Foreign workers: Assessing medical requirements

This section contains policy, procedures and guidance used by IRCC staff. It is posted on the department’s website as a courtesy to stakeholders.

Paragraph A16(2)(b) requires that subject to the regulations, foreign nationals must submit to medical examination. Certain foreign workers must pass a medical examination before undertaking work in Canada.

Paragraphs R(30)(1)(a) to (g) provides further detail.

Occupations in which the protection of public health is essential [R30(1)(a)(ii)]

Foreign workers intending to work in a field where the protection of public health is essential require a medical examination, regardless of the duration of stay. A work permit cannot be issued to them until they have passed the immigration medical examination, or if they still possess a valid medical certificate based on the most recent medical examination they were required to undergo within the previous 12 months. For more information, see Who must submit to an immigration medical examination?.

Procedures and processing

Foreign nationals medically inadmissible as permanent residents who may be admissible as temporary residents

Not all medical assessment results can be used interchangeably: a foreign national who is medically inadmissible as a permanent resident may be admissible as a temporary resident. The reverse may also be true if the temporary resident’s medical condition improves between applications, such as when an active medical condition becomes inactive after treatment.

With some exceptions (noted below), when an applicant changes categories, a medical officer must assess medical examination results for the new category. If the first examination was less than a year earlier, a new examination may not be necessary, as a medical officer may be able to review the existing results in the new category. Otherwise, officers should issue instructions for a new examination in the new category.

The only exceptions are permanent residence applicants with M1, M2 or M3 profiles and temporary residents with M1 and M2 profiles. They do not need a medical officer to assess their examination results in the new category, provided that the medical assessment is still valid, i.e., within 12 months of the applicant’s last immigration medical examination.

A medical officer must review the existing medical assessment of temporary residents with an M3 profile who apply for permanent residence.

Reminder: Officers should initiate a client search and review any previous medical results when appropriate.

Processing medical requirements at the port of entry

Paragraph R198(2)(b) states that, in order to apply for a work permit on entry, a person must hold a valid medical certificate, if they require one.

Foreign workers who have undergone a medical examination within the previous 12 months, before arriving at the port of entry and possess a valid medical certificate are not required to undergo any further medical examination, unless officers have reason to believe that the person may not be admissible for medical reasons. When the validity of the medical certificate is about to expire and the applicant did not arrive at the port of entry before then, a reassessment or a new medical examination is required.

Foreign workers who:

  • are seeking to work in Canada in an occupation in which the protection of public health is essential [R30(1)(a)(ii)]; or
  • are from a country where medical examination is required and will be working for more than six months in Canada [R30(1)(a)(iii)(A) and (B)]

must apply for their work permit at a visa office—whether visa-exempt or not—unless valid medical examination results are available at the time of entry.

Conditions related to medical status

If a client falls within a group defined by section R30, or where a client requests, and is eligible for, an unrestricted open work permit, medical instructions should be issued. An unrestricted open work permit may not be issued until proof is received that medical status is acceptable. The results of the medical examination will dictate whether an applicant may be issued an open work permit that is unrestricted, or one that has an occupational restriction due to health problems.

Note: Any restriction (not the client's actual medical condition which led to the restriction) should be noted on the work permit.

In-Canada extension requests

All temporary residents from medically designated countries, including foreign workers employed in occupations other than those described above should be issued normal extensions for the time requested by the client, if approved, with medical instructions. Remarks on the work permit must indicate “Additional condition: Must undergo immigration medical examination for further extensions to be considered.”

No follow-up takes place unless and until the client applies again for a new document. In cases where it is felt appropriate (i.e., including non-compliance), officers may impose conditions requiring the client to have a medical examination and prove compliance.

When the client has been previously assessed as M3 or M2 and the medical narrative specifies that an update or reassessment is required, the case must be referred to the Health Branch (HB) for review if the client is requesting an extension and the medical certificate has expired. In these cases, the steps detailed below should be followed:

  • Officers should send an email to the Medical-Services-Inquiries mailbox indicating the Client ID, medical file number, date of last immigration medical examination and details about the extension request, particularly the duration of stay requested by the client.
  • The file should be held for five working days to allow HB to respond to the request.
  • Once the HB responds, their advice should be followed.
  • If no response is received within five days, officers should immediately send a reminder to the HB indicating “URGENT” in the subject field of the message and continue to hold the file. This should also be recorded in GCMS notes.

Medical surveillance

The office (whether a CIC office, a port of entry, the Case Processing Centre in Vegreville or a visa office) which requested the medical examination in connection with a temporary resident’s application is, where required for clients with an M2 code for inactive tuberculosis, responsible for issuance of the Medical Surveillance Undertaking form [IMM 0535B]. Once completed, a copy, along with the pamphlet should be given to the client and the second one sent to the Public Health Liaison Unit (PHLU).

However, if, on the current visa, the client has a condition to report for medical surveillance and there is no documented proof of compliance, then the request for extension should be postponed or denied until such proof is available to CIC. The visa officer must re-issue the IMM 0535 form to the client and forward one copy to the PHLU.

Medical coding

Medical results are communicated in coded form (see Medical assessment coding).


  • Foreign nationals who claim refugee protection in Canada [R30(1)(a)(v)];
  • Foreign nationals who are seeking to enter or remain in Canada and who may apply to the Minister for protection under subsection A112(1), other than foreign nationals who have not left Canada since their claim for refugee protection or application for protection was rejected [R30(1)(a)(vi)];
  • Refugee claimants and the members of their family in Canada must undergo medical examinations before they can work in Canada. See Applicants with no other means of support [R206].

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