Every applicant for a green card must undergo a medical exam from an immigration approved physician and must be up to date on all required vaccinations. The results of the exam must be sealed in an envelope by the physician and submitted unopened to USCIS. However, you absolutely must request a photocopy of the exam results. Why? Because at least half the time the doctors are filling out an outdated form. USCIS rejects outdated forms. The only version of the medical form, Form I-693, that is currently acceptable is dated at the lower bottom right of the form (currently 7/20/2010). A form with any other date will be rejected. A quick glance at a photocopied form BEFORE it is submitted to USCIS with your green card application will save you the aggravation, delay and expense of having to return to the doctor for a new correct form.