Designated Medical Practitioner Handbook

Appendix II: Guide to the Completion of the
Medical Report Forms for Canadian Immigration

1. Medical report forms – General information

CIC’s Medical Report forms are the IMM 1017 (Medical Report: Section A) and the IMM 5419 (Medical Report: Sections B–E).

Canada’s Immigration and Refugee Protection Act provides three health grounds for inadmissibility: danger to public health, danger to public safety, and excessive demand on health or social services. Certain permanent resident applicants are exempt from excessive demand assessment, including refugees, spouses and dependent children of Canadians.

CIC has three different IMM 1017 forms, depending on whether or not an applicant is excessive demand exempt:

  • IMM 1017 – used for non-excessive demand exempt applicants. A sample form is presented in this appendix.
  • IMM 1017 EDE-EFE – used for certain excessive demand exempt applicants. It is similar in appearance to the IMM 1017, but marked with an EDE-EFE stamp to indicate it is an excessive demand exempt case. A sample form is presented in this appendix.
  • IMM 1017 EFC – used for certain excessive demand exempt family class applicants. A sample form is presented in this appendix, together with Appendix C – Medical Instructions. There are two IMM 1017 EFC forms, one used outside Canada and the other for persons examined in Canada.

IMM 1017 (05-1998)E

Sample of form IMM 1017 (Medical Report: Section A Client Identification and Summary)

IMM 1017 SCL (05-2004) E

Sample of form IMM 1017 SCL – Medical Report Spouse or Common–Law Partner

IMM 1017 (05-1998)E EDE-EFE

Sample of form IMM 1017 (Medical Report: Section A Client Identification and Summary)

IMM 1017 EFC (05-2003) and
Appendix C – Medical Instructions

Sample of Form IMM 1017 EFC - Medical Instructions

Appendix C – Medical Instructions

Sample of Appendix C – Medical Instructions



Appendix C — Fillable form
>> PDF format, size: 59 KB

When you and your family members go for your medical examination, make sure you have this sheet completed for each person, along with the following items:

  • passports for yourself and your family members, plus a photocopy of the bio-data page of each passport. If a passport is not available, provide an official identity document bearing the photo and date of birth of the family member;
  • eye glasses or contact lenses, if you or your family members wear them;
  • previous medical report(s), if any. You must tell the examining doctor about all past and present medical problems and conditions, and provide the doctor with any available documentation such as physician’s reports, treatment or prescriptions; and
  • five recent pictures taken within six months preceding the date of the examination and, where applicable, a negative for yourself and your family members (see section on photos in the instructions on how to complete the Application for permanent residence).

Make an appointment with one of the doctors identified on the enclosed list. A Medical Report, Section A (form IMM 1017 EFC) will be completed at the doctor’s office for yourself and each of your family members undergoing the medical exam. A photo of the person to be examined by the doctor will be affixed on both copies of that person’s form. This form is used to match your medical file to your immigrant file.

The doctor will sign the form and mail the first copy to the Canadian Regional Medical Office (RMO) with the results of the examination. You will be given the second copy as proof you underwent the medical examination. You must include this copy with your immigrant application when you send it to your sponsor. Photocopies will not be accepted. If you lose it, you will not be able to obtain a duplicate;you will have to redo the medical examination and pay any associated fees again.

We will review the medical results to determine whether there are any medical reasons which would prevent you or your family members from coming to Canada.You and each of your family members will also have to complete your own copy of the Medical Report, Section B (form IMM 5419). You will have to write your answers to the questions on this form in the presence of the examining doctor, who will then proceed to complete Section C, D and E. The medical examination includes:

  • complete physical examination for all family members;
  • chest X-ray and a radiologist’s report for everyone aged 11 years and over;
  • blood test for everyone aged 15 years or over;
  • urinalysis for everyone aged 5 years or over;
  • HIV testing for everyone aged 15 years or over, as well as for children who have received blood or blood products, or have a known HIV mother.

If your medical results prove satisfactory, they have a validity of one year from the date of examination. Therefore, you should make arrangements to have the date of your medical examination precede as closely as possible the date you will be sending your application and supporting documentation to your sponsor.

If the processing of your application for permanent residence is delayed and we cannot reach a decision about your application before the validity of your medical examination expires, you will be required to do the medical examination again.

IMM 5419 (08-1998)E
Section B

Sample of form IMM 1017 (Medical Report: Section B Functional Inquiry, Background information and applicant’s declaration

IMM 5419 (08-1998)E
Section C

Sample of form IMM 1017 (Medical Report: Section C Examining Doctor’s findings

Sample of form IMM 1017 (Medical Report: Section C Examining Doctor’s findings

IMM 5419 (08-1998)E
Section D

Sample of form IMM 1017 (Medical Report: Section D Laboratory Requisition

IMM 5419 (08-1998)E
Section E

Sample of form IMM 1017 (Medical Report: Section E Chest X-Ray report

Sample of form IMM 1017 (Medical Report: Section E Chest X-Ray report

2. IMM 1017 and IMM 1017 EDE-EFE – Section A: Client identification

2.1 The medical examination of an applicant is usually initiated after a Canadian immigration office has given an applicant an IMM 1017 or an IMM 1017 EDE-EFE with the client information completed.

2.2 The photograph of the applicant attached to the IMM 1017 or IMM 1017 EDE-EFE must match that on the government-issued photo-identity document, such as a passport or national identity card, and the appearance of the person attending for the IME. Discrepancies should be brought to the attention of the regional medical officer.

  • When a passport is not available, only an original national identity document incorporating a current photograph, full name, date of birth and signature can be substituted. The national identity card should have been issued within the last 10 years. Only original identity documents should be used.
  • Photocopies (certified or not certified) of passport or national identity documents are not acceptable.

    Once the applicant’s identity is confirmed, the photograph is to be stamped in the right corner by the DMP with the DMP stamp as acknowledgement and confirmation of identification of the applicant.

2.3 The “IMS Serial Number” and the “FOSS Client ID” boxes are normally blank as they are usually not known at the time the IMM 1017 or IMM 1017 EDE-EFE is issued to the applicant.

2.4 It is the responsibility of the DMP to ensure that the person being examined is the person referred to by name on the Medical Reports (IMM 1017 and IMM 5419). Information concerning the person’s surname (for married females, include the maiden name in brackets), forename and date of birth, and recent photographs attached to the front of the IMM 1017 and IMM 5419 (Sections D and E) should match the information and photographs in the applicant’s identity documents. Should there be doubts or suspicions regarding the identity of an applicant, the examination or investigations and the IME documents should be completed as usual. Details related to these doubts or suspicions must be recorded on the immigration medical examination form and forwarded to the responsible regional medical office as described in Chapter 9 of this handbook.

3. IMM 1017 EFC – Section A: Client information

3.1 The IMM 1017 EFC is used for certain excessive demand exempt members of the family class whose application is being processed outside Canada. DMPs will have a supply of these forms provided by their responsible regional medical office. These applicants have received an information guide specific to their geographic region which includes Appendix C: Medical Instructions (an example is provided earlier in this handbook).

3.2 The Appendix C: Medical Instructions section of the IMM 1017 EFC used outside Canada will identify the applicant as a member of one of the family classes exempted from the excessive demand determination and to whom the IMM 1017 EFC applies. Appendix C: Medical Instructions contains an identification section that the applicant must complete. An immigration medical examination should be undertaken only when the applicant brings a completed Appendix C: Medical Instructions to the DMP’s office. These applicants will not be in possession of an IMM 1017 or IMM 1017 EDE-EFE issued by a CIC office.

3.3 The DMP will confirm the applicant’s identity using a government-issued photo-identity document such as a passport or national identity card. When a passport is not available, only an original national identity document incorporating a current photograph, full name, date of birth and signature can be substituted. The national identity card should have been issued within the last 10 years.

Photocopies (certified or not certified) of passport or national identity documents are not acceptable.

Should there be doubts or suspicions regarding the identity of an applicant, the examination or investigations and the IME documents should be completed as usual. Details related to these doubts or suspicions must be recorded on the immigration medical examination form and forwarded to the responsible regional medical office as described in Chapter 9 of this handbook.

Following confirmation of the applicant’s identity, the DMP will:

  • ensure that the applicant indicates or states which member of the exempt family class they are, as specified in Appendix C (sponsored spouse, common-law partner, conjugal partner or dependent child);
  • attach photographs of the applicant to both copy 1 and copy 2 of the IMM 1017 EFC and to sections D and E of the IMM 5419, and stamp the top right corner of the photographs using the DMP stamp;
  • complete, in full, the required information in the sections “Details of person examined” and “Details of principal applicant” of the IMM 1017 EFC. The information must be identical on each of the two parts of the form (carbonless copy) and on Appendix C: Medical Instructions;
  • ensure that the field “the name of medical office to which the IMM 5419 will be sent” is completed, which will help the visa office locate the results if the office changes;
  • ensure that the applicant or parent/guardian signs the declaration in section 4 of the IMM 1017 EFC;
  • submit copy 1 of the IMM 1017 EFC and the rest of the medical examination documents to the regional medical office. Copy 2 must be returned to the applicant along with Appendix C: Medical Instructions as proof that the medical examination was completed and for return to the applicant’s sponsor in Canada.

3.4 It should be noted that the two duplicate copies of the IMM 1017 EFC contain an identical bar code identification number. This number makes each IMM 1017 EFC form unique. CIC will use this unique identification number to match the results of the medical examination to the immigration file. To avoid having the same identification number assigned to two different applicants, these forms must not be reproduced. The forms are printed with a special ink that makes it impossible to photocopy the green background properly. Thus, DMPs must ensure that they have enough of the IMM 1017 EFC forms to meet demand. The regional medical office has a sufficient stock of these forms to supply DMPs with forms on request.

4. IMM 1017 AND IMM 1017 EDE-EFE – Section A: Physician’s summary

4.1 After the medical examination of the applicant has been fully completed, the DMP should categorize the applicant’s condition and prognosis under one of the four categories described in this section of the form.

4.2 If, in the clinical opinion of the DMP, the applicant’s condition does not clearly fit into one of the first three categories (A, B, C) or if there is not yet sufficient information to make this determination, then the fourth category (D) should be used.

5. IMM 1017, IMM 1017 EDE-EFE, AND IMM 1017 EFC – Section A: Declaration of examining physician

5.1 This section must be fully completed, signed and stamped with the DMP stamp. A medical examination report that has not been signed or is not fully completed will be returned to the DMP for completion. This will cause a delay in the IMA.

5.2 It should be understood that the DMP, in signing this declaration, accepts full responsibility for the accuracy of what is entered on the form (except for omissions or errors on the part of the applicant).

5.3 Once the medical examination is fully completed and the declaration signed, the DMP should collate and forward the Medical Report with all required and relevant reports directly to the appropriate regional medical office. The DMP must not allow the completed Medical Report forms (IMM 1017 and IMM 5419) to be reviewed by the applicant or the applicant’s agent, nor provide them with copies.

Instructions on how applicants or their representatives may request copies of this information can be found in Chapter 6 of this handbook.

6. IMM 5419 – Section B: General information

6.1 Applicants who are excessive demand exempt are identified by, and will bring with them to the DMP office for examination, one of the following forms:

  • IMM 1017 EDE-EFE Medical Report
  • IMM 1017 EFC (in Canada) Medical Report
  • Appendix C: Medical Instructions

6.2 Applicants identified as being excessive demand exempt should not be investigated by the DMP beyond the functional inquiry, the physical/mental examination, and the required routine laboratory and radiology tests (chest radiograph, serological test for syphilis, serological test for HIV).

  • If an excessive demand exempt applicant provides information on a condition that might require significant medical or social services in Canada, either verbally or by providing copies of specialists’ reports, this information may be included with the immigration Medical Report, but should neither cause delay nor add additional expense for the applicant.
  • If, in the DMP’s clinical opinion, conditions so identified are likely to require immediate care following the applicant’s arrival in Canada, this information should be noted on the immigration medical report.

6.3 Applicants identified as being excessive demand exempt may require further investigation to determine whether they present a risk to the public health or safety of Canadians. Active tuberculosis and untreated syphilis are examples of medical conditions that present a risk to the public health in Canada. Conditions that pose a threat to public safety in Canada might include:

  • certain impulsive sociopathic behaviour disorders
  • some aberrant sexual disorders such as pedophilia
  • certain paranoid states
  • some organic brain syndromes associated with violence or risk of harm to others
  • applicants with substance abuse leading to antisocial behaviour such as violence, impaired driving, or other types of hostile, disruptive behaviour

6.4 HIV infection is not of itself considered a significant public health risk for immigration assessment purposes. However, the behaviour of an HIV-infected individual may present a threat to public health and safety if the applicant does not understand the condition and the steps necessary to prevent its spread. This is why post-test counselling is fundamental to the management of HIV-infected individuals. Counselling ensures that the applicant is aware of the condition and can take the measures necessary to prevent or minimize the spread of the virus. Counselling also provides an opportunity for the physician to identify those rare applicants who may actually indicate that their intention is to infect others with HIV. The DMP providing post-test counselling must ensure that the applicant signs the Acknowledgement of HIV Post-Test Counselling.

6.5 For all applicants, whether excessive demand exempt or not, positive responses to questions in Section B should be described in as much detail as possible, including the past and present history of the problem, its treatment and the applicant’s stated response to treatment. Positive response(s) in the functional history section may require an entry in the physical examination record contained in Section C of the IMM 5419.

6.6 When significant abnormalities are detected, and the applicant is not excessive demand exempt, the DMP will generally note these abnormalities in the appropriate section, submit the file and wait for instructions from the medical officer. In some cases, on the basis of standing instructions issued by the regional medical officer or noted in this handbook, the DMP may refer the applicant for additional investigations or to an appropriately qualified and reputable specialist without waiting for such a specific request from the medical officer.

Whenever a specialist’s report is obtained, as indicated in these guidelines or requested by a medical officer, the report should include:

  • complete details of the applicant’s current clinical status;
  • the history of onset, etiology, treatment, progression and complications of the disease;
  • copies of reports of any relevant investigations necessary to determine the etiology, specific diagnosis, stage or remission status of the disease;
  • the current treatment plan; and
  • the specialist’s opinion on the prognosis of the condition and the individual’s future treatment and management requirements over the subsequent five to 10 years.

The report and opinion should make no reference to medical admissibility to Canada.
It is the responsibility of the DMP to identify specialists and consultants who are able and willing to provide comprehensive reports of this nature.

6.7 Reports, consultation summaries and medical history documents must be translated into either English or French. The applicant is responsible for translation costs.

7. IMM 5419 – Section B: Functional inquiry guidance

All responses on the form should be clearly indicated; for example, “Yes,” “No,” “Normal” or “Abnormal” should be clearly circled. If nothing of note is found, “Nil” or “NAD” (no abnormality detected) should be indicated in the appropriate space. Answers should not be left blank.

Question 1: Operation or hospital treatment
When the applicant has had an operation or hospital treatment, the details from the applicant should include the date and reason for the admission and/or the operative procedure performed and pathology reports.

Note: If the applicant is not excessive demand exempt, the discharge summary and any pathology report from admissions for serious illnesses within the last five years should be included. For all malignant and/or neoplastic diseases treated within the past five years, the relevant operative and pathology reports, with a current specialist’s report, should be included.

Question 2: Seizures, loss of consciousness or epilepsy
When there is a history of seizures, loss of consciousness or epilepsy, the details from the applicant should include the type of disorder, the age of onset, any precipitating factors, current drugs taken, and the frequency of attacks, severity and sequelae. The date of the last seizure should be noted.

Question 3: Anxiety, depression or nervous problems
In the case of a positive response to a history of mental illness, which might include depression, psychosis, schizophrenia, eating disorders, or drug and alcohol abuse, the details should include the specific diagnosis with details of the type and duration of treatment, any history of non-compliance with treatment or of relapses, and an assessment of potential for self-harm or harm to others.

The DMP may consider completing an Adult’s Global Assessment of Functioning Scale (GAF) – see Appendix VII.

Question 4: Cardiovascular and respiratory disease
If there is a history of hypertension, the details obtained from the applicant should include the date of diagnosis, current treatment and whether or not there is any history of renal, cardiovascular or cerebrovascular disease. A history of peripheral vascular disease, either venous or arterial, should be noted.

If there is a history of ischemic heart disease, the details obtained from the applicant should include the date of diagnosis, current treatment, frequency of angina, and activities that provoke angina.

If there is a history of congestive heart failure, the details obtained from the applicant should include the date of diagnosis, current treatment, current symptoms and dates of admission to hospital.

If there is a history of lung disease, such as pulmonary fibrosis, asthma, COPD or chronic cough, the details obtained from the applicant should include the history of symptoms, current treatment, and current impact of the respiratory disease on occupational and leisure activities.

Question 5: Recurrent or chronic joint pain
With a history of chronic recurrent muscular pain, arthritis or joint pain, the details from the applicant should include the severity of pain at rest and in motion, any functional limitations in activities of daily living, the distance that the applicant is able to walk, and the medications that are used. If there is indication of significant limitations, an Assessment of Activities of Daily Living (Appendix VIII) should be completed.

Question 6: Digestion problems, stomach pains, etc.
Any applicant who gives a positive history should undergo additional questioning to determine cause. Attention should be given to those with chronic, persistent or recurrent symptoms (weight loss or gain, gastrointestinal bleeding, varices, for example).

Question 7: Tuberculosis, sexually transmitted diseases, etc.
When there is a past history of tuberculosis, the details from the applicant should include the date of diagnosis, duration and type of treatment. In all applicants, whether excessive demand exempt or not, copies of previous treatment reports, x-rays and other relevant information should be obtained and forwarded with the immigration medical forms, if possible. If the medical history reveals any suggestion of previous tuberculosis, then clinical, bacteriological and radiological examinations will be required to determine the activity of the disease.

Where there is an abnormal chest radiograph but no history of previous active tuberculosis, or there is a history of previous tuberculosis with or without previous adequate treatment, the DMP should generally note the abnormality and send the file in for review by the regional medical office. In most cases the file will be furthered until:

  • a minimum of two chest films, taken at a minimum interval of three months, have a stable appearance; and
  • three sputum samples taken at least 24 hours apart, examined for acid-fast bacteria (smear), and incubated for six to eight weeks for tubercle bacilli by standard culture methods are negative.

In the absence of secretion bacteriology and culture, serial chest radiographs showing stability of abnormalities compatible with pulmonary tuberculosis for greater than six months may be requested.

All applicants who are diagnosed clinically, radiologically or bacteriologically as having active pulmonary tuberculosis must be treated and rendered “inactive” before entry to Canada.

Question 8: Hepatitis
When there is a history of hepatitis in those older than 15 years of age, the details from the applicant should include the date and type of hepatitis, if known.

Note: If the applicant is not excessive demand exempt, then the results of serum AST and ALT should be provided. If these are abnormal (greater than 1.5 X normal value), then a specialist’s report including hepatitis C antibodies and hepatitis B surface antigen should be provided.

Question 9: Kidney or bladder disease
When there is a history of significant urinary tract or renal disorder (chronic recurrent infections, chronic pyleonephiritis, glomerulonephritis, polycystic renal disease, chronic renal insufficiency or failure, renal transplantation, urinary tract malignancy), the details from the applicant should include the date of onset, diagnosis, treatment and current status.

Note: If the applicant is not excessive demand exempt, a serum creatinine must be performed. If elevated, a repeat serum creatinine, along with a random urine protein to creatinine ratio, [note 4] must be performed.

Question 10: Diabetes
When there is a history of diabetes, the details from the applicant should include the date of onset, type of treatment, history of complications, and presence or absence of symptoms related to target-organ damage, such as nephropathy, neuropathy, ischemic heart disease, peripheral vascular disease or retinopathy.

Note: If the applicant is not excessive demand exempt, a serum creatinine must be performed.

Question 11: Other illness
When there is a positive response to the question, provide details.

Question 12: Medication or medical treatment
When there is a positive response to the question, details including the type of treatment and description of drugs used should be provided. The chemical or pharmaceutical name of the medication should be provided, not the proprietary or generic name.

Question 13: Alcohol/drug abuse or addiction
When there is a positive history of alcohol and/or drug abuse or addiction, the details should include the history of any social or occupational consequences of the abuse or addiction, any history of detoxification or rehabilitation programs, and the duration of abstinence or if there is current use of alcohol or drugs. See also “Question 17: Medical or Other Treatment” below.

Question 14: HIV or AIDS
If there is a positive history of HIV or AIDS, include the date of diagnosis and whether the applicant has ever been prescribed or advised to take, or has taken anti-retroviral drugs, and provide an assessment of the applicant’s understanding of and compliance with practices necessary to prevent transmission of the disease.

Question 15: Pension for medical/psychological reasons
When there is a positive response to the question, provide details.

Question 16: Autism, developmental delay, dementia, etc.
If there is a history of autism, mental retardation or developmental delay, and if the applicant is not excessive demand exempt, provide a specialist’s report from a pediatrician, clinical psychologist or child psychiatrist, as appropriate, to describe:

  • specific diagnosis
  • developmental history
  • psychometric testing, including IQ testing
  • assessment of adaptive skills, associated behaviour disorders
  • history of special or assisted schooling, vocational training and/or work records
  • current and future treatment, support requirements and recommendations for speech therapy, occupational therapy, physical therapy, special education or vocational training (including recommended frequency and duration of interventions)
  • current and future need for ongoing supervision or institutional care.

If there is a history of senile debility, Alzheimer’s disease or dementia, and if the applicant is not excessive demand exempt, provide a complete assessment to include:

  • duration and rate of progression of symptoms
  • diagnostic evaluation
  • treatment and management requirements
  • activities of daily living form (see Appendix VIII)
  • a completed Mini Mental Status Examination questionnaire (see Appendix IX)

If the applicant is illiterate, and is not excessive demand exempt, then describe:

  • the applicant’s current adaptive life-skills
  • the applicant’s capacity to communicate orally and through print
  • the applicant’s counting skills and ability to use money
  • etiology of the illiteracy to include whether there is evidence of mental retardation or a learning disability, with results of psychometric tests
  • whether vocational training is required
  • whether the applicant has any other condition or disability that would prevent or impair the applicant’s ability to lead an independent life.

For more information, see:

  • Appendix VII – Adult’s Global Assessment of Functioning Scale (GAF)
  • Appendix VIII – Assessment of Activities of Daily Living
  • Appendix IX – The Mini Mental State Examination

Question 17: Medical or other treatment
When there is a positive response to the question, provide details.

Question 18: Pregnant
If a female applicant is pregnant, record the date of the last menstrual period as well as the expected date of delivery.

Question 19: Previous immigration medical examination
If there is a history of a previous immigration medical examination, the details from the applicant should include where and when the examination was done.

8. IMM 5419 – Section B – Declaration and authorization of applicant

This declaration must be completed and signed by the applicant, or by the parent or guardian. This section of the form is very important because it authorizes the release of medical information about the client to Citizenship and Immigration Canada, and then allows the Department to release medical information to public health agencies or physicians in Canada. If incomplete, the form will be returned to the DMP for completion.

The applicant also declares that the information provided on the form is correct.

9. IMM 5419 – Section C – Examining doctor’s findings

It is imperative that the physical examination of applicants be conducted in a manner respecting their privacy, dignity and cultural norms. Applicants’ decisions and permission should be respected, and examinations done only with their expressed consent.

Where applicants decline to undergo clinically indicated examination(s) by the DMP, referral to a physician, acceptable to the applicant, is necessary to obtain recent reports of such examination(s).

An entry must be registered for all questions. If a part of the medical examination is not undertaken, please enter “Not Performed” and explain the reason.

If the medical history and completion of the form was done with the assistance of a translator, this should be noted. If the translation services were provided by non-professional translators (such as family), this should be noted as well.

Examination guidelines for Section C

Field 1 – Weight, height, vision, hearing

The weight and height of all applicants are required.

Note: Children less than 12 who are not excessive demand exempt, and whose height or weight is below the third percentile, require a pediatric assessment.

The hearing screening test is to measure the ability to hear a softly whispered voice in each ear starting at a distance of six metres or 20 feet with the back turned to the examining physician. The distance at which the applicant can repeat two or more syllables, words or numbers should be recorded.

For hearing-impaired applicants, please clearly assess the communication skills used by the applicant, whether lip reading, signing, reading or writing.

For infants, auditory assessment with a bell or other instrument to assess sound detection bilaterally should be performed.

Field 2 – Ear, nose, throat, mouth, teeth

A high index of suspicion is necessary to detect malignant tumors of the nose, throat and mouth. Signs such as unilateral nasal obstruction and discharge, leukoplakia, erythroplakia and masses should be noted.

Note: If an abnormality suggestive of neoplasia is detected, and the applicant is not excessive demand exempt, a report from an otorhinolaryngologist will likely be required.

Field 3 – Endocrine system

Endocrine disorders can cause a variety of signs, such as central obesity, abnormal skin pigmentation, galactorrhea, gynecomastia, hirsutism, acromegaly or thyroid nodules or enlargement, and must be assessed with good clinical judgment. A history of diabetes requires specific comments in the physical examination section to address the presence or absence of complications from the disease.

Field 4 – Skin, lymph nodes and breasts

Fully describe all skin and subcutaneous lesions. The presence of operative scars should be correlated with the applicants’ response to their history of operations in question 1, Section B of the IMM 5419. When present, lymph gland enlargement should be fully described and correlated with regional conditions, if possible.

Women must be advised of and must give their consent before breast examination. If consent is not given, indicate on the report “Breast Examination Not Done – Consent Denied.” Referral to an appropriate physician, acceptable to the applicant, for a report on breast examination findings should be made and a copy of that report should be forwarded with the IME.

Field 5 – Cardiovascular system

Cardiovascular system examination includes an assessment of blood pressure, cardiac rhythm, location of the apex beat, cardiac auscultation, including heart sounds and/or murmurs, peripheral pulses and any peripheral edema. The blood pressure must be recorded for all persons over the age of 15 years, or where there is a history or sign of cardiovascular disease. If blood pressure is elevated (greater than 140/90 mm/hg), the reading should be repeated after rest.

Note: If the applicant is not excessive demand exempt and a diagnosis of hypertension is confirmed or reported, a serum creatinine must be reported even if the blood pressure is within the normal range at the time of the IME. If this test is abnormal, or the hypertension is not controlled, then an appropriate specialist’s report will likely be required to assess hypertension plus target-organ damage.

If the applicant is not excessive demand exempt and there is evidence of significant cardiovascular disease, such as peripheral vascular disease, ischemic heart disease, arrhythmia, congestive heart disease, valvular heart disease, congenital heart disease, or aneurysm, then a full specialist’s assessment and report on the condition will likely be required.

Field 6 – Respiratory system

If the immigration medical examination reveals or suggests active infectious disease, the DMP should adhere to local public health requirements regarding the notification, referral, diagnosis and management of the disease. On no occasion should routine investigation or management of active or suspected active tuberculosis be deferred or delayed because of immigration medical activities. Canadian DMPs who are not able to contact an applicant suspected of having active infectious disease should immediately inform the Director of Operations, Health Management Branch (see contact information in Appendix I).

Field 7 – Gastrointestinal system

Examination seldom provides evidence of disease, but it remains essential to identify operative scars, ileostomy or colostomy sites, hepatomegaly or splenomegaly, hernias and any abdominal masses. Pulsatile masses, bruits and venous distension, if present, should be noted.

Field 8 – Urogenital system

Vaginal examination, together with a Papanicolaou smear, should be undertaken only if clinically indicated, such as by the presence of pelvic masses noted on abdominal examination, or dysfunctional uterine bleeding. At the applicant’s request, this examination may be undertaken by the applicant’s own physician or gynecologist, who should provide a written report. That report is to be included and forwarded to the regional medical office with the IME.

Rectal examination is required for male applicants more than 50 years old. At the applicant’s request, this examination may be undertaken by the applicant’s own physician or proctologist, who should provide a written report. That report is to be included and forwarded to the regional medical office with the IME.

Field 9 – Locomotor system/Physical build

Appropriate clothing must be removed sufficient to reveal the habitus and physical characteristics of the applicant. The presence of conditions or deformities that restrict or limit activity or employment must be noted. Musculoskeletal disease and previous joint or orthopedic surgery must be noted.

Limitations or difficulties with activities of daily living such as bathing, dressing, walking, climbing stairs or getting into automobiles due to musculoskeletal conditions must be documented.

Note: For disabled applicants and those with clinical indications of limited mobility, an assessment of mobility and self-care capacity is essential.

If the applicant is not excessive demand exempt, and a significant locomotor problem is identified, provide appropriate radiographs, a completed activities of daily living form (see Appendix VIII), and a complete report from an orthopedic surgeon or rheumatologist to include disease stability or progression, current and proposed medication, and expected requirements for surgery, assistive devices and physical therapy.

Field 10 – Indication of any substance abuse

Substance abuse is a serious problem with the potential for danger to public safety as well as significant demand on health and social services. The CAGE questionnaire is a useful tool for screening individuals at increased risk for alcohol abuse. It asks four questions:

  • Have you ever felt that you should Cut down on your drinking?
  • Have people ever Annoyed you by criticizing your drinking?
  • Have you ever felt bad or Guilty about drinking?
  • Have you ever taken a drink first thing in the morning (Eye-opener) to steady your nerves or get rid of a hangover?

If applicants answer “yes” to two or more of these questions, or if addiction is suspected, then a detailed assessment of their substance-related abuse or dependence status is necessary. This specialist’s assessment report must include the clinical history, assessment for end-organ changes on physical, cognitive and laboratory examination, reports from relevant investigations, the diagnosis including the Axis V Global Assessment of Functioning score, history of abstinence and an opinion on prognosis.

Field 11 – Nervous system

Applicants should be assessed for the presence and symmetry of sensory, motor and cognitive functions.

Absent or asymmetrical reflexes should be noted, as should paralysis, muscle wasting, tremor or other movement disorder.

Higher nervous system functions should be assessed by noting whether the applicant has been unable to attain levels of personal independence and social responsibility expected of persons of equivalent age in their cultural setting. In school-age children, questions on school performance can help to raise a flag for possible learning disorders, behaviour disorders, developmental delay or mental retardation.

Evidence of developmental delay or mental retardation in pre-school children can be sought through office observation combined with reports from the child’s parent or caregiver. A chart of early childhood development, included as Appendix X, provides a simple guide to some of the milestones.

If there is evidence of a memory deficit sufficient to interfere with normal activities, a Mini-Mental State Examination, included as Appendix IX, should be done to screen adults for dementia.

Note: If the applicant is not excessive demand exempt and there is evidence of a significant neurologic disorder, then a full specialist’s assessment will likely be required.

If the applicant is not excessive demand exempt and there is evidence of autism, developmental delay, a learning disorder, mental retardation or dementia, then a specialist’s assessment and report (as outlined previously in Section 7, question 16) will be required.

Field 12 – Physical or mental condition

If there is evidence on examination of a significant personality disorder, mental illness or substance abuse, a specialist’s report will likely be required.

Note: If applicants are not excessive demand exempt and there is evidence of a physical disability, not otherwise reported, that would affect their ability to earn a living, to take care of themselves, or to adapt to a new environment, then an appropriate specialist’s report will likely be required.

Field 13 – Personal/Family history relating to serious chronic disease

Seek information on personal or family history of conditions that might reasonably lead to a future requirement for extensive treatment, organ transplantation or dialysis, such as a family history of polycystic kidney disease, congenital blood disorders such as Thallasemia, cystic fibrosis or congenital malignancy (i.e., polyposis coli).

Field 14 – Past history of cancer

Provide details of findings if the malignancy occurred within the preceding five years.

Field 15 – Alcohol usage and related problems

Provide details.

Field 16 – Close contact with tuberculosis

Provide details.

Summarize abnormalities, provide prognosis and declaration of DMP

These sections must be completed and the DMP stamp applied.

10. IMM 5419 – Section D – Laboratory requisition

The Applicant’s Declaration must be signed by the applicant, or by a parent or guardian for those under legal age in the jurisdiction in which the examination is performed, or those incapacitated or unable to provide a declaration.

A photograph of the applicant must be attached to the form, and confirmation of identification must be given by stamping the upper right corner of the photograph with the DMP stamp. This allows the person collecting the blood or laboratory specimen to confirm that the sample was collected from the applicant to prevent fraudulent substitution.

It is the responsibility of the DMP to select a certified, licensed and reliable laboratory service. If the laboratory specimens are not taken at the DMP’s office, the DMP must ensure that the laboratory uses procedures to ensure the identity of the person sent for investigation as the applicant, takes and confirms that the sample was collected from the identified individual, and then returns the completed form, with results, directly to the DMP.

10.1 A urinanalysis is required of all applicants five years of age and older. Female applicants should not be menstruating.

If the applicant is not excessive demand exempt, and there is persistent proteinuria greater than “trace” on two urine specimens taken on separate days, serum creatinine and a random urine protein to creatinine ratio are required.

10.2 Syphilis serology is required of all applicants 15 years and older. A positive non-treponemal test, such as a VDRL, must be confirmed with a treponemal-specific test, such as an FTA-ABS. If the specific treponemal screening test for syphilis is unavailable or positive, then treatment in accordance with Canadian STD guidelines is required and must be documented on the medical exam form. Excerpts on syphilis testing and treatment from the Canadian Guidelines on Sexually Transmitted Infections, 2006 Edition, are included as Appendix XI.

10.3 Serum creatinine is required if the applicant is not excessive demand exempt and there is a history or finding of hypertension, diabetes, autoimmune disorder, persistent proteinuria or kidney disorder.

10.4 HIV testing is required for applicants 15 years of age and older, children who have received blood or blood products, or have a known HIV-positive mother, or where a risk factor is identified. This should be noted in IMM 5419, Section C, Summary/Prognosis.

It is considered the standard of medical practice and an obligation that a DMP counsel individuals having an HIV test both before and after the results are available. More information is available in Appendix III, including a section on HIV serology interpretation. See also Appendix IV – HIV Pre-Test Counselling, and Appendix V – HIV Post-Test Counselling, which provide an overview of issues and actions to be considered.

An ELISA test for HIV 1 and HIV 2 should be done initially. If positive, another ELISA test on the same blood sample should be performed. If the two ELISA tests are positive, these results must be confirmed with a test like the Western Blot. If the Western Blot is not available, confirmation is done with a third ELISA test by a different manufacturer.

HIV-positive applicants should have a chest x-ray done whatever their age.

Concern regarding risks to public health or safety will continue to be most important in assessing a migrant’s admissibility to Canada. HIV is not readily transmitted and is usually not considered a significant public health risk to the general public in Canada. However, those individuals with HIV who would refuse to practice safe sex, actively conceal from their partners that they are infected, and purposely seek to infect others may be considered a risk to public health and public safety. In reporting the results of HIV-positive individuals, it is very important that you provide your opinion regarding the applicant’s understanding of risk-reduction strategies and to report (Section C, Summary/Prognosis) those applicants whose behaviour may present a danger to others.

For applicants who are HIV-positive and either a spouse, a common-law partner or a conjugal partner of a Canadian sponsor, post-test counselling must include a recommendation that the applicants inform their partner of their HIV status.

After completing post-test counselling, the DMP will then ask the applicant to sign the CIC form Acknowledgement of HIV Post-Test Counselling (see Appendix VI) and include this form with the Medical Report forms sent to the regional medical office.

11. IMM 5419 – Section E – Chest x-ray report

It is the responsibility of the DMP to select a certified, licensed and reliable radiological facility.

The Applicant’s Declaration must be signed by the applicant, or by the parent or guardian.

A photograph of the applicant must be attached to the form, and confirmation of identification given by stamping the upper right corner of the photograph with the DMP stamp. This allows the radiographer to confirm that the chest x-ray taken is that of the intended applicant. The radiographer must certify that the x-ray was of the person whose photograph and signature are on the form.

A routine (PA) chest x-ray is required for all applicants aged 11 years or older. A chest x-ray is also required for children under 11 years of age if they have a personal history of tuberculosis, a history of close contact with a case of active tuberculosis, or are HIV-positive.

A chest x-ray is required for children under 11 years of age with congenital or acquired heart disease or serious lung disease, only if they are not excessive demand exempt.

A woman of reproductive age should be asked the date of her last menstrual period to assess whether or not she is pregnant. Should the possibility of pregnancy exist, and after appropriate counselling, the applicant should determine whether she wishes to undergo chest x-ray examination or to defer it. The decision is totally the applicant’s and no recommendation should be made by the DMP.

If the applicant declines to undergo a chest x-ray on account of the pregnancy, then a chest x-ray should be obtained and submitted after delivery, even though this will delay the IMA process. If the applicant elects to undergo an x-ray examination, abdominal shielding must be used.

A radiologist must assess the chest x-ray for both general radiologic findings and specific findings related to tuberculosis. The radiologist must complete subsections 3, 4 and 5 of the Chest X-ray Report, providing amplifying comments when indicated. DMPs and radiologists should understand that for Canadian immigration purposes, lesions which could represent inactive tuberculosis are of particular interest, even if they are of minimal current clinical relevance.

 

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4. C.P. Price, R.G. Newall, and J.C. Boyd, “Use of Protein:Creatinine Ratio Measurements on Random Urine Samples for Prediction of Significant Proteinuria: A Systematic Review,” Clinical Chemistry 51 (2005): 1577-1586.

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