Canadian Panel Member Guide to Immigration Medical Examinations 2020

An introduction to the immigration medical examination process
Section 1: general guide for panel members
Section 2: supplementary information
Section 3: appendices

An introduction to the immigration medical examination process

A program administered by IRCC

Immigration, Refugees, and Citizenship Canada’s (IRCC) Migration Health Branch administers and delivers Canada’s medical screening program for people who want to visit or immigrate to Canada.

If someone applies to stay in Canada, they need to meet a set of criteria, including medical standards for admissibility. To be considered admissible, an applicant must not create a danger to public health or public safety, and must not create excessive demand on Canada’s healthcare or social services.

A network of panel members and regional offices

IRCC relies on a network of panel members – physicians and radiologists – to conduct immigration medical examinations (IMEs) on people applying to live here.

Panel members practising in Canada and overseas work with one of four IRCC regional medical offices to report the medical findings of the IMEs they carry out. Our offices are located in Ottawa, Canada; London, UK; Manila, Philippines; and New Delhi, India.

Who needs an IME?

Many criteria go into the decision about whether someone coming to Canada needs an IME, including how long they plan to stay, their type of visa application and where they have lived or travelled. In most situations, visa and migration officers determine who requires an IME before the applicant sees a panel physician.

Some people applying to stay in Canada will contact your clinic to get an appointment for an upfront medical exam. Others have files already created electronically, which you will use as the basis for performing an IME.

If you have questions about which category applies to an applicant, contact your Regional Medical Office (RMO).

What this guide tells you

This guide provides comprehensive information for panel members, including:

details about completing your application to become a panel member
the general responsibilities of your work, including your ethical and professional responsibilities
how to conduct an IME, including how you determine what examinations to do, the forms you will need, and how to administrate the paperwork
how to use the Interim Federal Health Program (medical insurance)
legislation that applies to conducting IMEs

Leveraging eMedical

IRCC has implemented an electronic, web-based processing system called eMedical for performing and reporting on IMEs.

eMedical is an information technology project among Canada, Australia, New Zealand and the USA that saves processing time, improves the integrity of the examination program, and provides many other benefits. Panel members working in countries where eMedical is implemented must use it to complete and transmit all IMEs.

A small number of panel members do not have access to eMedical. Those who work with a paper-based system will find key information about how to conduct an IME in Part 2 of this guide.

Check back for new information

The process for medically screening immigrants, and the immigration process itself, are subject to change. IRCC will update this guide as needed, and the updates will override the text they replace. This means the online version of the panel member guide is guaranteed to be the most current. Your RMO will also send you new information as it becomes available.

Please consult our list of acronyms, initialisms and definitions for clarification as you read this guide.

Visit IRCC’s website for more information on Canada’s immigration program.

Section 1: General guide for panel members

Your work as a panel member

Becoming a panel member

Thank you for considering becoming a panel member. If you are reading this section of the guide, you have likely been contacted by IRCC about participating in the immigration medical examination (IME) system and you’re looking for additional information about the application process.

If this is the case, to conduct IMEs on behalf of IRCC, ensure that you have submitted the following:

a series of forms that IRCC has provided:
- application form
- consent to share information
- consent to use eMedical where available
- acknowledgment of having read this guide
- acceptance of designation
all required documents, such as proof of professional license and certification
IRCC’s orientation about the IME process, which includes reading and understanding this guide and participating in discussions with IRCC Migration Health Branch personnel
all steps of IRCC’s IME training, including eMedical training, either individually or through a group activity

Panel members are not authorized to perform IMEs for IRCC during the orientation phase.

Getting your unique identifier and login

Once IRCC has received all your forms and documents, your regional medical office (RMO) will review your application and, if your status is approved, send you a unique identifier number (P number). Your P number enables IRCC to perform quality assessments of your work.

The unique identifier starts with the letter “P” followed by eight or more digits (e.g. P12345678). Your unique identifier will be embedded electronically in each IME or chest x-ray you submit through eMedical. (Paper-based clinics, please see our special set of instructions.)

Your unique identifier should be included in all your correspondence with IRCC.

eMedical user identification

All eMedical users will have a unique login ID and password to access the system. The eMedical login information is linked electronically to your unique identifier.

You must not share your eMedical login ID with any other person or let anyone else use it to submit IMEs or chest x-rays. It is the responsibility of the panel physician and panel radiologist to ensure all of the material entered into eMedical is accurate before submitting the IME. (Paper-based clinics, please see our special set of instructions.)

Panel member designation is not permanent

IRCC’s migration officials and medical officers regularly consult each other on how many panel members are needed in a given location. When you are designated as a panel member, you do not have permanent status, and completing the designation process does not create a contractual relationship with IRCC. This has several implications:

IRCC does not guarantee that any panel physician will receive a specific number of cases per year.
IRCC increases or reduces the number of panel members in a given location according to its needs.
As a panel member, you are expected to stay in good standing with your licensing body and notify IRCC about any investigation into your license or your authority to practice medicine.
You can be terminated as a panel member following a complaint or dispute about your performance. Please find more information about meeting IRCC’s performance standards and evaluations, and the complaints and resolution process.
You can also be terminated if you do not reply or provide documents such as applicants’ medical files when IRCC requests.
Your designation may be terminated at any time on 30 days’ notice. Your status may also be suspended at any time to allow for an investigation.

A summary of your responsibilities

Panel members are authorized to perform IMEs, arrange for diagnostics and investigations, and complete IME forms. You do not have the authority to assess or determine whether the medical conditions of applicants are grounds for health admissibility to Canada. More specifically, you may not give applicants an opinion on their medical admissibility. That decision rests with Canadian migration officers.

Panel members performing IMEs should ensure that they meet IRCC’s performance service standards and that there are no conflicts of interest in providing services. You are also required to help prevent fraud and abuse of Canada’s immigration laws, submit to performance evaluations, follow proper procedures for absences, and use English or French in your communications with IRCC.

For all applicants, the Canadian IME will include an examination by a panel member and a medical assessment by IRCC. Sometimes, applicants can be asked to undergo further medical evaluation to ensure compliance with Canada’s Immigration and Refugee Protection Regulations.

The assessment of whether or not a client is admissible on health grounds is largely based on findings reported in the IME, but it can include information unknown to panel members.

In parallel to the Immigration Medical Examination process, panel members are to provide appropriate and timely advice to the client when they discover a serious medical condition not known to the client. In doing so, panel members are to uphold professional and ethical standards by referring the client back to their usual treating physician or to an appropriate specialist upon request.

Here are your general responsibilities, organized according to your role in the IME process.

All panel members

As a panel member, you must do the following:

Stay familiar with the latest version of this guide and all associated administrative and IME instructions.
Follow instructions about verifying the applicant’s identity.
Hold valid professional registration and licensing issued by local or national regulatory authorities and ensure your RMO has a copy, along with an official translation in either English or French, if it is not in one of Canada’s official languages.
Maintain valid professional registration and licensing throughout the relationship with IRCC. If your license or other certification expires, it is your responsibility to send updated documents to your RMO promptly. If you fail to do so, you could be removed from the Panel Network.
Keep all immigration medical information in your possession confidential and store it securely.
Ensure that the fees you charge for immigration medical services fairly represent the services you perform, and that they comply with local guidelines or those of a medical association or group.
Ensure that a list of fees and charges for the IME and related expenses is either posted in your clinic, office or website, or emailed to applicants before their examination:
- The list should include fees for required radiological and laboratory investigations, postage or courier charges, and other services.
- Any special fees for groups or large families should also be listed.
- Copies should be available for applicants on request.
- All applicants should receive a receipt for services.
Ensure that all panel clinic staff members who you supervise are aware of the requirements and standards for the IME and its procedures, and that they understand your role and obligations.
Always offer to have a chaperone present for an IME. If a chaperone is declined, this should be documented.
Ensure that individual and clinic contact information is up to date. eMedical users must keep their contact information updated in the system and also alert their RMO when they make changes. Those who use paper-based forms must inform their RMO of changes in contact information.
Ensure high-quality work by all professionals involved in conducting IMEs, including staff members and specialist consultants.

Panel physicians

As a panel physician you must do the following:

Get the applicant to complete the IRCC’s Client Declaration and Notice Form, which explains how the information collected during the IME will be used and stored.
In addition to filling out the Client Declaration and Notice form, you are required to follow your country’s guidelines and legal requirements for documenting client consent for medical exams and tests, including vaccination.
Follow your country’s public health regulations for notifying authorities when you identify a condition that may present a public health concern, such as active tuberculosis (TB), untreated syphilis, human immunodeficiency virus (HIV) or acute viral hepatitis.
Conduct a complete, age-appropriate IME. Depending on an applicant’s age, and according to IRCC’s technical instructions (TIs), the IME can include physical and mental examinations, routine tests and appropriate pre- and post-test counselling for applicants who undergo HIV testing. You will find links for each TI in Appendix IV.
Coordinate all the IME results and the IME report to be submitted to the RMO, including lab results and chest x-rays, as well as reports from other consultants and specialists when required by your RMO.
Inform your RMO as soon as possible when you suspect fraud, misrepresentation or non-compliance.
Ensure that the laboratory you use:
- is aware of the requirements and standards for the Canadian IME
- is registered and licensed by a local or national regulatory authority and can provide proof of that when the RMO requests it
- has appropriate quality control procedures in place
- follows instructions for verifying the applicant’s identity
- complies with administrative requirements
- completes the Laboratory Requisition and Report section of the Medical Report (IMM 5419) accurately
- prevents fraudulent substitution

Chief radiologists

As a chief radiologist, you must do the following:

Monitor the performance of all nominated radiologists and their staff, and work with IRCC to resolve cases or issues of concern related to nominated radiologists. (A nominated radiologist is a licensed radiologist nominated by the chief radiologist to perform, grade and submit chest x-rays for Canada’s IMEs.)
Ensure that every nominated radiologist undertaking Canadian immigration radiological examinations is qualified as a specialist in radiology, that their license is valid, and that they are registered to work in the country where they practice.
Provide your RMO with the names, dates of birth, genders and unique email addresses of each of your nominated radiologists.
Add your nominated radiologists to the clinic profile in eMedical and notify IRCC of these changes so that we can grant them access to submit Canadian cases.
Supervise all nominated radiologists – including ensuring accuracy and quality control of the Chest X-Ray Requisition section of the Medical Report (IMM 5419).
Ensure that all nominated radiologists complete IRCC’s training regime.
Ensure that radiological examinations are conducted at the agreed site(s).
Implement and monitor the procedures for checking the identity of applicants.
Circulate any communications from RMOs and IRCC to nominated radiologists and their staff.
Advise IRCC of any anticipated interruption of service and any change related to the list of nominated radiologists. This includes absences, changes to staff, clinic contact details, capabilities and other working arrangements that could affect service.
Ensure that nominated radiologists conduct chest x-rays (routine posterior-anterior view for applicants 11 years old and older) according to the instructions laid out in this guide – and that they adhere to all procedures in this guide.
Ensure the quality and integrity of the IME process as it relates to radiology.

Nominated radiologists

Nominated radiologists are panel members who have been nominated by the chief radiologist at their clinic to help conduct IMEs. Your chief will have verified that you are a specialist in radiology, that your license is valid and that you are registered to work in the country where you practice. Your personal information will have been transmitted to your RMO to obtain a unique identifier, or “P” number for you to use.

As a nominated radiologist, you are responsible for managing your caseload and submitting chest x-rays for IMEs in a timely manner.

Chief and nominated radiologists

Both of these groups must do the following:

Conduct chest x-rays (routine posterior-anterior view only for applicants 11 years old and older) according to the instructions laid out in this guide.
Ensure that the associated panel physician is informed without delay of all chest x-rays where there is a high suspicion of active pulmonary tuberculosis.
Follow all procedures laid out in this guide.

Using eMedical

eMedical is a web-based system used by IRCC for electronically recording and transmitting IMEs. eMedical is also used by the Australian Department of Home Affairs, Immigration New Zealand, and the United States Centers for Disease Control and Prevention. It is available around the globe with a few exceptions; therefore, all panel members must submit IME results via eMedical whenever possible.

In rare cases where a panel member is unable to use eMedical (no internet signal, no computer available due to crisis, etc.), your RMO will consider allowing you to submit paper-based IME results. (Paper-based clinics, please see our special set of instructions.)

Where eMedical is available, all panel members must:

complete and submit all IMEs and related documents through the eMedical system
maintain and keep a secure eMedical account, including user ID, password, and secret questions and answers, that you do not share with anyone in your clinic
ensure all clinic staff who enter data into eMedical have their own account information
ensure that your personal and business information in the system is updated and accurate at all times
notify your RMO immediately if your password becomes known by an unauthorized person
take all reasonable steps to guarantee the security of applicants’ personal information in eMedical
ensure that applicants’ personal information contained in eMedical is treated in a manner consistent with Canadian privacy laws – including, but not limited to, protecting collected information against loss and unauthorized access, use, modification, disclosure and other misuse
ensure all panel clinic staff under your supervision are aware of and abide by the requirements and standards for completing IMEs in the eMedical system

Performance guidelines and expected timelines

Here are IRCC’s service standards for IME activities. Panel physicians are expected to perform 80 percent of these activities within the timelines set out in the table below. If you are unable to meet these standards, you must notify your RMO. You may be asked to provide a justification for the delay. If you are unable to schedule an appointment with a client within 20 days, you must provide them with proof that an appointment has been scheduled. These standards also apply when you are providing information after the initial IME results were submitted.

Activities	Time frame (in calendar days)
Appointment with panel physician, including upfront medicals	10 days
Appointment with panel physician in cases where the applicant is furthered	10 days
Obtain lab results	7 days after date of the exam
Obtain x-ray results	7 days after date of the exam
Submission of the IME to RMO by the panel physician	10 days of date of the exam
Responding to correspondence from RMO	48 hours
Forwarding inactive immigration medical files to the RMO	Paper-based: 8 week old IMEs eMedical users: Files are auto deleted after 365 days of inactivity
Notifying the responsible RMO of any change in practice location or contact information	At least 14 days before the change takes place
Notifying the responsible RMO of any absence of 7 days or more	At least 14 days’ notice, (preferably by email)
Being available for provision of performance and technical information related to the IME process (e.g. quality assurance visits, annual audits)	7 days’ notice

If you are not available for IME activities

If you plan to be unavailable for IMEs for more than seven calendar days, you must inform your RMO. Here are the rules that apply to your absences:

Enter leave dates directly into your eMedical profile.
If possible, tell your RMO when you will depart from work and when you will return. This is important information for applicants to know.
If a locum tenens will replace you while you are away, tell your RMO at least 14 days in advance, preferably by email. This will enable your RMO to approve your recommended replacement and activate their eMedical account. For more information, see our section below on using a locum tenens.
If you are identified as “on leave” in eMedical, you cannot submit IMEs. Your locum tenens can complete IMEs on your behalf.
If you have extended or repeated unreported absences, your status as a panel member may be revoked.

Please note that you are required to keep your contact information updated in the system.

Using a locum tenens

As panel member, you may ask your RMO to approve a locum tenens for your clinic if:

you will be absent from your clinic for longer than seven days
your clinic is experiencing a high volume of requests for IMEs and does not have the capacity to meet IRCC’s service guidelines

Here is the process for requesting a locum tenens:

Contact your RMO to get approval. (Your RMO can consider your request before you send documentation.)
Send your RMO the name and contact information for the locum tenens you want, as well as a copy of the locum’s medical registration and licence.
Send your RMO a statement from your proposed locum saying that they have read this guide and agree with the standards and requirements it defines. Note that before you recommend a particular physician or radiologist as your locum tenens, you must be satisfied that they have the qualifications and experience to perform IMEs, and that they understand the reporting procedures and are aware of any updates issued by eMedical or IRCC’s Migration Health Branch.
If your RMO approves the request, it will send you a written response by letter or email. You can then tell your locum that they have been authorized.

You must give your RMO at least 14 days’ notice, preferably by email, for every period of time where the locum will be acting on your behalf, or where a locum is required to temporarily increase capacity in the clinic. This gives the RMO time to activate the locum’s eMedical account. You also need to specify an end date for the locum.
IRCC will provide your locum tenens with a unique identifier.
- The locum will get their own password for eMedical. You must not share your password with the locum.
- The system will be updated with appropriate information about your locum, and their eMedical account will have a specific end date that aligns with the dates approved by your RMO.
- If you are terminated by IRCC, this will automatically cancel prior approvals for your locums.

Referring applicants to consultants and specialists

Panel physicians must not refer clients to specialists unless instructed by the Regional Medical Office, with exceptions for referral of cases of suspected active TB and HIV specialist consultations. All existing lab results and/or any specialist reports from previous specialist consultations must be attached to the IME if obtainable at the time of IME submission.

Panel physicians must not refer clients to specialists for IME purposes unless instructed by the Regional Medical Office, with exception of referral of cases of suspected active TB for specialist consultations.

All existing lab results and/or any specialist reports from previous specialist consultations must be attached to the IME if obtainable at the time of

If you relocate your practice

If you become a panel member and relocate your practice, you must tell your RMO because your designation is related to where you work. If you relocate, you may lose your designation as a panel physician. Once IRCC has assessed its requirements in your new location, it will let you know whether it needs you as a panel member there. You will have an opportunity to respond.

As a panel member, you must ensure IRCC has up-to-date documentation throughout the relationship. If your license or other certification expires, you must send the updated documents to IRCC. If you fail to do so you could be removed from the IME network.

Ethical conduct and conflicts of interest

As a panel member, you are expected always to conduct yourself ethically. When you conduct an IME for an applicant, you must carry out your professional obligations with competence, integrity and loyalty – the same way you do with all your patients.

You must also ensure that the people you employ and associate with in your practice meet these requirements. In conducting IMEs, you must:

be courteous and respectful towards all applicants
be mindful of applicants’ time, dignity, privacy and cultural practices
display integrity in professional practice, particularly in relation to conflicts of interest

Here are some of the more specific ways in which you are expected to behave:

Do not behave in a manner where you appear to be acting in a biased way because of a personal interest. You are expected to show professional behaviour and perform your IME-related activities in keeping with the principles of proper ethical medical practice and IRCC policy.
Provide appropriate and timely advice to an applicant when you discover a significant medical concern they either did not know about or did not fully understand. In such a situation, you must inform the applicant of the concern and, with their consent, refer them to an appropriate clinician.
Perform the duties of your practice impartially, uninfluenced by fear or favour.
Avoid situations where your private, financial or other interests might reasonably be thought to conflict with conducting IMEs for applicants.
- An example where a conflict of interest could arise is if there is a working relationship between your clinic and an immigration consulting firm, where you accept their referrals to conduct IMEs and, in return, you refer your clients to them.

If the following issues or events arise, you must notify your RMO as soon as possible:

You are suspended or come under investigation by your medical regulatory authority.
You learn that you have been accused of malpractice or improper behaviour, even if it has not yet been investigated.
You discover inappropriate activity relative to the provision of IMEs by your clinic, office, laboratory, or radiology centre staff.
You become aware that any associated panel member is under investigation for a criminal activity or has been charged with or convicted of a criminal offence.

IRCC reserves the right to suspend a panel member’s designation after an investigation has been completed by a medical or regulatory authority.

The Code of Conduct for Panel Members

The Canadian Government has close ties with its Migration 5 (M5) intergovernmental partners, namely the United Kingdom, New Zealand, Australia and the United States of America, as part of the M5 Health Working Group (M5HWG) in the area of migration health. The M5HWG share a collective desire to support panel members, aiming to ensure consistent and reliable, high-quality IME related services are performed, as well as to ensure the high standards of the behaviour of panel members and the level of service provided to individuals undergoing an IME are being met and maintained. Therefore, the M5WHG members have developed the Code of Conduct for Panel Members to articulate the required standards of behaviour and conduct of panel members and define protocols and procedures if there is a breach of the Code.

The Code of Conduct for Panel Members is accessible through the eMedical Support tab, under Support Material.

It is essential that all panel members are aware of, and comply with the Code. Panel members who breach the Code may be subject to action at the discretion of the relevant Migration 5 country.

Equal rights for all applicants

The principle of equal rights applies to all applicants that a panel member encounters, regardless of their:

race, national or ethnic origin, colour, religion
gender or sexual orientation
age, mental or physical disability

Canada protects the rights and privacy of an individual to identify in the gender of their choice and express their gender and sexual orientation freely. As a panel member, you are required to show the same respect and privacy for IRCC applicants.

This includes using proper gender pronouns and preferred names when addressing an applicant. Outside of IME procedures, you should never disclose an applicant’s medical information, including gender expression and sexual orientation.

Accommodating cultural and other needs

Some applicants may ask for special accommodation during the IME due to personal or cultural sensitivities. As good practice, you should routinely offer to have a chaperone present when you are examining a client. Patient consent is always necessary for a chaperone to be present.

Female applicants may be uncomfortable with a male examiner (and vice versa), in which case you should either offer to have a chaperone present during the examination or make alternate arrangements that preserve the integrity of the IME.

Preferably, the chaperone should be a trained health professional familiar with the examination so they can confirm it was appropriately conducted. If that is not possible, you can use non-medical staff. In some cases, it may be reasonable for you to suggest that the patient choose a person to bring to the examination.

Overall, you should accommodate personal and cultural sensitivities, while keeping in mind that IME standards must be respected. When you make an accommodation, record on the examination form the type of accommodation you provided and the roles other people played who may have been present during the IME.

Should you not be comfortable examining a client for any reason – due to a conflict of interest, dispute, religious reason, personal belief, etc. – it is your responsibility to tell the applicant and your RMO.

Using Canada’s official languages

English and French are the official languages of Canada and, as a panel member, you must be able to communicate verbally and in writing in at least one of them. You must also complete the IME in one of the official languages. Other things to keep in mind:

Inform IRCC of your preferred official language for correspondence, as well as any other language you speak. You can tell us about your other languages in a drop-down list in your eMedical profile.
You must choose your preferred official language for processing IMEs in eMedical.
When you submit reports from specialists as part of an IME, you must do so in one of Canada’s official languages. If a specialist submits a report in another language, you must have it translated.

Employing a medical interpreter

When you perform an IME, you may find yourself examining an applicant who does not speak one of Canada’s official languages – or any language you speak. In these cases, you and your clients would benefit from the services of an interpreter.

You may consider obtaining the service of a professional interpreter for clients, particularly in regions where a high proportion of clients may need a translator. An interpreter could also be a friend, a relative of the applicant or any other person. The person acting as an interpreter:

should be at least 18 years old (the interpreter must be mature enough to understand and appreciate the importance of the proceedings and questions)
must have sufficient knowledge of English or French
must be able to provide the required assistance

While providing this service is not an obligation, it is highly recommended by IRCC in order to provide accessible IME services to clients.

Administrative instructions

IRCC’s Migration Health Branch has put together this list of administrative instructions to guide you in various situations – from how to advertise your services to how to handle complaints from applicants.

Guidelines for managing records

All the forms, documents and results of investigations involved in completing IMEs are the property of IRCC once the IME is submitted. You can access the IME for 365 days after you submit it.

Panel members who perform IME-related activities must follow the procedures and guidelines here for copies and files as well as for original documents and information:

Keep a paper or electronic copy of the original IME for at least two years – or for the minimum retention time for medical documents in your area of jurisdiction, whichever is longer.
Information you collect during the IME is for Canadian immigration medical purposes only. You may not use it for other purposes – including research, clinical studies or investigations – without IRCC’s consent. Direct your consent requests to the Integrated Medical processing network by:

Email: IRCC.MHBIMPN-RITDMDGMS.IRCC@cic.gc.ca
Mail:
Senior Director, Integrated Medical Processing Network
Migration Health Branch
Immigration, Refugees, and Citizenship Canada
250 Tremblay Road
Ottawa, ON K1G 5P4
Forward original documents and information related to an IME to your RMO electronically via eMedical.
Save a full copy or a summary of the IME for your own records.
Print a copy of the IME by clicking the “Print health Case” button at the bottom of the Health Case details window.
Print out a full copy or a summary of the IME to give to the applicants or, in the case of children, their guardian – unless there is a strong reason to not do so. Examples include when there is information in the IME from a different client, or when releasing the information could reasonably lead to another person or entity being subject to significant inappropriate behaviour by the applicant.
Applicants may request a copy or a summary of their IME at any time. You should provide the requested information as long as your office has retained it – unless there is a strong reason to not do so.
Applicants who wish to have further access to IRCC’s review and assessment of their IME can do so by filing an access request.

Advertising your services

You may wish to advertise your IME services outside your clinic by using a website, or electronic or printed material. If you do this, the following rules apply:

You may:
- include information about regular fees associated with an IME (including user and related fees), the services included in your fees, your clinic’s address and contact information
- provide links to Government of Canada websites
You may not:
- post a summary of this information, as it changes frequently
- associate a Canadian flag with your website or advertisement
- use IRCC’s insignia in any way
- use the eMedical insignia or logo in any way.

How to communicate and where to send your questions

Regional medical offices

You will have regular contact with your RMO about medical and non-medical issues. Regional medical offices are your point of contact for all business issues, questions and comments about immigration medical cases and examinations, and about the immigration medical program. Your RMO will also update you on IME processes from time to time.

Questions and information about specific cases should always include identification details, such as the IME, unique medical identifier number (UMI) or unique client identifier number (UCI). To protect applicants’ confidentiality and personal information, information requests should not identify them by name or include their date of birth.

eMedical systems support

If you have questions about eMedical (regarding user functionality, adding or removing users, submitting exams, etc.) you can:

consult the eMedical support material under System User Guides and Quick Reference Guides
send the question via the email box that your RMO reserves for panel physician questions

For all other inquiries related to eMedical – issues with system glitches, unscheduled outages, etc. – contact the eMedical systems support team.

Canadian government officials and third parties

The Privacy Act says that you should never provide information about a specific case over the phone, private email or other means if you cannot verify the identity of the other person. Even acknowledging that you have a file on a specific applicant can constitute a breach of their privacy. If you have any doubts, consult with your RMO.

The media

The media may become interested in the IME of a particular individual and contact you for information. You must never provide the media with information about a particular case – or any confidential information about the immigration system or an applicant.

Refer all requests for comment or information to your RMO.

Remember that, as a third-party physician, you are doing IMEs on behalf of the Government of Canada. This means that all IMEs and their contents belong to the Government of Canada and not to you. Never grant a request from a third party – including a lawyer – for a copy of an IME. Instead, direct parties making requests like these to the Government of Canada’s online service for access to information or personal information.

Applicants

Applicants may have questions about the immigration process, particularly when RMO officials ask for additional medical information or investigations.

Although you can explain what the requested information means from a general medical point of view, you are not authorized to explain or justify any immigration reason for these requests. You should simply explain that the request came from the RMO, that you are only a contact person between RMO and the applicant, and that the applicant can contact their migration office for more information.

Specific questions about the IME process could include the following:

the time it takes IRCC to complete the medical assessment process
the time it takes between completion of the IME and the next steps of the immigration process or the issuing of a visa
administrative or policy aspects of the program
other immigration-related issues, including why the applicant’s IME is not linked to their application

Applicants can find many answers to their questions by reading IRCC’s website or by using IRCC’s help centre. These tools include the phone numbers applicants can use to contact the IRCC help line, and the forms to submit web enquiries about immigration applications. Some applicants can also use their ‘myCIC’ web account to ask questions.

You should never direct applicants in the following ways:

Never send applicants to your RMO or share any RMO or RMO staff contact details with applicants or their representatives. RMOs will not have all the information they need to reply to most types of enquiries and will be unable to verify the applicant’s identity.
Never direct clients to the eMedical help desk.

Ensure that your staff is aware of these instructions.

Charging and collecting fees for IMEs

All applicants, except those eligible for the Interim federal Health Program, are responsible for paying all fees and costs associated with their IME. These fees include the following:

panel physician services
radiological and laboratory services
consultations with specialists
investigations and treatment – e.g. when referred for treatment of tuberculosis or syphilis
costs related to sending medical documents to the RMO

You may also charge reasonable fees for:

follow-up visits in the case of furtherances
providing copies of the IME to the client upon request
missed appointments in accordance with local standards of practice
user fees – e.g. the IME clinic is in a hospital and the hospital charges the client a fee for using the facility

Rules associated with charging fees:

All current user or additional fees must be included in the cost of your clinic’s IME wherever the cost is displayed or advertised.
You should charge reasonable fees and either post a fees list in your clinic, office or website, or email your fees to the applicant before their examination.
Applicants should receive an itemized receipt that clearly indicates the services for which you charged them and includes the applicant’s name, age and IME number.
Your fees must reflect local conditions and service charges. Consequently, the fees for IMEs may vary from country to country and even within a country.

Quality assurance, incidents and complaints

Clear and transparent procedures for quality assurance, responding to complaints and resolving problems improve IRCC’s service to applicants and the overall integrity of the immigration medical program.

Our quality assurance regime

IRCC’s Migration Health Branch conducts regular quality assurance and quality control exercises, and its officers will occasionally visit panel members to ensure they are meeting IRCC’s IME performance guidelines.

When your RMO asks, you should make yourself and your staff available for evaluation, monitoring, training, quality assurance, training activities and onsite visits. Your RMO will usually give you seven days’ notice. Migration officers may also conduct administrative visits to panel sites on the behalf of the RMO.

When an RMO requests, you must provide, in a timely fashion, all the forms and documents they have asked to review (e.g. panel member appointment forms, quality assurance activities). The procedure for completing the IME is spelled out in this guide and your performance in this regard will also be evaluated.

Your RMO will evaluate all complaints and incidents related to your performance conducting IMEs.

If an incident occurs during the IME process

If you have a disagreement with an applicant during an IME, or confusion arises or an event occurs that might compromise client service, you should report the incident to your RMO, providing full details. Here are some examples of incidents you should report:

The applicant becomes upset, angry, threatening or violent toward you or your staff.
The applicant claims that you are deliberately delaying the IME process or requesting unnecessary investigations for personal gain.
The applicant refuses to undergo parts of the examination or investigation.
You or your clinic staff become aware of attempts by the applicant to falsify certain aspects of the IME, or clinical or laboratory investigations.
You or your clinic staff are asked to overlook or alter some aspects of the IME, or of clinical or laboratory investigations.
The applicant threatens to complain about the IME service or the IME process itself.
You feel that reporting an unusual situation may be instructive to the program or provide useful information to other panel members should they encounter a similar situation.

Email your respective RMO regarding the situation. Reports to your RMO should include:

the date of the incident
the client’s IME, UMI or UCI number
a brief description of the incident

What happens when someone complains about you?

Complaints are common in any client service procedure. Applicants, the people representing them and other people outside IRCC may make complaints about the IME and its related services. IRCC personnel may also make critical comments or notify RMOs about errors, performance issues, or other situations of concern regarding the IME and the services panel members provide.

If someone makes a complaint against you or your clinic, you may receive a letter of concern from your RMO. If this happens, you must comply with the instructions and timeframes indicated in the letter, including replying by the date that your RMO indicates. If you expect your reply to take longer, you should notify your RMO.

IRCC’s Migration Health Branch will carefully consider your opinions and viewpoints – as well as those of the person making the complaint – when they review a complaint or concern.

Resolution process for complaints and performance issues

If you engage in misconduct or poor performance, you may lose your designation as a panel member. Here are some examples of situations where you or your clinic staff are performing poorly:

Unacceptable behaviour or demonstrated misconduct:
- unprofessional or unethical conduct or activities
- breaching client confidentiality
- illegal activities
- performing IMEs after any loss or suspension of medical license
- reports or indications of physical, verbal or sexual abuse by panel members or their staff
Continued failure to maintain an acceptable level of performance as set out in this guide or in written instructions from the RMO. This includes when a panel member continues to be deficient, after they are repeatedly notified, in the following areas:
- timely and correct completion of IMEs
- appropriately providing necessary laboratory and clinical investigations and activities
- gathering and managing medical information
- transferring information to IRCC’s Migration Health Branch in a timely manner
- following the instructions in this guide

Resolving issues

Your RMO will address minor incidents or performance deficiencies by sending you a letter outlining the steps you must take to correct the issue. This could include additional training.

For serious or repeated administrative or clinical issues – such as harassment, allegations of sexual misconduct or illegal activities – the RMO can suspend you, issue a letter summarizing the facts that gave rise to the complaint and provide you with an opportunity to reply.

While your panel member designation is suspended, you must stop all IME activities related to taking on new applicants. Your RMO will tell you how you should work with applicants you are already seeing.

If you are suspended, your RMO will conduct an assessment once it has received your reply. If your response is deemed satisfactory, your RMO will inform you of its decision and potentially reinstate you with appropriate recommendations. Alternatively, your designation could be permanently terminated.

If you are terminated

IRCC has complete authority over the management of the panel member network. The number of panel members that we require may change if demand for IMEs shrinks in your area. If you are terminated for operational reasons, your RMO will notify you in writing at least 30 days in advance.

However, if your designation is terminated because of performance deficiencies or complaints, the termination is effective on the date of your RMO’s notification letter.

If you retire or wish to resign

Panel members may retire or ask to be removed from the panel network at any time. Send written notification to your RMO, including the date you expect your activities will end.

The Immigration Medical Examination

This section provides panel members who use eMedical with information they need to complete IME and associated forms.

Panel members using a paper-based system should refer to our supplementary section in this guide. IRCC has redesigned IME paper forms to ensure they are consistent with eMedical IMEs.

General information about the IME

The IME consists of a medical history, physical examination, age-specific laboratory tests and age-specific chest x-ray.

Usually, routine, age-specific laboratory and radiologic tests include:

urinalysis – applicants age 5 and older
chest x-ray (posterior-anterior view) – applicants age 11 and older
syphilis – applicants age 15 and older
HIV – applicants age 15 and older
serum creatinine – applicants age 15 and older

A medical examination includes any or all of the following:

physical examination
mental examination
review of past medical history
laboratory test
diagnostic test
medical assessment of records respecting the applicant
urinalysis – applicants age 5 and older
chest x-ray (posterior-anterior view) – applicants age 11 and older
syphilis – applicants age 15 and older
HIV – applicants age 15 and older

A medical examination does not include breast, genital, gynecological or rectal examination. If there is a history or a clinical suspicion of malignancy, record any relevant information in the medical history portion of the IME.

Panel members may request additional lab tests for an applicant younger than the recommended age based on an applicant’s individual risk factors.

It also be necessary to screen applicants below the ages indicated. See IRCC's technical instructions for more information.

How do I determine what examinations are required?

eMedical provides a questionnaire for all applicants. Depending on their answers, eMedical may populate the form with additional questions and possibly instruct you to send the applicant for consultation with a specialist.

As the panel physician, you are never required to decide on a course of treatment or additional tests. Once you submit the applicant’s IME, a medical officer working with your RMO will decide if additional tests are required and notify you through eMedical. Alternatively, instructions may be provided by your RMO before eMedical prompts have been updated. Instructions from your RMO supersede any prompts from eMedical.

Verifying an applicant’s identity and preventing fraud

It is essential that you identify applicants throughout the IME process to ensure the person undergoing the IME is the same person applying for entry to Canada, and that there is no substitution at any time during the lifecycle of the IME. An applicant’s identity is confirmed through a process of verifying the applicant’s photographs and identity documents.

You must take a live digital photograph of the client in your clinic and upload it to eMedical.
Photographs must meet IRCC’s photographic specifications standards (PDF, 506 KB).
The eMedical system will include the photograph on all requisitions and referrals (laboratory, radiology, specialists and others).

Required documents

The applicant must submit a passport or other identification document acceptable for the Canadian IME. IRCC strongly prefers that applicants submit passports. This includes new passports and passports expired for no more than a year.

Other approved identification documents include the following:

national ID card (an original birth certificate is an acceptable national ID document for applicants under the age of consent only)
driver’s licence (Drivers licenses will be accepted as valid identification only if issued by Canada, the United States, Australia, New Zealand and the United Kingdom and presented in panel clinics located within the same country.)
refugee travel document
Red Cross travel document
UN laissez-passer
Seaman’s book
Organization of American States travel document
Refugee Protection Claimant Document

If an applicant does not have approved identification

If an applicant does not provide an approved identification document, they must provide an alternative form of identification. You should not turn such applicants away, and you should conduct the IME as long as the applicant presents some form of identification.

If the applicant provides identification that is not approved, you must report “identity concern” in the eMedical system.

Important: To ensure the integrity of the IME process, the applicant must use the same identity document for all components of the IME, including laboratory, radiology and specialist referrals. Please inform applicants accordingly.

If you have an identity concern

If you cannot confirm that the person who has arrived for an IME is the person on the ID documents being presented, you should report that as an ID concern. In all cases except upfront medicals, biodata and information extracted from the applicant’s visa application will already appear in eMedical. You should compare this information with what the client attending the IME is presenting.

You should not report as an ID concern any minor differences in the eMedical information and the ID document such as misspelling of names, minor errors in date of birth or differences in validity dates.

If the applicant provides personal details that seem inconsistent with the information on the identity documents they submit, you must identify the concern in the eMedical system. For paper-based IMEs, report your concern on the IMM 1017: Medical Report – Client Biodata and Summary form.

Scan the identity document you are concerned about and attach a copy to the health case in the IME. You should then complete the IME according to customary procedures. The document will be submitted to IRCC once you have completed the IME.

IRCC will investigate your concern about the applicant’s identity.

Client Declaration and Notice

(See our sample Client Declaration and Notice form in Appendix II.)

Before undergoing an IME, all applicants must complete the Client Declaration and Notice form. A legal guardian or parent may provide and sign the declaration on behalf of the applicant if the applicant is under 16 years of age or is unable to complete and sign the declaration for reasons of incompetency (for example, if they have reduced mental capacity).

The Client Declaration and Notice form includes the following:

a declaration stating that all information provided at the time of the IME is true and complete
a notice stating that the IME information will be collected and temporarily stored in the eMedical system on segregated databases located in Australia
a notice explaining that the collection, use and disclosure to IRCC of IME information follows Canada’s Immigration and Refugee Protection Act or protects the health and safety of Canadians
a notice explaining the collection, storage, use and disclosure of vaccination information where the applicant has consented to the disclosure of this information to IRCC

Other important details:

eMedical will automatically enter the applicant’s information on the Client Declaration and Notice form beforehand.
You should print the form from eMedical and provide it to the applicant. The applicant must sign the copy of the Client Declaration and Notice provided in eMedical. Forms that have been altered or translated into another language are not acceptable.
You or your staff should review the Client Declaration and Notice form with the applicant and answer any questions.
The Client Declaration and Notice form is not a consent document and should not be construed as consent for the purpose of the IME or for vaccination.
You must ensure to obtain client consent according to your country’s guidelines or legal requirements before performing medical tests and procedures required for the IME and before administering any vaccination, where applicable.
You must ensure that the applicant understands and accepts that any relevant personal information collected during the IME process, including IME information and any vaccine-related information, when applicable, will be disclosed to IRCC.
If an applicant does not complete the Client Declaration and Notice form, you cannot carry out the IME and you must notify your RMO.
The applicant (or legal guardian/parent) must sign and date the Client Declaration and Notice form.
You must scan and upload the form to eMedical.
Tick the Client declaration check box in eMedical.
You cannot submit the IME information in eMedical unless the Client Declaration and Notice form is attached.

Medical Report – Client Biodata and Summary (IMM 1017)

(See our sample IMM 1017 form in Appendix III.)

IRCC has implemented one standard form, the Medical Report – Client Biodata and Summary (IMM 1017), for all immigration categories. This form displays information such as:

client information (biodata)
immigration information
IMM type: excessive demand exempt (EDE), non-EDE, or refugee overseas (see below for an explanation)
IME grading
panel physician declaration

Excessive demand exempt (EDE) applicants

EDE applicants are people who cannot be deemed inadmissible on the grounds that they would place an excessive demand on publicly funded Canadian health and social services. EDE applicants include refugees, refugee claimants, individuals with protected person status, and certain clients in the family classes.

However, EDE clients are assessed for:

danger to public health
danger to public safety

Non-EDE applicants

Non-EDE applicants are assessed for:

danger to public health
danger to public safety
excessive demand on publicly funded Canadian health and social services

Refugee overseas applicants

Refugee overseas applicants are automatically assessed as EDE. Panel physicians must complete and submit the Resettlement Needs Assessment Form (IMM 5544) for overseas refugees.

IRCC typically issues the Medical Report – Client Biodata and Summary (IMM 1017) form with the applicant’s information and immigration information sections completed.

Applicants who have been issued a Medical Report – Client Biodata and Summary (IMM 1017) must present the form to your clinic when they arrive for their IMEs. The form will include two applicant identifiers: IME number and UCI number. (Note: This form may not include a client photo).

Clinic staff must search for the applicant’s health case in eMedical using the IME number. They may search using the applicant’s name and passport number, or UCI number or UMI number.
Clinic staff should confirm the applicant’s identity by comparing the applicant’s information with the approved identity document.
The clinic must take a digital photo of the applicant and upload it to eMedical to verify the applicant’s identity throughout the IME process.
The panel members involved in the applicant’s IME then complete all components of the examination in the eMedical system.

Upfront Medical Report – Client Biodata and Summary (IMM 1017B upfront)

(See our sample IMM 1017B upfront form in Appendix III.)

An upfront medical is an IME performed when an applicant reports to a panel physician with no paper Medical Report – Client Biodata and Summary (IMM 1017) or file in the eMedical system. Upfront medical examinations are generally permitted for students, visitors and workers who are applying to be temporary residents of Canada.

Only certain applicants are permitted to undergo an upfront medical. When it is not possible to confirm whether an applicant is permitted an upfront medical, you should perform one and indicate that the applicant is a “worker”. Please note that all members of an application should be identified under the same category. Therefore, if the principal applicant (say, the mother) is a worker, all children on the application should also be identified as workers.

These exams do not apply to family members being sponsored by a permanent resident of Canada. Whenever IRCC makes changes to the rules about individuals who can undergo an upfront medical, panel physicians are notified by their RMO.

Here is the procedure for doing upfront medical exams:

You must first search eMedical for the applicant using their name and identity document number (e.g. passport number) to confirm that they do not already exist in the system. Always perform this step.
If the applicant does not exist in eMedical, click “create case.”
Enter the applicant’s personal details:
- title
- family name
- gender
- date of birth
- country of birth
Enter the identity document details. Clinic staff will check the applicant’s identity with the approved identification document. (Note: a live photo of the applicant must be taken and uploaded to eMedical at a later step during the IME.)
Enter the applicant’s preferred language.
In the “Proposed Visa Application Details” section, select the appropriate upfront category from the drop-down list (student, worker, visitor or family EDE).
Click “Create.”
Proceed to upload and attach the applicant’s photograph.
Complete “Identity Confirmation”.
An “Information Sheet” letter will be generated by the system and must be printed and given to the client for submission to IRCC along with the visa application.

Panel physicians must ensure that they provide the applicant with proof that they have completed their upfront medical examination. For eMedical, the proof is the “Information Sheet” letter that gets printed. Applicants must include this proof when they submit their visa application.

If the applicant has received instructions for further examinations, you do not need to repeat or submit a new IME; you should simply remind the applicant to provide the migration office with proof of the upfront medical examination.

Since an IME is valid for 12 months, you should remind applicants to submit their visa application along with proof that they have completed their upfront medical examination well before the expiration date; otherwise, the client may have to undergo a second IME.

Medical Report (501 Medical examination)

You will use the applicant’s medical report to assess their medical condition. The medical report may be completed by clinic staff or the applicant, but you as the panel physician must review it to confirm the information.

Medical conditions that do not impact the immigration medical assessment

The following medical conditions do not impact the immigration medical assessment. If noted during the exam, check the medical history of the affected organ or system as normal and report your findings in the general comments section. Assign these cases an A grading if there are no other significant conditions.

hypothyroidism or hyperthyroidism
any history related to pregnancy, childbirth and gynaecology (such as C-sections, gestational diabetes or hypertension, IUDs or other birth control, fibroids, non-cancer hysterectomy)
history of illness, injuries and surgeries with current normal function (such as repaired ventricular septal defect [VSD] or atrial septal defect [ASD], orthopedic injuries, appendectomy, negative biopsies or scopes, hepatitis A)
asthma and allergies
skin conditions not currently requiring treatment with biologic medications (such as psoriasis, acne, vitiligo, striae, uticaria)
stable musculoskeletal conditions with no or minimum impact on function (such as scoliosis, history of fractures, osteoarthritis, joint replacement)
cosmetic and plastic surgery not related to a disease process (such as bariatric surgery, breast implants, rhinoplasty, keloid removal, digit amputation)
dental observations (such as caries, dentures)
obesity
professional tattoos and piercings

Medical history questions

You must provide details along with all “Yes” answers to medical history questions. IRCC requires the following information:

date of diagnosis
date of treatment or surgery
relevant medications
current status of the condition (and, if applicable, the prognosis)

You must either provide this information in the comments section or attach a report to the IME.

The following table lists additional requirements when the answers to medical report questions show abnormality – whether the IME is completed in eMedical or on paper. See IRCC's technical instructions for more information.

Table: Medical history questions

Question	Related TI	IMM type	Requirements if “yes” in eMedical
Tuberculosis (TB), treatment for tuberculosis	Tuberculosis TI	EDE and non-EDE clients	Lateral CXR & AP CXR if ‹11 years old, Chest x-ray examination
Close household or work contact with tuberculosis (within last 5 years)	Tuberculosis TI	EDE and non-EDE clients	IGRA or TST, lateral CXR & AP CXR if ‹11 years old, Chest x-ray examination
Prolonged medical treatment and/or repeated hospitalization for any reason, including a major operation or mental illness	N/A	EDE and non-EDE clients	Medical report, if available when IME is submitted or if RMO requests
Psychological/psychiatric disorder (including major depression, bipolar disorder or schizophrenia)	Psychiatric conditions TI	Obtain x-ray results	Report from psychiatrist, psychologist or treating physician (attach all existing results and reports from labs and previous specialists)
History of HIV	HIV TI	EDE and non-EDE clients	HIV, CXR, Hepatitis B and C, syphilis, IGRA or TST regardless of age, and HIV specialist report including CD4 count, HIV viral load, and when antiretroviral medications will be needed
An abnormal hepatitis B or C blood test	Hepatitis / Liver disease TI	EDE and non-EDE clients	HIV, CXR, Hepatitis B and C, syphilis, regardless of age
Cancer or malignancy in the last five years	Cancer or Malignancy TI	non-EDE clients	Oncology report
Diabetes	Diabetes, hypertension, chronic renal or cardiac diseases TI	non-EDE clients	Screen for signs or symptoms and presence of end-organ damage.
Heart condition including coronary disease, hypertension, valve or congenital disease	Diabetes, hypertension, chronic renal or cardiac diseases TI	non-EDE clients	Screen for signs or symptoms (including blood pressure) and presence of end-organ damage. Serum creatinine, regardless of age
Blood condition (including thalassemia)	N/A	non-EDE clients	Check for history of admission.
Kidney or bladder disease	Diabetes, hypertension, chronic renal or cardiac diseases TI	non-EDE clients	Urinalysis, serum creatinine (eGFR if abnormal); regardless of age
An ongoing physical or intellectual disability affecting current or future ability to function independently or be able to work full-time (including autism or developmental delay)	Psychiatric conditions TI and Cognitive impairment in adults TI	EDE and non-EDE clients	Activities of daily living (ADL) if > 5 years old, Chart of Early Childhood Development (CECD) if < 5 years old, consult TI for complete requirements
Addiction to drugs or alcohol	Psychiatric conditions TI	EDE and non-EDE clients	Only if the RMO requests – a psychiatrist’s, psychologist’s or treating physician’s report that specifically comments on previous threatening behaviour and if there is evidence of IV drug use, HIV, hepatitis B and C, regardless of age. The report must also specifically address if it is reasonably likely the client will exhibit future behaviour that might be a threat to the client or others.
Prescribed pills or medication (excluding oral contraceptives, over- the-counter medication and/or natural supplements)	N/A	EDE and non-EDE clients	List relevant medications and mention the indication
For female clients: a) Are you pregnant?	N/A	EDE and non-EDE clients	N/A
b) If yes, what is the expected date of delivery?	N/A	N/A	eMedical generates this Pregnancy Deferral Letter.
c) If yes, do you wish to defer your chest x-ray at this time?	N/A	N/A	N/A

Physical examination

As the panel physician, you must complete the physical examination. You must provide details of all abnormal findings during the physical examination. IRCC requires the following information:

history
diagnosis
treatment details (including dates and medications)
lab results
specialist reports (as required)
current status
prognosis

You may enter this information in the comments section or attach a report to the IME in eMedical.

The following table lists additional requirements when the answers to physical examination questions show abnormality. See IRCC's technical instructions for more information.

Table: Physical examination

Physical examination	Related TI	IMM type	Requirements if abnormal
Was a chaperone offered?	All TIs	EDE and non-EDE clients	Not applicable. Offer a chaperone to everyone. If a chaperone is declined, this should be documented.
Ear/nose/throat/mouth	N/A	EDE and non-EDE clients	N/A
Hearing	Hearing impairment or deafness TI	EDE and non-EDE clients	N/A
Eyes (including fundoscopy)	N/A	EDE and non-EDE clients	N/A
Best distance visual acuity (with or without correction)	N/A	EDE and non-EDE clients	N/A
Blood pressure (clients = 15 years of age) Normal readings <150 systole and <90 diastole	Diabetes, hypertension, chronic renal or cardiac diseases TI	EDE and non-EDE clients	Repeat blood pressure
Repeated blood pressure (clients = 15 years of age) Normal readings <150 systole and <90 diastole	Diabetes, hypertension, chronic renal or cardiac diseases TI	non-EDE clients	Screen for signs or symptoms (including blood pressure) and presence of end-organ damage serum creatinine regardless of age
Cardiovascular system	Diabetes, hypertension, chronic renal or cardiac diseases TI	non-EDE clients	Serum creatinine, regardless of age,
Respiratory system	Tuberculosis TI	EDE and non-EDE clients	If signs of TB: CXR, HIV, regardless of age
Nervous system: sequelae of stroke or cerebral palsy, other neurological disabilities	Debilitating conditions, Activities of daily living, and/or Developmental milestones: Chart of early childhood development TIs	EDE and non-EDE clients	Complete Activities of daily living, Development milestone: Chart of early childhood development and/or an assessment of cognitive functioning forms
Mental and cognitive state	Cognitive impairment, Activities of daily living, and/or Developmental milestones: Chart of early childhood development TIs	EDE and non-EDE clients	ADL if > 5 years old, CECD if < 5 years old, consult TI for complete requirements
Intellectual ability	Cognitive impairment, Activities of daily living, and/or Developmental milestones: Chart of early childhood development TIs	EDE and non-EDE clients	ADL if > 5 years old, CECD if < 5 years old, consult TI for complete requirements
Developmental milestones (clients = 5 years of age)	Developmental milestones: Chart of early childhood development TI	EDE and non-EDE clients	Complete Developmental milestones: Chart of early childhood development form
Gastrointestinal system	Hepatitis/liver disease TI	EDE and non-EDE clients	N/A
Musculoskeletal system	Debilitating conditions TI and Activities of daily living TI	EDE and non-EDE clients	Complete activities of daily living if > 5 years old, CECD if < 5 years old
Skin and lymph nodes	Cancer and HIV TI	EDE and non-EDE clients	Screen for skin cancer, leprosy, surgical scars, tattoos and piercings. Inspect/palpate neck, axilla and groin for lymphadenopathy
Evidence of substance abuse (e.g. venous puncture marks)	Psychiatric conditions TI	EDE and non-EDE clients	Complete psychiatrist’s report and, if evidence of IV drug use HIV, hepatitis B and C screening, regardless of age
Endocrine system (such as evidence of complications from diabetes)	Diabetes, hypertension, chronic renal and cardiac diseases TI	non-EDE clients	If diabetes is present, proceed with screening.
Are there any physical or mental conditions that may prevent this person from attending a mainstream school, obtaining full-time employment or living independently now or in the future?	Psychiatric conditions and Cognitive impairment TI	EDE and non-EDE clients	ADL if > 5 years old, CECD if < 5 years old, consult TI for complete requirements

Laboratory Requisition and Report

eMedical will generate laboratory requisitions with applicant biodata and a photograph already printed on them. The system will also generate mandatory tests according to the applicant’s age and clinical findings.

Staff must document any identity concerns in eMedical. In such cases, laboratory testing may continue, and the panel physician will report the concerns to IRCC for follow up.

Urinalysis

A urinalysis is mandatory for all clients five years of age or older.

PPs and their clinic staff must NOT directly observe the collection of urine samples. Should there be a concern that a client has provided a falsified sample, the PP should grade the IME B and enter their concerns as a comment.

Refer to the Diabetes, hypertension, chronic renal or cardiac diseases TI for detailed recommendations on screening.

Syphilis serology

Syphilis is significantly prevalent in many regions of the world. You must pay special attention during the IME for all clients that have risk factors for syphilis, particularly those originating from areas with a high prevalence of syphilis.

Syphilis screening is required for all clients 15 years of age and older undergoing an IME. You must also request syphilis testing for clients below the age of 15 with any of the following risk factors:

signs or symptoms compatible with syphilis infection
high-risk sexual activity (for example, unprotected anal or vaginal sex, or multiple sexual partners)
history of another sexually transmitted infection such as HIV, herpes, chlamydia, gonorrhea
history of being born to a mother diagnosed with syphilis
history of sexual contact with a known case of syphilis
history of pregnancy
for men, a history of having sex with other men
history of sex work
injection drug use

The evaluation consists of a medical history, physical examination and laboratory tests. You are required to report:

if the applicant shows any signs or symptoms related to syphilis
if the applicant has had a previous syphilis diagnosis
evidence of recent or previous treatment

Symptoms are non-specific and it is entirely possible to go through the early stages of the infection without knowing about it.

See IRCC's technical instructions for more information – in particular, the syphilis TI.

If you see positive syphilis serology results from an applicant, you must:

treat the syphilis according to the Canadian Guidelines on Sexually Transmitted Infections and provide proof of treatment
accept previous treatment carried out according to the Canadian Guidelines on Sexually Transmitted Infections and provide proof of such treatment

IRCC requires the following treatment information:

dates
medications
dosages

To prove that treatment has been provided to the applicant, you may either include proof of treatment information in the general supporting comments of the syphilis test section or attach a report to the IME in eMedical.

HIV serology

HIV screening is required for all clients 15 years of age or older undergoing an IME. Panel physicians must also request HIV screening for clients below the age of 15 with any of the following risk factors (TB high-risk group, refer to TB TI):

signs and/or symptoms compatible with HIV diagnosis
history of being sexually active
history of another sexually transmitted infection such as syphilis, herpes, chlamydia, gonorrhea
history of sharing contaminated needles, syringes and other infected equipment and drug solutions for injection drug use
history of receiving unsafe injections, blood product transfusions or medical procedures that involve unsterile cutting or piercing
accidental needle stick injuries, including among health workers
suspected active tuberculosis, hepatitis B, hepatitis C
tattoos, body piercing, or acupuncture not thought to be done with aseptic technique
history of being born to an HIV positive mother
any child showing failure to thrive

You should also do the following:

Provide the applicant with culturally sensitive, age and gender appropriate pre- and post-test counselling.
Consider legal, ethical, social and human rights issues.
If you use an interpreter, select one who is unbiased and has no connection to the applicant. Family members or friends cannot act as interpreters. The applicant must pay the cost of a professional interpreter.
Provide pre-test counselling that includes information on the following:
- how HIV is transmitted and prevented
- a description of the testing procedure
- confidential HIV testing, reporting and record handling
- the meaning of HIV screening test results, including the possibility of false positive or false negative results
- the need to inform anyone at risk of infection if the test is positive
- the applicant’s consent to undergo testing

You can find detailed information about how to manage pre- and post-test counselling in International Organization for Migration (IOM) Guide for HIV Counsellors: IOM HIV Counselling in the Context of Migration Health Assessment.

For all clients with positive HIV testing, panel physicians must provide a completed (signed and dated) IMM 5728: Acknowledgement of Post-test Counselling form, available in Appendix III.

Chest X-Ray Requisition and Report

Routine posterior-anterior chest x-rays (CXRs) are mandatory for applicants 11 years of age or older. If a chest x-ray is required for a child less than 11 years old, an anteroposterior view is mandatory. A panel physician should request a CXR, regardless of age, if the medical questionnaire reveals a history of tuberculosis infection or treatment in applicants or their close contacts. All chest X-rays must be submitted in DICOM format. DICOM tag elements must state the client’s name, DOB, gender and the institution name.

The CXR must be examined for:

general radiological findings
evidence of active or inactive TB disease

The CXR must contain the following information:

applicant’s name
applicant’s date of birth
applicant’s gender
date of the chest x-ray

Applicants must bring their IME number, UMI number and UCI number with them to undergo their CXR. Panel radiology clinic staff will use these numbers or the applicant’s name and passport number to retrieve the applicant’s health case in eMedical.

If an applicant is pregnant for the CXR

There may be cases where an applicant is not pregnant for the IME, but is pregnant for the x-ray examination. If an applicant is pregnant and elects to proceed with the CXR examination with adequate pelvic lead shielding, there are no changes to the CXR procedures.

If the client chooses to defer her CXR because of pregnancy:

IRCC is informed electronically by eMedical that the client is pregnant, along with her estimated date of delivery
eMedical generates a pregnancy deferral letter with instructions for the client
the IME is put on hold status until the chest x-ray has been completed
the IME is submitted to IRCC along with the CXR results when they become available

CXR indicating active tuberculosis

When a panel radiologist indicates suspected active TB in the applicant’s CXR, they notify the panel physician. As the panel physician, you must do the following:

Arrange immediately for the client to undergo sputum testing.
For confirmed, active TB cases, notify the public health authorities according to the country’s or region’s public health guidelines and directives.
Submit the health case in eMedical within the service standard, including all reports available. The RMO will instruct you if further examinations are required.

For all confirmed, active pulmonary TB cases, you must also:

conduct screening for HIV, if not already done
proceed with contact screening as per the tuberculosis technical instructions for all family members or close contacts who are also IRCC clients
recommend that non-IRCC close contacts see their own physicians for screening
recommend that all contacts receive treatment for latent TB, as per IRCC's technical instructions.

Panel Physicians should notify the RMO as soon as possible if IMEs have already been completed and submitted for family members who require contact tracing.

As a result of contact tracing, applicants discovered to have latent TB should be reviewed by a local TB specialist to determine if treatment is recommended.

See IRCC's technical instructions for more information.

Radiology grading

Before submitting the CXR, the radiologist must provide a grading for the image.

The system will automatically provide a radiology grade based on the reported findings.
Grade A indicates that there is no evidence of TB or abnormalities suggestive of other significant diseases identified.
Grade B indicates that there is evidence of TB or abnormalities suggestive of other significant diseases identified.
If the system has provided an A grade and the radiologist believes that there is evidence of TB or abnormalities suggestive of other significant diseases, they may change the grade to B.
If the system has provided a B grade, it cannot be changed to an A grade.
No comments are permitted for A-grade CXRs.
Comments are mandatory for B-grade CXRs.

Panel Radiologist Declaration

The radiologist declaration confirms the following:

The client’s identity has been verified.
The radiology report is an accurate record of the radiologist’s findings.

Important information:

Panel radiologist declarations are provided electronically.
Radiology support staff can declare on behalf of a panel radiologist.

Submitting CXRs

Digital CXRs are uploaded to the eMedical system.
The radiologist or authorized radiology support staff enter the general and special findings in the eMedical system.
The CXR is graded in the eMedical system and submitted to the client’s IME.
The panel physician’s clinic is notified that the CXR examination has been completed.
The panel physician reviews the radiologist report and grading.
Once all examinations are completed, the panel physician submits the IME to IRCC.

Resettlement Needs Assessment (Exam 948 in eMedical)

When an applicant is being processed as a refugee overseas, the migration office issues a Medical Report: Client Biodata and Summary (IMM 1017) with the IMM category of “refugee overseas”.

In such cases, the Resettlement Needs Assessment is included in the medical instructions sent to the applicant by a migration office as part of the IME.

The form is available electronically under section 948 in eMedical. Panel physicians must complete this section for all applicants in the refugee overseas category. Please note that, for privacy reasons, this form must only indicate the anticipated services for the applicant and not provide medical information or a diagnosis.

See IRCC's technical instructions under Resettlement Needs Assessment for detailed instructions on how to complete the form.

Pregnant Client – X-Ray Deferred

If the client chooses to defer her chest x-ray (CXR) because of pregnancy, the following steps apply:

eMedical informs IRCC electronically when a CXR is deferred. The health case is put on hold when an applicant is pregnant and chooses to defer her CXR.
eMedical generates a CXR requisition and instructions, which are then provided to the applicant.
eMedical generates a “Pregnancy Deferral Letter” with instructions for the applicant.
The panel physician completes all other components of the IME, checks the box for “pregnancy” and submits the IME in eMedical. Migration officers can see the status of the IME in GCMS: “On HOLD pregnancy” until the CXR is completed.
The IME will be submitted to IRCC along with the CXR results when they are available for assessment by the RMO.

If the applicant is undergoing an upfront medical examination, then the applicant must be given a copy of the form Upfront Medical Report – Client Biodata and Summary (IMM 1017B upfront) so they can submit it with their visa application before undergoing the post-partum CXR.

Additional forms for the IME

See Appendix III for samples of the following additional forms:

IMM 5725 or Exam 903 in eMedical: Activities of Daily Living (ADL)
IMM 5738 or Exam 904 in eMedical: Chart of Early Childhood Development (CECD)
IMM 5728: Acknowledgment of HIV Post-Testing Counselling
You must print out, sign and scan this form when promoted by eMedical.
IMM 5734: Specialist’s Referral Form
The panel physician will send most referrals electronically. You may print the letter if the applicant requests a printer version, or for any other reason you wish.

Additional information for submitting IME forms

IME grading: Grade A or Grade B

Before you submit the IME, you must provide a grade for it. The system will automatically provide an IME grade based on your reported findings:

Grade A indicates that there are no abnormal findings present and no significant abnormal history.
Grade B indicates that there are significant abnormal findings present and/or an abnormal history.
If the system has provided an A grade and you believe there are significant abnormal findings, you may change the grade to B.
If the system has provided a B grade, you cannot change it to an A grade.
No comments are permitted for A grade IMEs.
Comments are mandatory for B grade IMEs.

Panel physician declaration

The panel physician’s declaration is provided electronically. It confirms the following:

You have verified the applicant’s identity.
The IME and medical report are an accurate record of your findings.

Furtherance process

RMOs may need more information to complete their medical assessment. They get this through the furtherance process. Furtherance might create additional costs for the applicant, including additional tests and specialist evaluation.

As the panel physician who did the original IME, you are responsible for the following:

Refer the applicant for additional testing to another panel physician, or to an appropriate specialist for consultation. (You, not the applicant, are responsible for selecting the specialist.) The applicant’s previous medical records may be provided along with the additional reports requested by the RMO.
Complete the furtherance requirements by reviewing the new medical results and ensuring they respond fully to the original furtherance request, then submitting the results to the RMO. If the new medical result does not respond fully to the original furtherance request, provide a written explanation as to why.

Here are the next steps of the process:

The RMO issues a letter to the applicant with instructions to return to a panel physician for further investigations.
The furtherance request is transferred to eMedical.
You retrieve the furtherance request from eMedical by carrying out a search using the IME or UCI number indicated in the client’s letter.
You complete the additional examination(s) or generate a referral letter with the information that will be sent to a specialist for the required investigation(s).
You enter the information into eMedical and submit the information to IRCC.

Panel members who work in Canada

This section of the guide provides information, instructions and reference material for panel members operating in Canada. It does not apply to panel members who perform Canadian IMEs in other countries.

Providing primary care for IME applicants

If you are asked to provide treatment to an applicant or provide a medical opinion outside the IME, you should make sure the applicant understands the different duties and responsibilities of a third-party physician (i.e. a panel physician) versus a treating physician. For example, if you recommend a treatment that is not mandatory for immigration purposes, the applicant must understand this.

The provincial and territorial medical licensing authorities give doctors guidance on the difference between a treating and third-party physician. Applicants should also understand that any medical services not related to the IME or covered under the Interim Federal Health Program do not involve IRCC.

Providing services in Canada’s official languages

IRCC is committed to providing applicants in Canada with service in their preferred official language: English or French. If your clinic cannot provide service in the applicant’s official language of choice, you should refer them to the nearest panel physician who can. If no such physician exists nearby, you should ask the applicant to contact IRCC’s Call Centre at 1-888-242-2100, or consult IRCC’s website.

Protection of personal information

Several Canadian statutes protect people’s personal information. They include:

the Privacy Act
the Access to Information Act
the Canadian Charter of Rights and Freedoms
the Library and Archives Act
the Personal Information Protection and Electronic Documents Act (PIPEDA)
Various provincial and territorial privacy laws

As a panel physician, you must follow these laws when you collect, use, disclose, retain and dispose of people’s personal information. It is critical, for example, to collect and store personal information in a way that protects it from unauthorized disclosure.

The laws of other jurisdictions where information is collected may also apply to your treatment of applicants’ personal information.

To comply with legislation, the IME forms sometimes require applicants to consent to the disclosure of their personal health information to third parties.

Panel physicians in Canada can get advice from their professional organizations or regulating bodies on how to apply the Personal Information Protection and Electronic Documents Act (PIPEDA) and provincial or territorial privacy legislation, as well as how to properly manage personal information.

Take a closer look at PIPEDA.

Refugee determination system in Canada

Refugee claimants – more appropriately called “asylum seekers” – are individuals who, after they arrive in Canada, make a formal claim to an IRCC or Canada Border Services Agency officer asking for Canada’s protection.

Under the Immigration and Refugee Protection Act (IRPA), all people seeking asylum must get an IME. They are referred for an IME when they make their claim. The IME forms and requirements for asylum seekers are the same as for other immigrants. They are given medical instructions and a list of panel physicians. They must undergo their IME within 30 days following their claim for asylum.

Immigrants are examined to identify medical conditions that might affect their admissibility to Canada under IRPA. Asylum seekers fall under the excessive demand exempt (EDE) category. This means they are examined primarily to identify conditions that might pose risks to public health and public safety; however, any additional services required by IRCC's technical instructions may also be provided.

Asylum seekers who have been granted protected person status by the Canadian authorities are entitled to health care under the Interim Federal Health Program (IFHP) until they become eligible for provincial or territorial health care coverage. This means their first IME is covered. If they must undergo a second IME, it is not covered under the IFHP.

Your duty to report tuberculosis

Individuals whose IME shows they have inactive tuberculosis are placed under medical surveillance in Canada. The Public Health Liaison Unit (formerly known as the Medical Surveillance Unit) reports such cases to the appropriate provincial or territorial public health authorities.

However, as a panel physician, you are also required to notify the appropriate provincial or territorial public health authorities of such cases according to the laws of the province where you practice.

At no time should routine investigation or management of active or suspected active tuberculosis be deferred or delayed because of immigration medical activities. If you cannot contact an applicant suspected of having an active notifiable infectious disease such as tuberculosis, you should immediately inform the IRCC Migration Health Branch.

The Interim Federal Health Program (IFHP)

IFHP for panel members working in Canada

The IFHP provides limited, temporary coverage of health care benefits in Canada to groups not eligible for provincial or territorial health insurance, such as resettled refugees, refugee claimants, victims of human trafficking and individuals detained under the Immigration and Refugee Protection Act.

IFHP covers the costs of services and products to eligible beneficiaries in Canada as indicated in the IFHP benefit grids. It is important to note that, in Canada, the IFHP only covers the cost of one IME and related tests.

The IFHP’s claims administrator, Medavie Blue Cross, adjudicates and pays claims for the program.

Panel members must register with IFHP

A panel member or any service provider assisting with IME-related tests must register as an IFHP Provider and comply with the terms and conditions of Medavie Blue Cross.

Please refer to the IFHP Benefit Grid – IME and IME tests available on the Medavie Blue Cross website for more information on the services, diagnostic tests, and the maximum dollar amount.

Verifying IFHP eligibility

Eligibility documents

There are three types of documents that show that an individual may be eligible under IFHP in Canada. Individuals must show one of these documents to their health care provider at each visit:
- Refugee Protection Claimant Document (RPCD)
- Interim Federal Health Certificate (IFHC)
- Acknowledgement of Claim and Notice to Return for Interview letter (AOC)
Confirm eligibility with Medavie Blue Cross

Panel physicians must confirm with Medavie Blue Cross that the individual’s coverage is active before the examination is carried out. It is important to note that it takes two business days for the IFHP eligibility to be reflected in the Medavie Blue Cross system. However, beneficiaries are still eligible during this two-day period. When an IFHP client asks for your services within two business days of the date on the IFHP eligibility documents, you must:
- review the “effective date” on the eligibility document to confirm that it is within the two business-day period
- provide the services and delay submitting the invoice to Medavie Blue Cross until the coverage has been updated in their system

Additional information

Please see the IFHP Information Handbook for Health Care Professionals (PDF, 7 MB) for more information. The handbook is available on the Medavie Blue Cross website, where you can find the IFHP Benefit Grids and more information about the IFHP, including:

prior approval procedures
claim submission guidelines
provider terms and conditions
payment procedures
important information on how to perform IMEs for refugee claimants in Canada

IFHP for panel members working overseas (pre-departure medical services)

On April 1, 2017, the IFHP was expanded to cover certain pre-departure medical services (PDMS) for Canada-bound resettled refugees before they come to Canada.

The claims administrator for the IFHP, Medavie Blue Cross, administers claims submitted by health care providers and secondary care providers such as hospitals, laboratories and specialists who have provided services to individuals eligible for PDMS. More information on PDMS is available on the Medavie Blue Cross website.

Groups and individuals eligible for PDMS

The following are eligible for PDMS:

individuals identified for resettlement to Canada (i.e. government-assisted asylum seekers)
privately sponsored asylum seekers
blended migration office-referred asylum seekers
groups or individuals who have been specially designated by the Minister of IRCC
certain people who are being resettled in Canada as a result of a public policy or on humanitarian and compassionate grounds as determined by the Minister of IRCC

Registering for PDMS

Panel members – whether or not they are affiliated with the International Organization for Migration (IOM) – should register with the IFHP through Medavie Blue Cross.

IOM-affiliated panel members must register with the IFHP; however, they will receive reimbursements for their services directly from IOM. They are not required to submit the claims for reimbursements to Medavie Blue Cross.

Non-IOM affiliated panel members are required to register with the IFHP and claim reimbursement for their services directly from Medavie Blue Cross.

To learn more about the registration process, see the IHFP Handbook for Pre-Departure Medical Services (PDMS) Providers (PDF, 5.1 MB).

PDMS coverage and benefits

The scope of the IFHP PDMS coverage is limited to:

the cost of the Immigration Medical Examination (IME) and follow-up treatment for health conditions that would affect an individual’s medical admissibility to Canada (i.e. active tuberculosis and untreated syphilis)
communicable disease prevention and control by providing vaccinations that are aligned with Canadian immunization guidelines
medical support required during travel to Canada includes medical attendant and/or medical devices (e.g. oxygen, wheelchairs)
management and control of communicable diseases in refugee camps

Please see the IFHP Benefit Grid for PDMS (PDF, 357 KB) for a list of eligible services and additional information.

Pre-departure vaccination services

Panel physicians affiliated with the International Organization for Migration (IOM), can provide certain vaccination services covered by the IFHP to eligible individuals. This service is voluntary and does not impact their application for resettlement to Canada.

Immunizations can be provided only in countries where the IOM has the capacity to deliver vaccinations. The Immunization Manual (1.5 MB) contains more information including:

standard operating procedures
vaccine administration and schedule
consent form and vaccination documentation worksheet

Medical support in transit

The costs related to medical support in transit (medical attendant and/or medical devices) are covered by the IFHP. A prior approval request (PDF, 178 KB) must be sent to the IFHP Unit (IRCC.IFHP-PFSI.IRCC@cic.gc.ca) with the provider’s Regional Medical Office (RMO) in cc. The request must include clinical information and recommendations for medical support in transit with detailed medical services, devices or products required and expected cost.

If approved, an IFHP officer will sign and return Part 1 (administrative) of the form to the requestor. For more information or questions, please contact IRCC.IFHP-PFSI.IRCC@cic.gc.ca.

You can find the Medical Support in Transit Form (PDF, 226 KB) (prior approval request) on the web site of the IFHP Claims Administrator Medavie Blue Cross.

Outbreak response

When a communicable disease outbreak occurs in a refugee camp, the IFHP will reimburse services and products related to the following:

diagnostic testing (rapid and serologic)
post-exposure prophylaxis (vaccines and drug therapy)
pre-departure health screening and personnel cost, including the cost of physician and nursing visits.

The costs related to the management and control of an outbreak are covered by the IFHP. A prior approval request must be sent to the RMO as soon as an outbreak is identified by the PP/IOM. Please note that the request will also be reviewed by the IFHP Unit to ensure compliance with the IFHP Policy. The request must include the following information:

Location and description

Provide a short description of population demographics and a description of the area/facility where the outbreak has occurred (i.e. camp, region, province, country, etc.)

Confirmation of an outbreak

Your description should include the following:

epidemiological case definition
case finding
lab confirmation (if any)
how the outbreak was initially reported and steps taken to confirm it
how serious the outbreak is (potential for spread, mortality and complications)
number of cases and particular groups at risk among those identified for resettlement to Canada
how soon the individuals will be traveling to Canada

Ongoing action (capacity)

Provide a brief description of the current response and capacity, including the investigations done and control measures taken (human, medical, etc.)

Proposed response

What should be done to control this outbreak? Propose the control activities and supplies needed (medicines, materials) and the expected cost per individual, including:

treatment of cases and carriers
isolation of cases
surveillance of suspects
immunizations:
- Obtain all immunization records (consult IFHP Vaccination Documentation Worksheet (PDF, 321 KB), if available).
- Identify required vaccine(s) and number of doses.
- Confirm the vaccine cost per dose, including the administration cost.
chemoprophylaxis
personal protection
environmental hygiene
personal hygiene
disinfection and sterilization
pre-departure screening
other

For claims-related instructions please consult the provider handbook.

Verifying IFHP eligibility for PDMS services

It is your responsibility as a panel physician to confirm an individual’s eligibility to the IFHP before services are rendered. This is an important aspect of protecting the integrity of the program.

Non-IOM affiliated providers must complete the following procedures:

confirm that the individual has an IFHC
confirm that the identity of the individual on the IFHC matches the individual in the identification document
retain a photocopy of the individual’s IFHC in their records

IOM-affiliated providers will do the following procedures to confirm an individual’s eligibility:

confirm that the individual’s name appears on the list received from IRCC visa offices
confirm that the identity of the individual matches the individual in the identification document
retain a copy of the list of eligible individuals received from IRCC visa offices

Important: If you have questions related to an individual’s eligibility, please contact Medavie Blue Cross at CIC_Inquiry@medavie.bluecross.ca, including the individual’s UCI and the benefit code.

For more information, please see the PDMS provider handbook (PDF, 5.1 MB).

Claim submission guidelines for in-Canada or overseas services

You have up to six months after providing your services to submit invoices to either the IOM or Medavie Blue Cross. When you submit claims for IMEs and related tests, you must use current IFHP benefit codes, which you can find in IFHP Benefit Grid – IME and IME tests available on the Medavie Blue Cross website (for panel members working in Canada) or the Benefit Grid for PDMS (PDF, 357 KB) (for panel members working overseas).

Here are some key elements of IFHP’s fee policy:

Your compensation is based on a fee-for-service model. The IFHP fee policy is to reimburse physicians according to usual and customary fee rates in place on the date of service or according to fee rates established by the IFHP.
You must not collect from the client the difference between the total amount billed for the services and the amount to be reimbursed by Medavie Blue Cross, if any.
The IFHP is not designated to reimburse beneficiaries directly. Do not directly charge patients covered by the IFHP. If a beneficiary pays you directly for services or products covered by the IFHP, they cannot be reimbursed.
You may not refuse to provide IMEs for individuals covered by the IFHP. However, you may charge for missed appointments according to your local standards of practice. This charge will not be reimbursed under the IFHP.
You must accept whatever method of payment an applicant wishes to use. In addition, the services you provide must not be influenced by whether the service is a covered benefit for the client.

Section 2: Supplementary Information

Instructions for completing paper-based IMEs

This section provides panel members who use a paper-based system with information they need to complete IME and associated forms.

Panel members using eMedical should refer to The Immigration Medical Examination section of this guide.

IME paper forms have been redesigned to ensure they are consistent with eMedical IMEs.

General information about the IME

The IME consists of a medical history, physical examination, age-specific laboratory tests and age-specific chest x-ray.

Usually, routine, age-specific laboratory and radiologic tests include:

urinalysis – applicants age 5 and older
chest x-ray (posterior-anterior view) – applicants age 11 and older
syphilis – applicants age 15 and older
HIV – applicants age 15 and older
serum creatinine – applicants age 15 and older

A medical examination includes any or all of the following:

physical examination
mental examination
review of past medical history
laboratory test
diagnostic test
medical assessment of records respecting the applicant
urinalysis – applicants age 5 and older
chest x-ray (posterior-anterior view) – applicants age 11 and older
syphilis – applicants age 15 and older
HIV – applicants age 15 and older
serum creatinine – applicants age 15 and older

Panel members may request additional lab tests based on an applicant’s individual risk factors.

It also be necessary to screen applicants below the ages indicated. See IRCC's technical instructions for more information.

How do I determine what examinations are required?

As the panel physician, you are never required to decide on a course of treatment or additional tests for an applicant. Your regional medical office (RMO) will contact you with the specifics of the applicant’s case and the medical examinations they require. You must follow the technical instructions for all tests and procedures.

Getting your unique identifier and login

Once IRCC has received all your forms and documents, your RMO will tell you that you are approved as a panel member. You will get a unique identifier number (P number), which enables IRCC to perform quality assessments of your work.

The unique identifier starts with the letter “P” followed by eight or more digits (e.g. P12345678).

For panel members or their locum tenens performing a paper-based IME, the unique identifier, along with their name, must be clearly readable on the front page of each Medical Report – Client Biodata and Summary (IMM 1017) as well as on the “Laboratory Requisition and Report” and “Chest X-Ray Requisition Report” sections of the IMM 5419: Medical Report form.

The panel member or their locum tenens must clearly indicates their name, the P number, the city and the country in all correspondence with IRCC. For example:

Name:
P#:
City, Country:

Each photo attached to the Medical Report – Client Biodata and Summary (IMM 1017) must be signed to confirm the identity of the applicant. Make sure that each IME is signed properly. In cases where the IMEs are not properly signed, the RMO can refuse them and return the IMEs to the panel physician’s office.

Panel radiologists may embed this information on the chest x-ray along with other required information about the client.

For IMEs sent by mail or courier, the value on any customs declaration should state “No commercial value”.

Reporting contact information and absences

Panel members and clinics that have been approved by their RMO to use paper-based forms must actively inform the RMO of any changes in their contact information.
When you are absent from IME activities, the RMO will update the information in your record to track the leave.
When you use a locum tenens, the locum must sign the Medical Report – Client Biodata and Summary (IMM 1017) “for and on behalf for Dr. , ”. The locum must also use their personal wet stamp.
You must forward an inactive immigration medical file to your RMO within eight weeks of initiating an IME.

Guidelines for managing paper records

Original documents and information related to an IME must be forwarded by the panel physician or a trusted employee to their RMO by regular mail or commercial courier and must never be given to the applicant or their representative for delivery to the RMO.

You are encouraged to give a copy of the IME to the applicant (or their guardian) unless there is a strong reason to not do so (e.g. information from a different applicant is found within the IME or releasing the information would reasonably lead to another person or entity being subject to significant inappropriate behaviour by the client.

You must keep copies and records of files for two years or longer if required by your local medical regulatory authority. Remember, you can access the IME in eMedical for only 365 days after submitting the case.

Fees for IMEs

If you are completing a paper-based IME that must be mailed to the RMO, you should discuss the method and cost of sending the documents with the applicant beforehand.

Verifying an applicant’s identity

Obtain photos of the applicant

The applicant must provide four recent photographs to the panel clinic.
Photographs must meet IRCC’s photographic specifications standards (PDF, 506 KB).
If the photographs do not meet the specifications, ask the applicant to provide new photographs before you complete the IME.

What to do with the photos:

You must attach photos to the Medical Report – Client Biodata and Summary (IMM 1017) as well as on the “Laboratory Requisition and Report” and “Chest X-Ray Requisition Report” sections of the IMM 5419: Medical Report form.
When your clinic uses these photos, it must confirm that the photos are a true and recent likeness of the applicant being examined.
You must signed the photograph on the Medical Report – Client Biodata and Summary (IMM 1017) in the top right corner with your panel physician’s ID.

If you have an identity concern

If you cannot confirm that the person who has arrived for an IME is the person on the ID documents being presented – or if the applicant provides personal details that seem inconsistent with the information on the identity documents they submit – you should report that as an ID concern.

Attach photocopies of the identification document in question to the IME and submit it to IRCC.

IRCC will investigate your concern about the applicant’s identity.

Required documents

Other approved identification documents include the following:

national ID card (an original birth certificate is an acceptable national ID document for minors under the age of consent only)
driver’s licence (Canadian licences only)
refugee travel document
Red Cross travel document
UN laissez-passer
Seaman’s book
Organization of American States travel document
Refugee Protection Claimant Document

If an applicant does not have approved identification

If an applicant does not provide an approved identification document, they must provide an alternative form of identification. You should not turn such applicants away, and should conduct the IME as long as the applicant presents some form of identification.

If the applicant provides identification that is not approved, or if you have doubts about the authenticity of the document presented, you must report your concern on the Medical Report – Client Biodata and Summary form (IMM 1017). A copy of the identity document of concern should be attached to the IME.

Client Declaration and Notice

(See our sample Client Declaration and Notice form in Appendix II.)

The Client Declaration and Notice form for paper-based IMEs includes the following:

a declaration stating that all information provided at the time of the IME is true and complete
a notice stating that the IME information will be collected and temporarily stored in the eMedical system on segregated databases located in Australia
a notice explaining that the collection, use and disclosure to IRCC of IME information follows Canada’s Immigration and Refugee Protection Act or protects the health and safety of Canadians
a notice explaining the collection, storage, use and disclosure of vaccination information where the applicant has consented to the disclosure of this information to IRCC

Other important details:

The applicant must sign the copy of the Client Declaration and Notice provided by you or your staff. Forms that have been altered or translated into another language are not acceptable.
You or your staff should review the Client Declaration and Notice form with the applicant and answer any questions.
Clinic staff must attach the form and submit it along with the IME.
The IME must not be submitted to your RMO without a completed Client Declaration and Notice form.
The Client Declaration and Notice form is not a consent document and should not be construed as consent for the purpose of the IME or for vaccination.
You must ensure to obtain client consent according to your country’s guidelines or legal requirements before performing medical tests and procedures required for the IME and before administering any vaccination, where applicable.
You must ensure that the applicant understands and accepts that any relevant personal information collected during the IME process, including IME information and any vaccine-related information, when applicable, will be disclosed to IRCC.
If an applicant does not complete the Client Declaration and Notice form, you cannot carry out the IME and you must notify your RMO.
The applicant (or legal guardian/parent) must sign and date the Client Declaration and Notice form.

Medical Report: Client Biodata and Summary (IMM 1017)

(See our sample IMM 1017 form in Appendix III.)

IRCC has implemented one standard form, the Medical Report – Client Biodata and Summary (IMM 1017), for all immigration categories. This form displays information such as:

client information (biodata)
immigration information
IMM type: excessive demand exempt (EDE), non-EDE, refugee
IME grading
panel physician declaration

Excessive demand exempt (EDE) applicants

However, EDE clients are assessed for:

danger to public health
danger to public safety

Non-EDE applicants

Non-EDE applicants are assessed for:

danger to public health
danger to public safety
excessive demand on publicly funded Canadian health and social services

Refugee overseas applicants

Refugee overseas applicants are automatically assessed as EDE. Panel physicians must complete and submit the Resettlement Needs Assessment Form (IMM 5544) for overseas refugees.

IRCC typically issues the Medical Report – Client Biodata and Summary (IMM 1017) form with the applicant’s information and immigration information sections completed.

Here are the steps you should take as a paper-based clinic:

Confirm the applicant’s identity by comparing the applicant’s information with the approved identification document.
Attach a recent applicant photo (provided by the applicant) to the Medical Report (IMM 1017).
Complete and submit the Medical Report (IMM 1017) along with all other IME forms.

Upfront Medical – Client Biodata and Summary (IMM 1017B upfront)

(See our sample IMM 1017B upfront form in Appendix III.)

An upfront medical is an IME performed when an applicant reports to a panel physician with no paper Client Biodata and Summary (IMM 1017) or file in the eMedical system. Upfront medical examinations are generally permitted for students and workers who are applying to be temporary residents of Canada.

Only certain applicants are permitted to undergo an upfront medical.

When you complete this form, you must use the IMM 1017B upfront paper forms that have been provided to you. They are pre-populated with a UMI number and a barcode.

Here are the steps your clinic and staff must take:

Check the applicant’s identity with a valid, government-issued ID.
Attach a photo of the applicant (provided by the applicant) to the form.
Select the immigration category by checking the appropriate box (usually student or worker).
Complete page 1 of the IMM 1017B upfront form “Copy to Client” and give it to the applicant so they can submit it to IRCC along with their visa application.
Complete page 2 of the IMM 1017B upfront form “Copy to Health Branch” and submit it to your RMO along with all other IME forms (e.g. IMM 5419, chest x-rays, lab results, etc.).

Note: It is very important to ensure the correct page goes to the client and the correct page goes to your RMO:

Page 1 — Client
Page 2 — RMO

Panel physicians must ensure they provide the applicant with proof that they have competed their upfront medical examination. For paper-based upfront medicals, it is the top page of the Upfront Medical Report – Client Biodata and Summary (IMM 1017B upfront) form. Applicants must include this proof when they submit their visa application.

Since an IME is valid for 12 months, you should remind applicants to submit their visa application along with proof that they have completed their upfront medical examination well before the expiration date; otherwise, the client may have to undergo a second IME.

Medical Report (IMM 5419)

You must provide details along with all “Yes” answers to medical history questions. IRCC requires the following information:

date of diagnosis
date of treatment or surgery
relevant medications
current status of the condition (and, if applicable, the prognosis)

You must either provide this information in the comments section or attach a report to the IME.

The following table lists additional requirements when the answers to medical report questions show abnormality – whether the IME is completed in eMedical or on paper. Refer to IRCC's technical instructions for more information.

Medical history questions

Question	Related TI	IMM type	Requirements if abnormal
Tuberculosis (TB), treatment for tuberculosis	Tuberculosis TI	EDE and non-EDE clients	Lateral CXR & AP CXR if < 11 years old, Chest x-ray examination
Close household or work contact with tuberculosis (within last 5 years)	Tuberculosis TI	EDE and non-EDE clients	IGRA or TST, lateral CXR & AP CXR if < 11 years old, Chest x-ray examination
Prolonged medical treatment and/or repeated hospitalization for any reason, including a major operation or mental illness	N/A	EDE and non-EDE clients	Medical report, if available when IME is submitted or if RMO requests
Psychological/psychiatric disorder (including major depression, bipolar disorder or schizophrenia)	Psychiatric conditions TI	EDE and non-EDE clients	Report from psychiatrist, psychologist or treating physician (attach all existing results and reports from labs and previous specialists)
History of HIV	HIV TI	EDE and non-EDE clients	HIV, CXR, Hepatitis B and C, syphilis, IGRA or TST regardless of age, and HIV specialist report including CD4 count, HIV viral load, and when antiretroviral medications will be needed
An abnormal hepatitis B or C blood test	Hepatitis / Liver disease TI	EDE and non-EDE clients	HIV, CXR, Hepatitis B and C, syphilis, regardless of age
Cancer or malignancy in the last five years	Cancer or Malignancy TI	non-EDE clients	Oncology report
Diabetes	Diabetes, hypertension, chronic renal or cardiac diseases TI	non-EDE clients	Screen for signs or symptoms and presence of end-organ damage.
Heart condition including coronary disease, hypertension, valve or congenital disease	Diabetes, hypertension, chronic renal or cardiac diseases TI	non-EDE clients	Screen for signs or symptoms (including blood pressure) and presence of end-organ damage. Serum creatinine, regardless of age
Blood condition (including thalassemia)	N/A	non-EDE clients	Check for history of admission.
Kidney or bladder disease	Diabetes, hypertension, chronic renal or cardiac diseases TI	non-EDE clients	Urinalysis, serum creatinine (eGFR if abnormal); regardless of age
An ongoing physical or intellectual disability affecting current or future ability to function independently or be able to work full-time (including autism or developmental delay)	Psychiatric conditions TI and Cognitive impairment in adults TI	EDE and non-EDE clients	ADL if > 5 years old, CECD if < 5 years old, consult TI for complete requirements
Addiction to drugs or alcohol	Psychiatric conditions TI	EDE and non-EDE clients	Only if the RMO requests – a psychiatrist’s, psychologist’s or treating physician’s report that specifically comments on previous threatening behaviour and if there is evidence of IV drug use, HIV, hepatitis B and C, regardless of age. The report must also specifically address if it is reasonably likely the client will exhibit future behaviour that might be a threat to the client or others.
Prescribed pills or medication (excluding oral contraceptives, over- the-counter medication and/or natural supplements)	N/A	EDE and non-EDE clients	List relevant medications and mention the indication
For female clients: a) Are you pregnant?	N/A	EDE and non-EDE clients	N/A
b) If yes, what is the expected date of delivery?	N/A	N/A	N/A
c) If yes, do you wish to defer your chest x-ray at this time?	N/A	N/A	Attach IMM 5733 Instructions for Pregnant Client – X-Ray Deferred

Physical Examination

As the panel physician, you must complete the physical examination. You must provide details of all abnormal findings during the physical examination. IRCC requires the following information:

history
diagnosis
treatment details (including dates and medications)
lab results
specialist reports (as required)
current status
prognosis

You may enter this information in the comments section or attach a report to the IME.

The following table lists additional requirements when the answers to physical examination questions show abnormality. See IRCC's technical instructions for more information.

Table: Physical Examination

Physical examination	Related TI	IMM type	Requirements if abnormal
Was a chaperone offered?	Genital, Gynecological and rectal examination TI; Breast examination TI	EDE and non-EDE clients	Non applicable. A chaperone should be offered to everyone.
Ear/nose/throat/mouth	N/A	EDE and non-EDE clients	N/A
Hearing	Hearing impairment or deafness TI	EDE and non-EDE clients	N/A
Eyes (including fundoscopy)	N/A	EDE and non-EDE clients	N/A
Best distance visual acuity (with or without correction)	N/A	EDE and non-EDE clients	N/A
Blood pressure (clients = 15 years of age) Normal readings <150 systole and <90 diastole	Diabetes, hypertension, chronic renal or cardiac diseases TI	EDE and non-EDE clients	Repeat blood pressure
Repeated blood pressure (clients = 15 years of age) Normal readings <150 systole and <90 diastole	Diabetes, hypertension, chronic renal or cardiac diseases TI	non-EDE clients	Screen for signs or symptoms (including blood pressure) and presence of end-organ damage serum creatinine regardless of age
Cardiovascular system	Diabetes, hypertension, chronic renal or cardiac diseases TI	non-EDE clients	Serum creatinine, regardless of age,
Respiratory system	Tuberculosis TI	EDE and non-EDE clients	If signs of TB: CXR, HIV, screen for hepatitis B and C, regardless of age
Nervous system: sequelae of stroke or cerebral palsy, other neurological disabilities	Debilitating conditions, Activities of daily living, and/or Developmental milestones: Chart of early childhood development TIs	EDE and non-EDE clients	Complete Activities of daily living, Development milestone: Chart of early childhood development and/or an assessment of cognitive functioning forms
Mental and cognitive state	Cognitive impairment, Activities of daily living, and/or Developmental milestones: Chart of early childhood development TIs	EDE and non-EDE clients	ADL if > 5 years old, CECD if < 5 years old, consult TI for complete requirements
Intellectual ability	Cognitive impairment, Activities of daily living, and/or Developmental milestones: Chart of early childhood development TIs	EDE and non-EDE clients	ADL if > 5 years old, CECD if < 5 years old, consult TI for complete requirements
Developmental milestones (clients = 5 years of age)	Developmental milestones: Chart of early childhood development TI	EDE and non-EDE clients	Complete Developmental milestones: Chart of early childhood development form
Gastrointestinal system	Hepatitis/liver disease TI	EDE and non-EDE clients
Musculoskeletal system	Debilitating conditions TI and Activities of daily living TI	EDE and non-EDE clients	Complete activities of daily living if > 5 years old, CECD if < 5 years old
Skin and lymph nodes	Cancer and HIV TI	EDE and non-EDE clients/td>	Screen for skin cancer, leprosy, surgical scars, tattoos and piercings. Inspect/palpate neck, axilla and groin for lymphadenopathy
Evidence of substance abuse (e.g. venous puncture marks)	Psychiatric conditions TI	EDE and non-EDE clients	Complete psychiatrist’s report and, if evidence of IV drug use HIV, hepatitis B and C screening, regardless of age
Endocrine system (such as evidence of complications from diabetes)	Diabetes, hypertension, chronic renal and cardiac diseases TI	non-EDE clients	If diabetes is present, proceed with screening.
Are there any physical or mental conditions that may prevent this person from attending a mainstream school, obtaining full-time employment or living independently now or in the future?	Psychiatric conditions and Cognitive impairment TI	EDE and non-EDE clients	ADL if > 5 years old, CECD if < 5 years old, consult TI for complete requirements
Breast examination	Genital, gynecological and rectal examination TI	EDE and non-EDE clients	Investigate (e.g. ultrasound, mammogram, specialist report)

Laboratory Requisition and Report

Here are the general instructions for completing this report:

Complete the Laboratory Requisition and Report (IMM 5419), entering the applicant’s personal information:
- surname
- given name
- date of birth
- IME number or UMI number, if applicable
Attach the applicant’s photograph to ensure the integrity of the IME for laboratory testing.
Indicate with a checkmark (R) the tests required.

Laboratory staff must do the following:

Confirm the applicant’s biodata and identity by comparing the photograph on the Laboratory Requisition and Report (IMM 5419), the photograph on the applicant’s approved identity document and the applicant reporting for laboratory tests.
Document any identity concerns on the paper laboratory requisition forms. In such cases, laboratory testing may continue, and the panel physician will report the concerns to IRCC for follow-up.
Fill out the declaration to confirm the following:
- the requested laboratory tests have been performed
- the sample for testing was collected from the client identified on the requisition

Urinalysis

A urinalysis is mandatory for all clients five years of age or older.

Refer to the Diabetes, hypertension, chronic renal or cardiac diseases TI for detailed recommendations on screening.

Syphilis serology

signs or symptoms compatible with syphilis infection
high-risk sexual activity (for example, unprotected anal or vaginal sex, or multiple sexual partners)
history of another sexually transmitted infection such as HIV, herpes, chlamydia, gonorrhea
history of being born to a mother diagnosed with syphilis
history of sexual contact with a known case of syphilis
history of pregnancy
for men, a history of having sex with other men
history of sex work
injection drug use

The evaluation consists of a medical history, physical examination and laboratory tests. You are required to report:

if the applicant shows any signs or symptoms related to syphilis
if the applicant has had a previous syphilis diagnosis
evidence of recent or previous treatment

Symptoms are non-specific and it is entirely possible to go through the early stages of the infection without knowing about it.

See IRCC's technical instructions for more information – in particular, the syphilis TI.

If you see positive syphilis serology results from an applicant, you must:

treat the syphilis according to the Canadian Guidelines on Sexually Transmitted Infections and provide proof of treatment
accept previous treatment carried out according to the Canadian Guidelines on Sexually Transmitted Infections and provide proof of such treatment

IRCC requires the following treatment information:

dates
medications
dosages

HIV serology

HIV screening is required for all clients 15 years of age or older undergoing an IME. Panel physicians must also request HIV screening for clients below the age of 15 with any of the following risk factors (TB high-risk group, refer to TB TI):

signs and/or symptoms compatible with HIV diagnosis
history of being sexually active
history of another sexually transmitted infection such as syphilis, herpes, chlamydia, gonorrhea
history of sharing contaminated needles, syringes and other infected equipment and drug solutions for injection drug use
history of receiving unsafe injections, blood product transfusions or medical procedures that involve unsterile cutting or piercing
accidental needle stick injuries, including among health workers
suspected active tuberculosis, hepatitis B, hepatitis C
tattoos, body piercing, or acupuncture not thought to be done with aseptic technique
history of being born to an HIV positive mother
any child showing failure to thrive

You should also do the following:

Provide the applicant with culturally sensitive, age and gender appropriate pre- and post-test counselling.
Consider legal, ethical, social and human rights issues.
If you use an interpreter, select one who is unbiased and has no connection to the applicant. Family members or friends cannot act as interpreters. The applicant must pay the cost of a professional interpreter.
Provide pre-test counselling that includes information on the following:
- how HIV is transmitted and prevented
- a description of the testing procedure
- confidentiality of HIV testing, reporting and record handling
- the meaning of HIV screening test results, including the possibility of false positive or false negative results
- the need to inform anyone at risk of infection if the test is positive
- the applicant’s consent to undergo testing

For all clients with positive HIV testing, panel physicians must provide a completed (signed and dated) IMM 5728: Acknowledgement of Post-test Counselling form, available in Appendix III.

Chest X-Ray Requisition and Report

Routine posterior-anterior chest x-rays (CXRs) are mandatory for applicants 11 years of age or older. A panel physician should request a CXR, regardless of age, if the medical questionnaire reveals a history of tuberculosis infection or treatment in applicants or their close contacts. All chest X-ray reports must be submitted along with a CD image in DICOM format. DICOM tag elements must state the client’s name, DOB, gender and the institution name.

The CXR must be examined for:

general radiological findings
evidence of active or inactive TB disease

Information to include on the CXR

The panel physician must enter the applicant’s personal information on the chest x-ray (CXR) requisition form:

surname
given name
date of birth
IME or UMI number (if applicable)
the applicant’s photograph must be attached to the CXR requisition form

If an applicant is pregnant for the CXR

If the client chooses to defer her CXR because of pregnancy:

The radiology clinic must notify the panel physician that the CXR has been deferred.
The panel physician may complete the IME, except for the CXR.
The IME is submitted only once the post-partum CXR is returned to the panel physician.
See the sample Instructions for Pregnant Client - X-Ray Deferred (IMM 5733) form in Appendix III.

CXR indicating active tuberculosis

A panel radiologist who indicates suspected active TB in the client’s CXR must notify the panel physician immediately. The radiologist sends the CXR and report to the panel physician, and the panel physician then submits it to IRCC along with the results of your examination. As the panel physician, you must also do the following:

Arrange immediately to have the applicant referred for a TB investigation.
For confirmed, active TB cases, notify the public health authorities according to the country’s or region’s public health guidelines and directives.
Ensure that the treatment provided to the applicant follows WHO recommendations and protocols (PDF, 1 MB).

For all confirmed active pulmonary TB cases, you must also:

conduct screening for hepatitis B and C
conduct screening for HIV (if not already done)
proceed with contact screening for all family members or close contacts who are also IRCC clients
recommend that non-IRCC close contacts see their own physicians for screening
complete the IME and submit it to IRCC

As a result of contact tracing, applicants discovered to have latent TB should be reviewed by a local TB specialist to determine if treatment is recommended.

See IRCC's technical instructions for more information.

Radiology grading

Radiologists must provide a radiology grade based on their reported findings.

Grade A indicates that there is no evidence of TB or abnormalities suggestive of other significant diseases identified.
Grade B indicates that there is evidence of TB or abnormalities suggestive of other significant diseases identified.
Comments should not be included for A-grade chest x-rays.
Comments are mandatory for B-grade chest x-rays.

Panel Radiologist Declaration

Radiologist declarations are provided in writing on the radiology report and include the panel radiologist’s name, signature, number and the date of the CXR report.

Submitting CXRs

The radiologist provides the general and special findings and grades the digital CXRs or film using the proper form.
The radiologist or authorized radiology staff forward the CXRs and the report to the panel physician.
The panel physician reviews the radiologist’s report and grading.
Once all examinations are completed, the panel physician send the IME to IRCC.

Resettlement Needs Assessment (IMM 5544)

When an applicant is being processed as a refugee overseas, the migration office issues a Medical Report: Client Biodata and Summary (IMM 1017) with the IMM category of “refugee overseas”.

In such cases, the Resettlement Needs Assessment (IMM 5544) is included in the medical instructions sent to the applicant by a migration office as part of the IME.

As the panel physician, you must complete the Resettlement Needs Assessment IMM 5544 along with the IME and send them both.

Pregnant Client – X-Ray Deferred (IMM 5733)

If the client chooses to defer her Chest x-ray (CXR) because of pregnancy, the following steps apply:

Complete the CXR requisition and give it to the applicant.
Complete the Instructions for Pregnant Client – X-Ray Deferred (IMM 5733) and give it to the applicant. (The applicant may forward a copy of the IMM 5733 to the migration office as proof that the IME has been started and the CXR has been deferred because of pregnancy.)
You may complete the IME, except for the CXR.
Send the IME only once the post-partum CXR has been returned to you.

See the sample Instructions for Pregnant Client - X-Ray Deferred (IMM 5733) form in Appendix III.

If the applicant is undergoing an upfront medical examination, then the applicant must be given a copy of Upfront Medical Report – Client Biodata and Summary (IMM 1017B upfront) form for them to submit with their visa application prior to undergoing the post-partum CXR.

Additional Forms for paper-based IMEs

IMM 5725: Activities of Daily Living (ADL)
IMM 5738: Chart of Early Childhood Development (CECD)
IMM 5728: Acknowledgment of HIV Post-Testing Counselling
IMM 5734: Specialist’s Referral Form
IMM 5738: Chart of Early Childhood Development (CECD)

Additional information for submitting forms

IME grading: Grade A or Grade B

Before you submit the IME, you must provide a grade for it based on your reported findings:

Grade A indicates that there are no abnormal findings present and no significant abnormal history.
Grade B indicates that there are significant abnormal findings present and/or an abnormal history.
Comments cannot be included for A-grade IMEs.
Comments are mandatory for B-grade IMEs.

Panel physician declaration

The panel physician’s declaration is provided in writing on the Medical Report (IMM 1017) and includes your name, signature, number and the date of the IME submission.

Furtherance process

RMOs may need more information to complete their medical assessment. They get this through the furtherance process. Furtherance might create additional costs for the applicant because the panel physician involved cannot be employed at the clinic where the initial IME was completed.

Here is what is involved in the furtherance process:

The RMO issues a letter to the applicant with instructions to return to a panel physician for further investigations.
The RMO provides the applicant with a sealed letter for the panel physician, which details the specific instructions for further investigations.
As the panel physician, you either complete the additional examination(s) or refer the client to a specialist.
Your referral letter must include the client’s biodata and photograph, and clearly indicate the investigations required by IRCC.
Once all the required investigations have been completed, you return the reports to IRCC.

NOTE: If a furtherance is issued on paper it cannot be completed in eMedical.

Legislation related to the Immigration Medical Examination

Immigration is a shared federal/provincial responsibility. As a panel member, you should be aware of the following three pieces of legislation – in particular how they relate to the administration of IMEs, your responsibilities for protecting the personal information of applicants and how an applicant can be denied admission on health grounds.

The Immigration and Refugee Protection Act

The Immigration and Refugee Protection Act (IRPA) is a federal act. One of its objectives is to ensure that the movement of people into Canada contributes to the country’s cultural, social, and economic interests, and affirms its humanitarian commitments while protecting the health, safety and security of Canadians.

IRPA and its accompanying regulations set out the medical requirements for applicants who want to come to Canada as temporary or permanent residents. The legislation also sets out the grounds on which a person may be found to be inadmissible to Canada – including inadmissibility on health grounds.

A foreign national can be found inadmissible on health grounds if their medical condition:

is likely to be a danger to public health
is likely to be a danger to public safety
might reasonably be expected to cause an excessive demand on health or social services

Take a closer look at IRPA.

The Privacy Act

The purpose of this legislation is to protect the privacy of people’s personal information when it is collected, retained, used and disclosed by government, and provide individuals with the right to access their personal information.

Many aspects of the Privacy Act apply to your work as a panel member – in particular your responsibility to protect the information of the applicants you examine.

Take a closer look at the Privacy Act.

Collection of panel members’ personal information under IRPA

IRCC’s Migration Health Branch is responsible for administering the department’s medical screening program. This includes managing panel members who perform IMEs in Canada and abroad. As part of the medical screening program, the branch collects and creates personal information about panel members, including your:

name
business name
provider type/specialty
professional affiliation, licensing or certification
contact information (address, postal code)
languages spoken
sex
signature
photograph
evaluations performed by IRCC’s Migration Health Branch
evaluations shared with Canada by the governments of Australia, New Zealand, the United Kingdom and the USA

The Access to Information Act

The Access to Information Act gives every Canadian citizen, permanent resident, individual or corporation in Canada the right to request access to records, in any format, held by a government institution, subject to certain exceptions.

Take a closer look at the Access to Information Act.

Find out how to request access to information or personal information.

It is not necessary for applicants to use these acts to get a copy of their own IME. As a panel physician, you are authorized to give them a copy if they ask.

Acronyms, Initialisms and Definitions

The following list provides definitions for acronyms and technical terms found in this guide:

ADL:: Activities of daily living
Biodata:: Information that establishes each client’s identity
CECD:: Chart of Early Childhood Development
IRCC:: Immigration, Refugees, and Citizenship Canada
Chief radiologist:: Licensed radiologist designated by IRCC to perform, grade and submit chest x-rays for Canada’s immigration medical examinations (IMEs).
Client:: A foreign national seeking to enter or remain in Canada who may be required to submit to an IME (in accordance with the Immigration and Refugee Protection Act and its regulations).
Clinic staff:: Persons who are working in the panel member’s clinic and may be involved in the immigration medical examination process.
CXR:: Chest x-ray
ED:: Excessive demand – a type of demand placed by a client on Canadian health or social services.
EDE:: Excessive demand exempt refers to specified groups of IRCC clients who are not denied entry or permission to stay in Canada because their medical condition may create an excessive demand.
ELISA:: Enzyme-linked immunosorbent assay, also known as enzyme immunoassay, which is one of the types of blood tests used to screen for HIV infection.
eMedical:: An online application that provides a paperless process for electronic recording, transmission and storage of immigration medical examination results.
Furthered cases:: Cases that require additional supplemental information.
GAF:: Global assessment of functioning
Guardian:: A person who looks after and is legally responsible for someone who is unable to manage their own affairs, especially an incompetent or disabled person or a child.
Guide:: This guide is the standard reference for the orientation and training of panel members. All panel members must ensure that they remain familiar with it and with related departmental instructions, including interim changes and updates provided by IRCC.
HIV:: Human immunodeficiency virus
IFHP:: Interim Federal Health Program – a program funded by IRCC that provides limited, temporary coverage of costs related to health screening and care for specific categories of people, including protected persons, refugee claimants (asylum seekers in Canada), rejected refugee claimants in Canada, certain persons detained under the Immigration and Refugee Protection Act and other specified groups.
IGRA:: Interferon gamma release assay. A blood test that is a screening test used to determine if a client has latent (inactive) tuberculosis.
IMA:: Immigration medical assessment – the medical opinion made by Migration Health Branch concerning an IRCC client’s health admissibility to Canada as defined under immigration legislation.
IME:: Immigration medical examination – the examination conducted by panel members. The results of these examinations are sent to IRCC regional medical offices via eMedical (or exceptionally by courier/post) who then provide an IMA.
IME number:: Immigration medical examination number – a unique number assigned to a specific IME.
IMM 1017:: An IME form containing the client’s biodata, IME grading and panel physician declaration.
IMM 5419:: An IME form containing the client’s medical history, physical examination findings, laboratory and the chest x-ray requisition results.
IMM 5544:: Supplemental medical and resettlement needs assessment form providing information on special accommodations a refugee may require to settle in Canada.
IOM:: The International Organization for Migration, an intergovernmental organization that became a related organization of the United Nations in 2016.
IRCC:: Immigration, Refugees, and Citizenship Canada. The Canadian federal government department that has primary responsibility for managing the entry into Canada of foreign nationals.
IRPA and IRPR:: Immigration and Refugee Protection Act and the Immigration and Refugee Protection Regulations (IRPR). Canadian legislation setting out the requirements for entry to Canada by foreign nationals. This legislation determines requirements to enter Canada including requirements for an IME. View the Act and regulations.
LFT:: Liver function test – a laboratory test used to evaluate liver function.
locum tenens:: Medical practitioners who replace panel physicians for a short period while they are on vacation, taking training or unable to provide service for other reasons.
LTBI:: Latent tuberculosis infection – sometimes referred to as ‘inactive tuberculosis’.
Nominated radiologist:: Licensed radiologist nominated by a chief radiologist located in the same radiology clinic to perform, grade and submit chest x-rays for Canada’s IMEs.
Panel clinic:: A clinic where designated physicians and/or radiologists conduct IMEs.
Panel member:: A general term that refers to a panel physician, panel radiologist or panel laboratories or specialists authorized by IRCC to perform IME related activities.
Panel physician:: A licensed medical doctor designated by IRCC to perform, grade and submit IMEs. Designated medical practitioner (DMP) was the previously used term.
P number:: A unique identifier given to specific panel members issued by IRCC’s Migration Health Branch.
Protected person – In Canada:: A person in Canada who according to Canada’s Immigration and Refugee Protection Act, is a person who has been determined to be either (a) a convention refugee or (b) a person in need of protection (including, for example, a person who is in danger of being tortured if deported from Canada).
PTB:: Pulmonary tuberculosis
PTC:: Post-test counselling
Radiologist:: For IRCC purposes, this refers to both chief and nominated radiologists.
Refugee overseas:: A person overseas who has been determined to be a convention refugee or a person in similar circumstances. A convention refugee is a person who meets the refugee definition in the Geneva Convention signed in 1951 relating to the status of refugees and the protocol to that convention signed in New York in 1967.
RMO:: RMO stands for regional medical office. These offices contain IRCC employees who are responsible for providing Canadian immigration medical services in a specific region. In 2019, there were four RMOs, located in Ottawa, London, New Delhi and Manila.
TB:: Tuberculosis.
TIs:: Technical instructions – the instructions for completion of the IME.
TST:: Tuberculin skin test. One screening test that can be used to determine if a person might have latent (inactive) tuberculosis infection.
UCI:: Unique client identifier. A unique number assigned to a client used for internal IRCC identification purposes.
UFM:: Upfront medical. An IME done prior to IRCC assigning a specific IME number to a client. Only certain IRCC clients can use UFM procedures.
UMI:: Unique medical identifier. A unique number used to associate to a specific upfront medical.
VDRL:: Venereal Disease Research Laboratory test, a blood test used to diagnose syphilis.
Visa Officer:: Any IRCC employee who under Canadian legislation has the delegated authority to make decisions/recommendations on visa issues. Previously the term visa officer referred to IRCC employees outside of Canada and migration officers referred to IRCC employees in Canada.

Section 3: Appendices

Appendix I: How to contact us

In Canada

For general inquiries about the Interim Federal Health Program (IFHP), please contact the IFHP team:

Migration Health Branch
Immigration, Refugees, Citizenship Canada
300 Slater Street, 7th Floor
Ottawa, ON K1A 1L1
Email: IRCC.IFHP-PFSI.IRCC@cic.gc.ca

To register as an Interim Federal Health Program service provider, and for inquiries about eligibility, benefits, claim requests or for general information, please contact the Medavie Blue Cross IFHP provider inquiry team:

IFHP Medavie Blue Cross^TM
644 Main St., P.O. Box 6000
Moncton, NB E1C 0P9
Website: https://www.medaviebc.ca
Customer Service Centre: 1-888-614-1880
Email: CIC_Inquiry@medavie.bluecross.ca
Fax for inquiries: 506-867-4651
Fax for claims submissions: 506-867-3841

Send paper-based IME and other documents that cannot be uploaded to eMedical to:

Operations Directorate
Integrated Medical Processing Network Division
Migration Health Branch
Immigration, Refugees, Citizenship Canada
300 Slater Street, 7th Floor
Ottawa, ON K1A 1L1

eMedical systems support

For service in English

Contact the Australian Department of Home Affairs via the “Contact Us” tab in the eMedical system.

For service in French

Email IRCC at: IRCC.MHBeMedical-eMedicalDGMS.IRCC@cic.gc.ca

This email is monitored from 8 a.m. to 4 p.m., Canadian Eastern Time, Monday to Friday, excluding statutory holidays.

For critical incidents

Contact IT support immediately.

Telephone: +61-2-6264-0400

Email: ITSupport@homeaffairs.gov.au

Critical incidents include the following:

total loss of the eMedical system (unexpected outages)
loss of core functions (cases cannot be submitted, attachments cannot be uploaded)

Note: This service is provided by the Australian Department of Home Affairs 24 hours a day, seven days a week, in English only.

For enquiries regarding medical clinical issues

Panel members should continue to direct all immigration medical exam-related enquiries to their regional medical office.

Regional medical offices

Your RMO is your point of contact for attaining your status as a panel member, submitting IME results and reports, and all other matters regarding your work as a panel physician or radiologist.

London

Overseas Regional Medical Office
Canadian High Commission
Canada House – Trafalgar Square
London SW1Y 5BJ
United Kingdom
Email: LDNPPMD@international.gc.ca

Manila

Overseas Regional Medical Office
Canadian Embassy
Level 7, Tower 2, RCBC Plaza
6819 Ayala Avenue
Makati City 0707
Philippines
Fax: +632-843-1103
Email: MANILMC-MD@international.gc.ca

New Delhi

Overseas Regional Medical Office
High Commission of Canada
7/8 Shantipath, Chanakyapuri
New Delhi 110021
India
Fax: +91-11-41782020
Email: Delhi-mc@international.gc.ca

Americas

Ottawa Regional Medical Office
Migration Health Branch
Immigration, Refugees, Citizenship Canada
300 Slater Street
Ottawa, ON Canada K1A 1L1
Fax: +1-613-941-2179
Email: IRCC.MHBPMInquiries-RenseignementsMPDGMS.IRCC@cic.gc.ca

Appendix II: Client Declaration and Notice (IMM 5743)

IMM 5743: Declaration and Notice with respect to Immigration Medical Exam and Notice with respect to Vaccination (PDF, 1 MB)

Appendix III: Forms

IMM 1017: Medical Report – Client Biodata and Summary
IMM 1017B upfront: Upfront Medical Report – Client Biodata and Summary
IMM 5419: Medical Report
IMM 5725: Activities of Daily Living (ADL)
IMM 5728: Acknowledgment of HIV Post-Testing Counselling
IMM 5733: Instructions for Pregnant Client - X-Ray Deferred
IMM 5734: Specialist’s Referral Form
IMM 5738: Chart of Early Childhood Development (CECD)

IMM 1017: Medical Report – Client Biodata and Summary

IMM 1017B upfront: Upfront Medical Report – Client Biodata and Summary

IMM 5419 Medical Report

Sample of IMM 5419 Medical Report Page 3

Sample of IMM 5419 Medical Report Page 4

Sample of IMM 5419 Medical Report Page 5

Sample of IMM 5419 Medical Report Page 6

IMM 5725: Activities of Daily Living (ADL)

IMM 5728: Acknowledgment of HIV Post-Testing Counselling

IMM 5733: Instructions for Pregnant Client - X-Ray Deferred

IMM 5734: Specialist’s Referral Form

IMM 5738: Chart of Early Childhood Development (CECD)

Appendix IV: List of immigration medical examination technical instructions

A) TIs related to process changes resulting from eMedical implementation

Activities of daily living (ADL)

Subject

Instructions for completing the Activities of Daily Living (ADL) form in the context of the Canadian Immigration Medical Examination (IME).

Goal/objective

These instructions are provided to ensure that panel physicians (PPs) follow a consistent and appropriate process for the following:
- Identification of clients with a possible diminished ADL capacity
- Completion of the ADL form
- Completion and grading of an IME for a client with diminished ADL functions
Instructions

The ADL assessment provides information about which activities of daily living are impacted by disability due to mental or physical conditions/illnesses. PPs must evaluate clients’ activities of daily living and rate them accordingly. Scoring is based on their level of function, how independently a task can be performed, and whether supervision or assistance is needed in performing the task.

An ADL assessment is mandatory for all clients who:
- are 75 years of age or older
- have abnormal findings on physical examination of the musculoskeletal system
- have abnormal findings on physical examination of the nervous system
- have abnormal findings on physical examination suggestive of cognitive impairment or intellectual disability; and /or
- have an ongoing physical or mental health condition that might prevent them from attending a regular school program, obtaining full-time employment, or living independently
Reporting

PP’s must not refer clients to specialists unless instructed by the Regional Medical Office. All existing lab results and/or any specialist reports from previous specialist consultations must be attached to the IME.

In parallel to the Immigration Medical Examination process, PPs are to provide appropriate and timely advice to the client when they discover a serious medical condition not known to the client. In doing so, they are to uphold professional and ethical standards by referring the client back to their usual treating physician or to an appropriate specialist upon request.

Grading and submission of files

IMEs for clients with an abnormal ADL assessment must be graded B.

All files are to be submitted within the 10 day client service standard. For cases with pending report(s), submit the IME with a note indicating additional medical information is pending. The RMO will create a furtherance request for the outstanding information.

Algorithm

Text version: TI ADL (Activities of Daily Living)

TI ADL (Activities of Daily Living)

IME should be graded B if any abnormalities in the ADL assessment are found.

Q1: Is the client 75 years old or older?

No: No need for an ADL assessment

Yes: ADL assessment is mandatory

Q2: Is there abnormal findings on physical examination of the musculoskeletal system?

No: No need for an ADL assessment

Yes: ADL assessment is mandatory

Q3: Is there abnormal findings on physical examination of the nervous system?

No: No need for an ADL assessment

Yes: ADL assessment is mandatory

Q4: Is there abnormal findings on physical examination suggestive of cognitive impairment or intellectual disability?

No: No need for an ADL assessment

Yes: ADL assessment is mandatory

Q5: Is there an ongoing physical or mental health condition that might prevent the client from attending a regular school program, obtaining full-time employment, or living independently?

No: No need for an ADL assessment

Yes: ADL assessment is mandatory
Assessment of cognitive functioning

Subject

Instructions for assessing cognitive functioning in the context of the Canadian Immigration Medical Examination (IME).

Goal/objective

These instructions are provided to ensure that panel physicians (PPs) follow a consistent and appropriate process for the following:
- Identification of clients with possible diminished cognitive capacity
- Completion and grading of an IME for a client with diminished cognitive capacity
Instructions

There are various tools available for assessing cognitive functioning (Mental State Exam, Montreal Cognitive Assessment). For the purpose of standardizing scores, the raw score of the tool used to assess cognitive functioning must be transposed to a scale of 30. In scoring the client’s cognitive functioning, the PPs may need to take into account mitigating factors such as the client’s educational attainment, literacy and cultural considerations. In certain circumstances, the raw score may be interpreted upon consideration of additional information such as anecdotal information from family members.

An assessment of cognitive functioning is mandatory for all adult clients who:
- are 75 years of age or older
- have abnormal findings on physical examination of the nervous system
- have abnormal findings on physical examination suggestive of cognitive impairment or intellectual disability; and/or
- have an ongoing physical or mental health condition that might prevent them from attending a regular school program, obtaining full-time employment, or living independently
Reporting

PP’s must not refer clients to specialists unless instructed by the Regional Medical Office. All existing lab results and/or any specialist reports from previous specialist consultations must be attached to the IME.

In parallel to the Immigration Medical Examination process, PPs are to provide appropriate and timely advice to the client when they discover a serious medical condition not known to the client. In doing so, they are to uphold professional and ethical standards by referring the client back to their usual treating physician or to an appropriate specialist upon request.

Grading and submission of files

All IMEs for clients with a cognitive functioning score of 25/30 or lower must be graded B.

All files are to be submitted within the 10 day client service standard. For cases with pending report(s), submit the IME with a note indicating additional medical information is pending. The RMO will create a furtherance request for the outstanding information.

Algorithm

Text version: TI for cognitive functioning assessment

TI for cognitive functioning assessment

IME should be graded B if any abnormalities in the cognitive functioning assessment are found.

Q1: Is the client 75 years old or older?

No: No need for a cognitive functioning assessment

Yes: cognitive functioning assessment is mandatory

Q2: Is there abnormal findings on physical examination of the nervous system?

No: No need for a cognitive functioning assessment

Yes: cognitive functioning assessment is mandatory

Q3: Is there abnormal findings on physical examination of the musculoskeletal system?

No: No need for a cognitive functioning assessment

Yes: cognitive functioning assessment is mandatory

Q4: Is there abnormal findings on physical examination suggestive of cognitive impairment or intellectual disability?

No: No need for a cognitive functioning assessment

Yes: cognitive functioning assessment is mandatory

Q5: An ongoing physical or mental health condition that might prevent the client from attending a regular school program, obtaining full-time employment, or living independently

No: No need for a cognitive functioning assessment

Yes: cognitive functioning assessment is mandatory

COVID-19 vaccines

Note: The following instructions are only for panel physicians practising outside of Canada.

The COVID-19 vaccine given at the time of the immigration medical examination (IME) is strictly voluntary, and clients must consent to receive the vaccine. Panel physicians are responsible for ensuring local requirements are followed when getting consent for vaccination.

Subject

Instructions for administering COVID-19 vaccines accepted by the Government of Canada or recording proof of COVID-19 vaccination at the time of the IME.

Goal/objective

These instructions are provided to ensure that panel physicians (PPs) outside of Canada follow a consistent and appropriate process for the following:

administering COVID-19 vaccines accepted by the Government of Canada
recording proof of COVID-19 vaccination presented by clients

Background

In support of global efforts to reduce the transmission and spread of COVID-19, Immigration, Refugees and Citizenship Canada (IRCC) is encouraging all panel physicians to offer a COVID-19 vaccine accepted by the Government of Canada to their clients undergoing an IME, where available and accessible. IRCC will collect information related to the client’s COVID-19 vaccine history, including timing and type of vaccines received.

COVID-19 vaccines are not a mandatory component of the IME and will have no bearing on visa issuance or immigration admissibility to Canada, but PPs should offer the vaccine to clients during the IME, where available and accessible. The recording of vaccine history will provide IRCC with information about international access to COVID-19 vaccines accepted by the Government of Canada, general COVID-19 vaccine uptake, and other relevant trends that could be used to inform future program and policy decisions.

Instructions

Administering COVID-19 vaccines accepted by the Government of Canada

If available, PPs may administer any COVID-19 vaccine accepted by the Government of Canada. PPs must not wait to administer the subsequent dose(s) before submitting the IME, but should offer to administer or provide information about subsequent doses to clients where appropriate. Follow the guidelines in your jurisdiction regarding vaccine mixing.

Note: If clients require TST/IGRA testing during the IME as per the tuberculosis technical instructions, it should be performed before a vaccine is administered.

After administering any dose of a COVID-19 vaccine accepted by the Government of Canada to a client, take the following steps:

Complete the 951 Vaccinations Exam to record the PP-administered vaccination. Consult the eMedical tip sheet instructions on where to enter PP-administered vaccines.
Do not upload a copy of the vaccination record or any related documents.
In the Remarks section in the 951 Vaccinations Exam, do not record information about client immunity or history of COVID-19 illness.
After submitting the 951 Vaccinations Exam, give the client a copy of the Vaccination Worksheet for their records.

Recording proof of prior COVID-19 vaccination

PPs should instruct clients to provide all available records of COVID-19 vaccination for review, regardless of the number of doses received or the type(s) of vaccine received.

Acceptable vaccination documentation must come from a vaccination record, either a personal vaccination record or a copy of a medical chart with entries made by a physician or other appropriate medical professional. Follow your local public health guidance to determine whether the documentation provided is acceptable.

Use the 951 Vaccination Exam to record vaccination information for clients with proof of prior vaccination. Record the vaccination history for all types of COVID-19 vaccinations, regardless of whether the vaccines are accepted by the Government of Canada for border entry or quarantine exemptions.

Review the client’s vaccination record.
Complete the 951 Vaccinations Exam for any COVID-19 vaccine that the client has received, whether it be from the PP or from a prior source.
In the Remarks section of the vaccine module, do not record any information about the client’s immunity or history of COVID-19.
In the Attachments section in the 951 Vaccinations Exam screen, do not upload a copy of the vaccination record or any related documents.

Tips for completing the 951 Vaccinations Exam section

If the client has already received a COVID-19 vaccine, fill out the record results section for each COVID-19 vaccine the client has received by selecting the appropriate COVID-19 vaccine. Within the screen for recording the vaccine, fill out the appropriate sections and record whether

the PP administered the vaccine or
the vaccine was previously administered

If the PP does not administer a COVID-19 vaccine accepted by the Government of Canada at the time of the IME, select the relevant reason in the “Reasons for not providing vaccine” section.

If a client is already fully vaccinated before the IME, do not select one of the “Reasons for not providing vaccine”. IRCC will be able to determine if a client is fully vaccinated from an analysis of the vaccination history.

Do not upload a copy of the vaccination record or any related documents in the Attachments section.

For detailed instructions on how to complete the 951 Vaccinations Exam section for different scenarios, consult Appendix A and the algorithm.

Grading and submission of files

Clients with a COVID-19 vaccine do not require a B grading unless a B grading is indicated in conditions outlined in the Canadian Panel Member Guide to Immigration Medical Examinations.

Submit all files within the 10-day client service standard.

References

COVID-19 vaccines accepted by the Government of Canada

Information for clients:

Algorithm: Technical instructions for administering and recording COVID-19 vaccination in eMedical

Text version: Technical instructions for administering and recording COVID-19 vaccination in eMedical

Scenario 1 (Client already vaccinated):

Client provides proof of a previously obtained COVID-19 vaccine.

In the 951 Vaccinations Exam, select "COVID-19" in the drop-down list. Select the vaccine and record the vaccination data in the appropriate fields.