Designated Medical Practitioner Handbook
Appendix XII: Consent to Share Information with Australian, and U.S. Immigration Health Authorities
Consent to
Share Information with Australian [ ] and
U.S. [ ]
Immigration Health Authorities
(indicate one or both with an “×”)
Citizenship and Immigration Canada undertakes regular monitoring and evaluation of immigration medical examination (IME) processing to ensure the integrity of the Canadian immigration medical program. As described in the Handbook for Designated Medical Practitioners, monitoring and evaluation can consist of on-site visits and inspections or review of the documentary aspects of practitioners’ IME activities. Similar procedures are used by Australia and the United States to monitor and evaluate their respective IME procedures and programs.
In some locations, practitioners who perform Canadian IMEs also perform similar functions for Australia and the United States. Assessment and evaluation visits and activities undertaken by these nations are often similar in nature. As a consequence, information and observations acquired during monitoring and evaluation activities by one nation’s immigration medical program may be of interest and importance to other nations for which the practitioner is providing service. They may, depending upon the situation, fulfil the monitoring and evaluation requirements of other immigration programs.
In situations where a practitioner performing Canadian IMEs is also a panel physician for Australia and/or the United States, monitoring and evaluation information related to the performance of the immigration medical program may be shared with immigration health officials at the U.S. Centers for Disease Control and Prevention (CDC) and/or the Department of Immigration and Citizenship of Australia (DICA). The sharing of information gathered during monitoring and evaluation by one nation may preclude the need for a separate visit by another nation’s immigration health service.
The information to be shared will be limited to the practitioner’s administrative and operational activities related to IMEs, and will not include or make reference to personal information associated with the IME documents or information about individual applicants.
I understand that administrative, technical and processing information gathered during CIC immigration medical examination, evaluation, audit and assessment visits related to my performance as a practitioner performing Canadian immigration medical examinations may be shared with immigration health officials from DICA or CDC. This information may include analysis of my adherence to technical standards and the capacity and quality of clinical, laboratory and investigative services related to IMEs performed by me or by those under my supervision and control.
I understand that this information will not include the individual or personal information of the clients examined and will not include information recorded on individual immigration medical examination forms.
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(Print Name)
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(Signature)
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(Stamp #)
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(Address)
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(Address)
- Date Modified:
