the 'consulate file' is another 'sealed envelope', is handed over to the CBP goons at the POE.
It contains the entire I-129F petition, all VISA application forms, resulting namecheck documentation, notes from USCIS/NVC/USEmbassy.
If THAT is lost - ouch - I don't know what to tell you.
Sometimes the 'medical exam' is inside the 'SEALED ENVELOPE' itself, so it won't be 2 sealed envelopes - instead - it will be only one.
This varies by country and Embassy - but....
make sure he has that SEALED ENVELOPE from the Consulate - if he has that, then he doesn't need to worry about the medical exam - as
EITHER
--he can get a new medical exam in the USA or
--the medical exam is IN the SEALED ENVELOPE from the Consulate.