ic ation . ▁When ▁the ▁National ▁Vis a ▁Center ▁( N VC ) ▁determ ines ▁that ▁an ▁imm igr ant ▁vis a ▁is ▁available , ▁the ▁case ▁can ▁be ▁adj ud ic ated . ▁If ▁the ▁al ien ▁is ▁already ▁in ▁the ▁US , ▁that ▁al ien ▁has ▁a ▁choice ▁to ▁final ize ▁the ▁green ▁card ▁process ▁via ▁adjust ment ▁of ▁status ▁in ▁the ▁US , ▁or ▁via ▁cons ular ▁processing ▁abroad . ▁If ▁the ▁al ien ▁benef ici ary ▁is ▁outside ▁of ▁the ▁USA ▁they ▁can ▁only ▁apply ▁for ▁an ▁imm igr ant ▁vis a ▁at ▁the ▁U . S . ▁cons ulate . ▁The ▁US C IS ▁does ▁not ▁allow ▁an ▁al ien ▁to ▁purs ue ▁cons ular ▁processing ▁and ▁adjust ment ▁of ▁status ▁( A OS ) ▁simultaneously . ▁Prior ▁to ▁fil ing ▁the ▁form ▁I - 4 8 5 ▁( Ad just ment ▁of ▁Status ) ▁it ▁is ▁required ▁that ▁the ▁applic ant ▁have ▁a ▁medical ▁exam ination ▁performed ▁by ▁a ▁US C IS - appro ved ▁civil ▁sur geon . ▁The ▁exam ination ▁includes ▁a ▁blood ▁test ▁and ▁specific ▁imm un izations , ▁unless ▁the ▁applic ant ▁provides ▁proof ▁that ▁the ▁required ▁imm un izations ▁were ▁already ▁done ▁elsewhere . ▁The ▁civil ▁sur geon ▁hands ▁the ▁applic ant ▁a ▁se aled ▁en velope ▁containing ▁a ▁completed ▁form ▁I - 6 9 3 , ▁which ▁must ▁be ▁included ▁un open ed ▁with ▁the ▁I - 4 8 5 ▁application . ▁( The ▁c ited ▁reference ▁also ▁states ▁that ▁the