green Card medical exam with a panel physician. Panel physicians are different from civil surgeons as they are designated by the US State Department and provide immigration medical examinations for consular visa processing at a US Embassy or consulate abroad.

What To Bring to a Green Card Medical Exam

Once you have scheduled a medical exam with an authorized civil surgeon or panel physician, you’ll need to prepare the following materials:

  • Form I-693, Report of Medical Examination and Vaccination Record – this is the official report that must be completed and signed by the civil surgeon or panel physician
  • Government-issued photo ID – such as a driver’s license or US passport. If you are 14 or younger, you can bring any form of identification that shows your name, place of birth, date of birth, and parent’s full name (such as a birth certificate or affidavit) 
  • Vaccination and/or immunization records – such as DT, DTaP, DTP, hepatitis A, hepatitis B, Hib, IPV, meningococcal disease, MMR, OPV, pneumococcal influenza, rotavirus, Td, Tdap, or varicella

Be sure to bring proof of insurance and means to pay for the exam, too. It’s a good idea to call ahead to ensure the doctor accepts your insurance provider, and to verify the cost of the exam.

What to Expect During the Exam

The doctor will check your vaccination records and test you for communicable diseases such as syphilis and tuberculosis. If you need any new vaccinations, the doctor will administer them at this time. The tuberculosis test involves two parts, so you’ll need to return to the doctor’s office within 2 – 3 days to complete the test. The syphilis test involves a blood test.

The doctor will conduct an oral review of your health history. Most of these questions are specifically required for Form I-693, though some questions may be added to supplement the primary questions based on the doctor’s discretion. Some of the factors that doctors are instructed to look for when determining the necessity of a drug test include:

  • A history of substance abuse or dependence with a specific substance listed in Schedules I – V of Section 202 of the Controlled Substances Act (note that marijuana is listed as a controlled substance)
  • Any findings, presentation, or demeanor that may be associated with substance abuse or dependence, such as impaired motor functions, impaired speech or interpersonal skills, needle scarring, deepened skin coloring, skin ulcers along the veins in the arms or legs, or an abnormal liver (shrunken, bumpy, or hard to the touch)
  • Conflicting information provided by family members or other records, such as employment, school, military, or police records
  • Disturbing behavior that may be associated with a substance-related disorder
  • Evidence of false or unreliable information offered during the medical examination or interview
  • Evidence of intoxication with any substance during the examination
  • Follow-up of an initial positive drug screen, or a history of positive drug-screening tests
  • Inexplicable gaps in time between schooling or employment

When a doctor determines that a drug test may be necessary, he or she may request a test with as little as 24 – 48 hours’ notice. If “soft drugs” such as marijuana appear in the standard blood or urine test, this can also trigger a full drug test at the doctor’s discretion.

After the Exam

Assuming that you pass your medical exam, the doctor will complete and sign Form I-693. An assistant will make a copy for your records, and the doctor will need to seal the original form in an envelope for you to submit to USCIS. Make sure the envelope is properly sealed when you leave the appointment, as USCIS will not accept Form I-693 if the envelope has been opened or altered.

Keep in mind that passing the initial medical exam and attaining the doctor’s signature doesn’t mean that the doctor can’t request a drug test in the following days. If any drugs appear in your urine screening, or if the doctor later discovers a discrepancy in your medical history, he or she can still demand a drug test and alert USCIS that you may be inadmissible due to illicit drug use.

Call our Immigration team at(480) 626-2388 to discuss your case today.

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Call our Immigration team at (480) 626-2388 or fill out the contact form to discuss your case today.

Llame a nuestro equipo de leyes de inmigración al (480) 626-2388 para hablar sobre su caso hoy.