N‑648 Medical Waiver Exam for U.S. Citizenship
Table of contents
What is the N‑648?
The N‑648 is a special medical form for immigrants applying for U.S. citizenship who cannot learn English or U.S. history due to a serious brain or mental condition. USCIS uses the results of this exam to consider whether to waive the required English and civics tests.
Getting approved for this waiver is very difficult. USCIS denies most requests, even when the case appears strong. Filing this form does not guarantee approval.
Who is this for?
This form is only for people with severe cognitive or psychiatric conditions that make learning or remembering impossible.
Conditions that may qualify
- Dementia or Alzheimer’s disease.
- Stroke or traumatic brain injury.
- Autism or major developmental delay.
- Schizophrenia, severe PTSD, or other serious psychiatric disorders.
People who typically qualify
Those who:
- Cannot work or drive.
- Need daily assistance at home.
- Cannot pass written tests.
- Have extensive medical records and a formal diagnosis.
USCIS approval is very difficult
Even if your condition is serious, most N‑648 forms are denied.
What makes your case stronger
- Clear, long-term medical records.
- A formal diagnosis from a licensed specialist.
- History of therapy, hospital stays, or long-term treatment.
- Evidence that you cannot complete daily tasks independently.
What makes your case weaker
- No medical records or diagnosis.
- Ability to work, drive, or live independently.
- Struggles due to only poor schooling, illiteracy, or aging but not medical or psychiatric conditions.
- Condition caused by drug use or lasting less than 12 months.
Even with strong documentation, USCIS may still deny your request. We want to be honest—there is a high chance of denial, and it’s important to understand this before proceeding.
How much does the exam cost?
Includes:
- extended medical exam
- inspection and certification of prior health records
- documentation of disability status
- completion of N-648 paperwork
- electronic storage of records
The N-648 exam involves additional paperwork that takes time to organize and complete. It costs more than a regular medical exam. Depending on the findings of the exam, there can also be additional costs for required lab studies or diagnostic tests or other administrative services.
What happens at the exam?
- Length: At least 1 hour. Additional visits may be required.
- Includes: Physical exam, detailed interview, and medical record review.
- May include: Lab tests, imaging, or specialist referrals.
- Turnaround: Paperwork is usually ready about 2 weeks after all your records are received.
- Telehealth: Available in some states, but note that USCIS is more likely to reject video-based exams.
- Support: Limited post-exam assistance; additional charges may apply for follow-up documentation.
What to bring
- Valid Green Card.
- Medical records: Lab results, list of medications, imaging reports, therapy or progress notes.
- Doctor or therapist contact information.
- A translator, if needed:
- If you are not fluent in English, you must bring someone to interpret for you.
- The translator does not need to be a professional—a friend or family member is fine.
- However, they must speak and write fluently in both English and your language.
- If you are unable to bring a translator, we offer translation services.
- USCIS may also ask your translator to testify about the medical visit.
USCIS may disqualify your translator from participating in your citizenship interview if they are asked to testify about your exam.
Why choose Recharge Medical?
- Serving the immigrant community since 2007.
- Over 600 N‑648 exams per year.
- Exams performed by certified USCIS civil surgeons.
- Collaboration with attorneys and health care providers.
- All applications are reviewed thoroughly to meet strict USCIS standards.
Approval is not guaranteed
The N‑648 is for people with serious, documented medical conditions that truly prevent them from learning English or civics. If this describes you, we’ll handle your case with honesty, care, and professionalism—but approval is never guaranteed.
The N‑648 does not grant you the waiver. It is just one part of USCIS’s decision process.
They will also consider your:
- Your answers during your citizenship interview with a USCIS officer.
- The physician’s N‑648 form and exam findings.
- Any additional background information or documentation about you including your original I-693 documents.
- Testimony from your family or translator (if needed).
USCIS makes the final decision, and they often conduct their own review of your abilities and condition.