IMMIGRATION MEDICAL EXAM & N-648 CERTIFICATION
USCIS Form I-693 Immigration Physical & N-648 Medical Certification.
Performed in Fresno by Dr. Nidia Payan, MD — family medicine physician at Inside Out Medical Center and a USCIS-designated civil surgeon. We complete and seal your I-693 packet for green card applicants, and provide N-648 medical certifications for citizenship applicants with qualifying disabilities or medical conditions.
USCIS-Designated Civil Surgeon
Immigration physicals, inside a physician-led primary care practice.
Dr. Payan is designated by U.S. Citizenship and Immigration Services to complete the Form I-693 medical examination required for adjustment of status. You receive the same attentive, bilingual care she brings to her primary care and aesthetic patients — and leave with a signed, sealed packet ready for USCIS submission.
What's included in the I-693 visit
- Comprehensive medical history review
- Full physical examination (vitals, head-to-toe)
- Required vaccination review and on-site administration
- Tuberculosis (TB) testing — IGRA blood test or PPD
- Required blood work (syphilis serology, gonorrhea where applicable)
- Urine testing per USCIS guidance
- Mental health and substance use screening
- Completed and signed Form I-693 in a sealed envelope
Citizenship Medical Waiver
Need an N-648 medical certification for your citizenship test waiver?
If you are applying for a disability exception to the English and civics requirements for naturalization, Dr. Payan can evaluate whether you qualify for Form N-648, Medical Certification for Disability Exceptions. As a family physician, she brings a careful, compassionate clinical lens to the assessment and documentation.
Administered on-site
Vaccines and labs we handle in one visit.
Vaccines available
- MMR (measles/mumps/rubella)
- Tdap (tetanus/diphtheria/pertussis)
- Varicella (chickenpox)
- Hepatitis B
- Hepatitis A
- Polio (IPV)
- Influenza (seasonal)
- COVID-19
- Pneumococcal (age-dependent)
- Meningococcal (age-dependent)
Labs in-house
- TB IGRA blood test
- TB PPD skin test
- Syphilis serology (RPR)
- Gonorrhea (when applicable)
- Urine analysis
- Vaccination titers (if records missing)
How the process works
Call our Fresno office. We'll confirm pricing, what to bring, and your appointment time.
45–60 minute appointment with Dr. Payan, plus required labs and vaccines on-site.
TB results and any outstanding items are reviewed within several days.
We hand you a signed, sealed Form I-693 ready to submit to USCIS — do not open it.
Frequently asked questions
Is Dr. Payan a USCIS-designated civil surgeon?+
Yes. Dr. Nidia Payan, MD, is a family medicine physician at Inside Out Medical Center and is authorized by USCIS to perform Form I-693 immigration medical examinations in Fresno, California.
How long does the immigration physical take?+
The in-office exam typically takes 45–60 minutes. If your vaccination records are complete and no additional testing is required, the sealed I-693 packet can often be ready the same week.
What vaccinations are required for I-693?+
USCIS requires age-appropriate vaccinations including MMR, Tdap, varicella, hepatitis B, polio, influenza (seasonal), and COVID-19. We review your records and administer or refer for any missing doses.
How much does the immigration physical cost?+
Costs vary based on required vaccinations and lab work. We provide a transparent quote during scheduling. Payment is due at the time of service.
Do I need to fast before the appointment?+
No fasting is required. Bring your photo ID, vaccination records, list of current medications, and Form I-693 if you already have it.
What if my TB test or other test comes back abnormal?+
Dr. Payan will discuss next steps with you directly. Additional follow-up or treatment may be required before USCIS can finalize your application.
What if I don't have my vaccination records?+
Bring whatever records you have. For missing immunizations, we can administer required vaccines on-site or order a blood titer to confirm existing immunity.
Should I open the sealed envelope?+
No. Do not open the sealed I-693 envelope under any circumstances — USCIS will reject a broken seal and require you to repeat the exam.
Do you offer appointments in Spanish?+
Yes. Our team is bilingual (English / Spanish). Tell us at scheduling if you'd prefer your visit in Spanish.
N-648 Citizenship Medical Waiver
N-648 questions, answered.
What is Form N-648 and who needs it?+
Form N-648, Medical Certification for Disability Exceptions, is filed alongside the N-400 naturalization application. It is for applicants who cannot meet the English and/or civics testing requirements because of a physical, developmental, or mental impairment. A licensed medical doctor, doctor of osteopathy, or clinical psychologist must complete it.
Who qualifies for an N-648 medical waiver?+
You may qualify if you have a medically determinable physical or mental impairment — or a combination — that has lasted or is expected to last 12 months or more and that prevents you from learning or demonstrating English, U.S. history, or civics. The impairment cannot be caused by illegal drug use.
What happens during the N-648 evaluation visit?+
Dr. Payan reviews your medical history, current diagnoses, medications, and supporting records, then performs a focused clinical assessment. If you qualify, she completes Form N-648 in plain language, explaining the diagnosis, its origin, severity, and how it specifically prevents you from meeting the testing requirements.
What should I bring to my N-648 appointment?+
Bring a government-issued photo ID, your Form N-400 receipt or filing details, a list of current medications, and any medical records, specialist notes, hospital discharge summaries, neuropsychological testing, or imaging that support your diagnosis. The more documentation you bring, the stronger the certification.
How long does the N-648 process take?+
The evaluation visit typically takes 45–60 minutes. If supporting records are complete, the signed N-648 can usually be ready within a few business days. Complex cases that require additional records or specialist input may take longer.
Can I submit N-648 with my N-400, or later?+
USCIS prefers that you submit Form N-648 with your N-400 application, but you may also submit it later — including at your naturalization interview. Submitting it early helps USCIS schedule appropriate accommodations for your interview.
What if Dr. Payan determines I don't qualify?+
If your condition does not meet USCIS criteria, we'll explain why honestly and discuss alternatives, such as requesting reasonable accommodations for your interview without a full waiver. We will not certify a waiver that is not medically supported.
Is the N-648 evaluation available in Spanish?+
Yes. The evaluation, discussion, and patient-facing portions are available in English or Spanish. The completed Form N-648 itself is submitted to USCIS in English, as required.
Book your immigration physical.
Call our Fresno office or send a message to schedule your I-693 exam with Dr. Payan. We'll confirm pricing and what to bring — no consultation deposit required.