Help! Do I send Out Form I-130 First or the whole Adjusment of status packet?

Depends, if the person you are sponsoring is in the US or in the home country. If in the US, then you can send in the whole AOS packet. If outside, then you will need CP and should start by sending in Form I-130 first.
 
you can send the medical examination at the same time, otherwise they will send you an RFE and ask you to submit it
 
The medical examination is part of the required documents for the I-485. You need to send it when you send the I-485. If you don't and they send you a Request for Evidence (RFE) then your application will be placed on hold until they receive your medical report.
 
If it's based on marriage to a US citizen, and the immigrant spouse (you?) is in the US after entering legally, you can file the whole I-130 + AOS packet together. Optionally, you can initially file the I-130 by itself, but if you do that you must wait for the I-130 receipt to file the rest of it for AOS.

For most other family cases, they have to file the I-130 first and then wait months or years before they can file the AOS or consular paperwork.
 
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