After the medical exam is complete, the Civil surgeon will certify the results on the appropriate forms and place them in a sealed envelope with label on the back - “DO NOT OPEN THE SEALED ENVELOPE.” Do not accept it if it is not in a sealed envelope.USCIS will return the form to you if it is not in an envelope or if the envelope has been opened or altered. You, the applicant, not the Civil surgeon, are required to submit the Form I - 693 to USCIS. You need to turn in your envelope with your immigration application. Follow the instructions on or included with the application or the instructions given to you by the office requesting the medical examination.