Applying for a green card doesn’t only require you to file applications and submit documentation. Most individuals who are seeking U.S. permanent residency are also required to go through a medical examination by a certified USCIS doctor. A failure to submit Form I-693 (Report of Medical Examination and Vaccination Record) may result in the denial of a green card application.

The doctor will examine you and complete Form I-693. Both you and the doctor are required to sign the form. Once this is complete, place the document in a sealed envelope and submit to USCIS along with your application.

Here are 5 things you should know about the medical exam:

1. Only designated doctors are able to conduct the exam

Only certain doctors designated by the USCIS, also called civil surgeons, are able to conduct the exam. You can find a doctor close to you by using this online tool.

2. You must provide a record of all previous vaccinations

The record includes hepatitis A and B, and varicella. You will be required to be vaccinated for any diseases for which you cannot provide a vaccination record. The number of vaccines given will vary according to your medical history and the season. For example, the influenza vaccine is only given from October through March.

3. The doctor will ask you questions to assess your mental health

One of the key points of the exam is to determine if there are any mental health concerns such as drug abuse or harmful behavior that might make you ineligible for a green card. The civil surgeon may ask you questions that seem out of place in an attempt to analyze your behavior and reactions.

4. You will be tested for communicable diseases

The doctor will conduct a physical exam to evaluate the existence of symptoms associated with sexually transmitted diseases or leprosy. A blood test will be conducted to determine the existence of syphilis.

A tuberculosis test also called a tuberculin skin test, will also take place. In this case, you will have to come back to the doctor’s office two days later so that he or she can analyze your skin reactions associated with the test. If the initial tuberculosis screening is clear, no additional measures are necessary. If the initial screening results are not satisfactory, a chest X-ray will be prescribed for further investigation.

If the final results for any of the communicable diseases are positive, proper treatment will be prescribed by the doctor.

5. The cost of the exam varies

There is no USCIS filing fee associated with the medical exam form. However, each doctor will charge differently for the medical service. Some doctors will accept health insurance but others may not. Also, the cost will depend on your particular situation. For instance, if you have your vaccination record in order, the doctor will not need to prescribe new vaccinations and the cost will be lower. Keep in mind that the costs might increase if an X-ray is necessary or treatment for communicable diseases is needed.