Designated Medical Practitioner Handbook

Chapter 11: Canadian Immigration Medical Examinations

IRPA and the associated regulations stipulate that all applicants seeking permanent residence in Canada, and certain applicants applying for temporary residence, are required to complete an immigration medical examination. DMPs play a vital role for CIC by performing this examination and arranging for additional required radiological and laboratory investigations, and specialist or consultant reports, when required.

11.1 Canadian Immigration Medical Report Forms

CIC’s Medical Report forms are the IMM 1017 (Medical Report: Section A) and the IMM 5419 (Medical Report: Sections B, C, D and E). The numeric designation of the forms is located in the bottom left-hand corner of the first page. Different IMM 1017 (Section A) forms are used depending on the applicant’s immigration classification. The IMM 5419 forms (Sections B, C, D and E) are the same for all applicants. Most immigration medical forms are issued to applicants by visa or immigration offices (some EFC applicants in Canada may download forms from the CIC website). Applicants presenting to DMPs without medical forms should be instructed to contact CIC visa or immigration offices to obtain them.

It is important to note that certain permanent resident applicants are exempt from excessive demand assessment. At the time of preparation of this manual, the categories of permanent resident applicants exempt from the excessive demand assessment included:

• refugees, refugee claimants and individuals with protected person status
• spouses of Canadian permanent residents
• common-law partners or conjugal partners
• dependent children of Canadian permanent residents

Whether or not the applicant for permanent residence is subject to assessment for excessive demand determines the type of IMM 1017 (Medical Report: Section A) used for the examination. CIC currently has three different types of IMM 1017s, depending on whether or not an applicant is excessive demand exempt. Detailed instructions on the use and completion of these forms is described in Appendix II.

Up-front Medical Exams and Forms
(IMM 1017 EFC and Appendix C)

Up-front medical exams are performed when applicants arrive for their immigration medical exam appointment with a completed Appendix C – Medical Instructions form. The Medical Report – Section A (IMM 1017 EFC) form is used for up-front medical exams. DMPs should have a supply of IMM 1017 EFC forms on hand. To order forms, see the instructions in the table above.

As noted earlier, a detailed guide to the completion of the Medical Report forms for Canadian immigration is Appendix II.

11.2 Verifying the Identity of Individuals Presenting for an IME

The integrity of the IME process requires that the individual who undergoes the IME is the same individual who is the actual applicant for immigration. Attempts involving applicant substitution are infrequent but they do occur. DMPs must ensure that processes are in place to verify the identity of the applicant at the time of the IME and when clinical, radiological and laboratory investigations are undertaken.

The DMP must confirm the identity of the applicant 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 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 passports or national identity documents are not acceptable.

Following confirmation of identity, the DMP will take the following steps:

• Generally, ensure that the immigration or visa office has attached the photographs of the applicant to the IMM 1017 or the IMM 1017 EDE. If the IMM 1017 EFC is used, photographs must be attached to both copy 1 and copy 2 of the form. In addition, photographs must be attached to Sections D and E of the IMM 5419.
• DMPs in Canada may have to attach the photos provided by the applicant after verifying that the photographs are those of the applicant.
• Stamp the top right corner of all of the attached photographs using the DMP stamp.
• For IMM 1017 EFC forms, complete in full the required information in “Details of person examined” and “Details of principal applicant.” The information must be identical in each of the two parts of the form (carbonless copy) and in Appendix C: Medical Instructions.

Applicants or legal guardians should sign the documents personally in the presence of the DMP or clinic staff. Illiterate applicants should make a mark or provide a thumbprint witnessed by the DMP or clinic staff, and it should be noted on the document that the making of the mark or thumbprint was observed.

Concerns Regarding Identity

DMPs who are concerned about the validity of the applicant’s identity should not confront or challenge the applicant in that regard. In those situations, the IME should be completed routinely. Details related to the DMP’s concerns or suspicions must be recorded on the IME forms and, in addition, forwarded to the responsible regional medical office as described in Section 9.1 of this handbook.

Simultaneous or Duplicate IMEs

Occasionally, applicants may be seeking examination at two locations at the same time. In addition, DMPs may encounter applicants presenting for a second IME while the initial examination is still in process. If a DMP becomes aware that an applicant has recently been examined at another location or is currently undergoing another Canadian IME, the DMP must notify the responsible regional medical office.

11.3 Management of IME Forms and Documents

Completed medical forms, results of laboratory investigations and accompanying documents and radiographs are to be forwarded by post or courier by the DMP to the regional medical office responsible for the applicant’s case file and must not be given to the applicant or their representative. Completed files should be forwarded within five working days of the receipt of all required information.

• In the case of students or other urgent cases, DMPs may have received instructions from the regional medical officer to forward these records as soon as possible. In addition, applicants or their representatives may request the expedient forwarding of completed medical forms to the responsible regional medical office. In these situations, DMPs may levy additional charges for commercial courier services or expedited postal transmission. Applicants or their representatives should be advised of the additional costs when they request expedient transmission of the medical records.

Incomplete Cases

Occasionally, applicants will withdraw from the IME process or fail to complete or comply with instructions. When DMPs are advised or become aware that

• an applicant has withdrawn from the IME process,
• is unable or unwilling to comply with Canadian requirements, or
• fails to return to the DMP for a period greater than eight weeks for follow-up investigations,

the DMP should forward the incomplete medical report to the responsible regional medical office with an accompanying notification indicating the reason that the IME has not been completed. That notification should also outline the number and nature (telephone, post, fax) of attempts used by the DMP or staff to have the applicant return for the required investigations or follow-up.

11.4 Conducting an Immigration Medical Examination

In conducting a Canadian immigration medical examination, the practitioner performing the examination will undertake the following activities.

• Provide a routine appointment for Canadian IMEs within 14 days of a request by a person who presents with a Medical Report form IMM 1017 or other relevant document as indicated in Appendix II, “Guide to the Completion of the Medical Report Forms for Canadian Immigration.”
  • DMPs performing IMEs on international students may be requested by regional medical officers to schedule IME appointments for students on shorter notice. DMPs unable to meet these requests should discuss the issue with their responsible regional medical officer.
  • In rare instances, CIC will request an expedient medical examination in situations of emergency. In those situations, a DMP is expected to arrange an appointment within 24 hours.
• Verify that the person presenting for examination is the person pictured in Medical Report: Section A; Client Identification & Summary. See Section 11.2 regarding verifying identity and using the DMP stamp to authenticate the photograph.
• Ensure that the applicant, or parent/guardian, completes and signs Medical Report: Section B; Functional Inquiry, Background Information and Applicant’s Declaration (IMM 5419).
• Carefully review and provide details on the applicant’s responses to the questions regarding functional inquiry in Medical Report: Section B (IMM 5419).
• Perform a comprehensive physical and mental examination, and provide a complete report of this assessment by completing Medical Report: Section C; Examining Doctor’s Findings (IMM 5419).
• Attach the applicant’s photograph to the appropriate places on Medical Report: Sections D and E (IMM 5419). Using the official DMP stamp, stamp over the right end of the required signature areas and the top right corner of the photographs of the applicant on the IMM 1017 and IMM 5419. Ensure that the applicant or parent/guardian signs the Applicant Declaration in Medical Report: Section D (IMM 5419).
• Provide appropriate age-defined laboratory investigations as specified in Medical Report: Section D; Laboratory Requisition (IMM 5419):
  1. urinalysis (protein, glucose and blood by dipstick—if blood positive, then microscopic report required) for applicants five years and over;
  2. serological test for syphilis for applicants 15 years and over;
  3. HIV testing for applicants 15 years of age and over, as well as for those children who have received blood or blood products, have a known HIV-positive mother, or have an identified risk. An ELISA HIV screening test should be done for HIV 1 and HIV 2; and
  4. serum creatinine if the applicant has hypertension (resting blood pressure greater than 140/90 mm Hg), a history of treated hypertension, diabetes, autoimmune disorder, persistent proteinuria, or kidney disorder.
     
     Note: Excessive demand exempt applicants are not required to undergo serum creatinine testing even if the above-noted conditions are present.
• Provide applicants having an HIV test with HIV pre-test counselling. Ensure HIV-positive applicants receive post-test counselling and sign the acknowledgement of HIV post-test counselling form. Further information on HIV testing issues is located in Appendix II “Guide to the Completion of the Medical Report Forms for Canadian Immigration.”
• Have the person performing the phlebotomy and/or receiving the laboratory specimen(s), sign the signature box in Medical Report: Section D; Laboratory Requisition (IMM 5419), confirming that the sample was collected from the individual identified on the form.
• Provide an adequately labeled (name, date of birth, date of exam as per Gregorian calendar) postero-anterior chest x-ray film for applicants 11 years and older, and for those under 11 years of age if there is any relevant history or clinical indication. Examples of situations where applicants less than 11 years of age would provide a chest radiograph include an immediate family member suffering from or under treatment for tuberculosis, chronic respiratory disease such as cystic fibrosis, previous thoracic surgery, cyanosis or respiratory insufficiency that limits activity.
• Have the x-ray technician or radiographer sign the declaration (item 2, page 1) in Medical Report: Section E; Chest X-ray Report (IMM 5419), to certify that the x-ray was taken of the person whose photograph and signature are on the form.
• Have the radiologist complete the Chest X-ray Interpretation, the Record of Special Findings Noted, and the Certification in subsections 3, 4 and 5 of Medical Report: Section E; Chest X-ray Report (IMM 5419).
• Unless otherwise advised, ensure that the radiologist provides the labeled image of the chest x-ray either on CD (in an envelope, not a jewel case) or film.
• Ensure that the radiologist provides sufficient detail in the examination report to substantiate a definitive diagnosis or a requirement for additional investigation.
• Complete a summary of abnormalities and provide an opinion as to prognosis in the summary blocks of Medical Report: Section A (IMM 1017) and Section C (IMM 5419) for each applicant based on the history, mental/physical examination and diagnostic tests.
• Collate the completed Medical Report forms (in order) with laboratory reports and chest x-ray(s), and then arrange for the direct and timely transmission of these documents, by mail or courier, to the RMO. Medical office contact information is available in Appendix I.
• Provide or arrange for the provision of such supplementary reports or diagnostic tests as may be requested or required by standing instructions issued by a CIC medical officer. These supplementary reports and/or diagnostic tests should be sent directly from the laboratory or consultant to the DMP for collation and transmission to the RMO.
• Provide medical advice to an applicant with respect to any finding which is unknown to the applicant. In so doing, normal professional and ethical standards will be upheld with respect to referral back to the applicant’s usual attending physician or applicable referral to an appropriate specialist, if the applicant so requests.
• Personally conduct all clinical activities with respect to the medical examination of the applicant. When further medical reports are requested by a medical officer, these reports must be provided by a specialist of the DMP’s choosing. Reports provided by a physician of the applicant’s choosing are not acceptable, although the applicant’s previous medical records can be provided in addition to the currently requested report.
  • Specialists or consultants preparing additional reports requested as part of the IME should be advised that their reports should be objective, detailed and limited to the question posed. They should not include comments about their impressions regarding suitability for immigration or fitness for travel.
  • These reports should be complete and contain a thorough clinical review, discussion and interpretation of clinical findings. Prognostic determination should be based on the anticipated clinical course and likely need for intervention or treatment (medical and/or surgical) over the following several (five) years.
  • It is the DMP’s responsibility to select specialists and consultants who are able and willing to provide complete reports.
    
    Note: The DMP does not provide an assessment in terms of the medical admissibility or inadmissibility of the applicant to Canada. DMPs must take care not to make any statements or provide any indication to applicants which might be construed as implying a favourable or unfavourable immigration assessment outcome. This is the responsibility of the visa or immigration officer.

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