Completing the IMM 0535 form for cases requiring medical surveillance by the provincial or territorial public health authorities

This section contains policy, procedures and guidance used by Immigration, Refugees and Citizenship Canada staff. It is posted on the Department’s website as a courtesy to stakeholders.

Visa or immigration officers

The Medical Surveillance Undertaking form [IMM 0535B] (Part A – sections 1-11) must be completed overseas by the visa or immigration officer. The applicant must present the IMM 0535 form at the port of entry (POE) upon arrival to Canada to ensure that proper medical follow-up takes place.

Border services officers

Upon receiving the IMM 0535 form from the applicant, the border services officer must complete Part B of the form. There are three fields that must be filled out in Part B:

  • field 12 is for the confirmation or update of the applicant’s address and phone number;
  • field 13 is for the office stamp;
  • field 14 must be signed and dated by the examining officer.

The “Holder’s copy” must be returned to the applicant and the “CIC/Medical Surveillance copy” must be sent daily to the Public Health Liaison Unit via prepaid envelopes.

The border services officer should also remind the applicant that CIC must be notified of any change of address that occurs within three months of arrival in Canada; the applicant may report a change of address by accessing CIC's online services or by contacting the CIC Call Centre at 1-888-242-2100 (toll-free in Canada).

If the applicant does not hand over their IMM 0535 form at the POE, the border services officer must issue one and complete Parts A and B. If the border services officer uses the online version of the IMM 0535 form, two copies of the form must be printed and filled out. One copy is given is to the applicant and the second one is returned to CIC's Public Health Liaison Unit (as described above).

A medical surveillance handout must also be issued to applicants who require medical surveillance for inactive tuberculosis.

The Public Health Liaison Unit will notify the provincial or territorial public health authorities of newly arrived applicants who require medical surveillance. It is then the applicant’s responsibility to request that the public health officials return a proof of compliance to CIC’s Public Health Liaison Unit.

Questions regarding the procedure for clients requiring medical surveillance (by the provincial or territorial public health authorities) should be directed to the Public Health Liaison Unit.

How to complete Part A of the IMM 0535 form

An IMM 0535 form must be completed for all clients requiring medical surveillance by the public health authorities in Canada. The client must present the IMM 0535 form at the port of entry upon arrival to ensure that proper medical follow-up takes place in Canada.

For FOSS and CAIPS cases

Step 1

Fields 1-6: Complete these self-explanatory sections if not already inputted by GCMS.

Print legibly with sufficient pressure to ensure clear transfer through the carbon.

Step 2

Field 7: Enter a contact address and/or telephone number in Canada.

It is imperative to enter contact information in this field. The IMM 0535 form is crucial in notifying the Canadian provincial or territorial health authorities that medical surveillance is required.

Note: It is also important to obtain an e-mail address, if the applicant has one.

Possible contact information include the address and/or telephone number of:

  • the client;
  • the sponsor;
  • a relative;
  • a friend;
  • the educational institute (include the discipline of study);
  • the employer;
  • a non-government organization.

The officer should also remind the applicant that CIC must be notified of any change of address that occurs within three months of arrival in Canada. Once in Canada, the applicant may report a change of address by accessing CIC's online services or by contacting the CIC Call Centre at 1-888-242-2100 (toll-free in Canada).

Step 3

Field 8: Select box S2.02 or S2.02U to match the surveillance code from the Medical Assessment Screen/Diagnosis Narrative (PF3 in CAIPS) or Medical Screen (MS in FOSS) in order to identify why medical surveillance is required.

Step 4

Fields 9-11: Complete these self-explanatory sections.

Note: For GCMS cases, the IMM 0535 form can be found under the “Correspondence” tab. The fields in Part A of the form are automatically filled out by the system with the information available.

For all cases (FOSS, CAIPS and GCMS)

Step 5

Provide the client with a completed IMM 0535 form stapled to the appropriate medical surveillance handout, together with the entry document (i.e. the IMM 5292 form for FOSS and CAIPS, or the IMM 5688 form for GCMS). Enter a note in the appropriate system (CAIPS or GCMS for visa or immigration officers and FOSS for border services officers) stating that the IMM 0535 form was issued. For temporary residents, enter the medical details above/below the temporary resident visa counterfoil as follows: surveillance code, medical file number and validity of medical results (e.g., S2.02 (ABC1234567) 25.Jul.01).

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