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This Handbook provides instructions, information and reference material related to the work of panel members and to the IME process.
Issues affecting the health of immigrants and the immigration process itself are subject to change. Client A foreign national who is seeking to enter Canada, and in accordance with the Immigration and Refugee Protection Act and its Regulations, is required to submit to an IME.
Clinic staff Persons who are working in the panel member’s clinic and may be involved in the immigration medical process.
EDE Excessive demand exempt is a category of client who is exempt from assessment of excessive demand. ELISA Enzyme-linked immunosorbent assay, also known as enzyme immunoassay, which is a blood test for HIV. Furthered cases Cases that require supplemental medical reports to complete the medical assessment. Guardian A legal guardian is a person who has custody or who is empowered to act on behalf of another person and has been recognized as such by the competent authorities in the jurisdiction where the status was either recognized or granted. Handbook This Handbook is the standard reference for the orientation and training of panel members. IFHP Interim Federal Health Program: a program funded by CIC that provides limited, temporary coverage of costs related to health care for specific categories of people, including protected persons, refugee claimants, rejected refugee claimants, certain persons detained under the Immigration and Refugee Protection Act (IRPA) and other specified groups. IMM 0535 Medical Surveillance Undertaking Form, issued to individuals who have undergone their IME in Canada or abroad and have been determined to require medical surveillance by Canadian Public Health Authorities. IMM 1017 An IME form containing the client’s biodata, IME grading and panel physician declaration.
IMM 5544 Supplemental medical and resettlement needs assessment form providing information on the special needs a client may have while settling in Canada. 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.
Panel member A general term that refers to a panel physician, panel radiologist or panel laboratories or specialists authorized by CIC to perform IME-related activities. Panel physician New term used for a medical doctor designated to perform, grade and submit IMEs.
Panel radiologist A radiologist designated to perform, grade and submit chest x-rays for IMEs. PHLU Public Health Liaison Unit, located in the Health Branch, CIC (the former term was Medical Surveillance Unit).
Protected person – In Canada People who have been determined to be protected persons by the Immigration and Refugee Board of Canada (IRB), or in a Pre-Removal Risk Assessment, and who have been granted permanent residence as a result. RMO Regional medical office is the location of operations for medical officers who are CIC officials with responsibility for the Canadian immigration health program in a given region. The IRPA and its accompanying regulations set out the medical requirements that clients must meet in order to come to Canada as temporary or permanent residents. In addition, the legislation sets out the grounds on which a person may be found to be inadmissible to Canada, including inadmissibility on health grounds. The purpose of this Act is to protect the privacy of individuals with respect to personal information collected by the government and to provide individuals with a right of access to their personal information. Under the Privacy Act, all individuals have the right to the protection of their personal information held by a federal institution. Pursuant to paragraph 8(2)(f) of the Privacy Act, Health Branch has concluded Memoranda of Understanding with certain partner countries on information sharing in order to align our network of panel members, which allows Health Branch to share information about our network with partner countries.
The Access to Information Act gives every Canadian citizen, permanent resident and individual or corporation present in Canada the right to access records, in any format, held by a government institution, subject to certain exceptions. The Act is used to access information held by the government apart from an individual’s own personal information. It is not necessary for clients to use the Act to obtain a copy of the results of their own IME. Completion of orientation, which includes reading and understanding this Handbook and participating in discussions with CIC medical personnel. Completion of training, including eMedical training where and when relevant, which may be done individually or through group activities involving several panel members in locations where they operate in geographic proximity. Designation is not a permanent status and completing the designation process does not create any contract or agency relationship with CIC. CIC immigration officials and medical officers consult one another regularly in order to determine the number of panel members required in a given location. If a panel member relocates his or her practice, that relocation must be brought to the attention of the RMO, as designation as a panel member is related to your location.
Complaints or disputes regarding a panel member’s performance may result in termination, depending on the situation.
Panel members, depending on their field of work, are authorized to perform IMEs, arrange for diagnostics and investigations, and complete immigration medical forms.
Panel members performing IMEs should ensure that they meet CIC-mandated service standards and that there are no conflicts of interest in providing services.
For all clients, the Canadian IME will include an examination by a panel member and a medical assessment by a CIC medical officer. The assessment of whether or not a client is inadmissible on health grounds is based on the health findings identified during the examination by a panel member. Once CIC has designated a laboratory in your area, panel physicians will be required to use this facility. The eMedical system is a Web-based system implemented by CIC and the DIAC for the electronic recording and transmission of IMEs. Panel physicians are to provide appropriate and timely advice to the client when they discover a serious disease not known to the client.
In doing so, they are to uphold professional and ethical standards by referring back to the client’s usual physician or to an appropriate specialist, upon request.
The panel member discovers inappropriate activity relative to the provision of IMEs by clinic, office, laboratory or radiology centre staff.
To support fraud prevention and the integrity of the IME process, panel members must confirm the identity of the client using an identification document acceptable for the Canadian Immigration medical examination. Panel members or clinic staff must also inform CIC if they suspect that clients are providing false information or attempting to falsify any aspect of the IME. Panel members can proceed with the IME, and CIC will follow up on the concern raised about the individual’s identity and any other report of possible fraud. Panel members should help prevent fraud by educating their staff on procedures used to verify client identity (refer to Section 4.1 for additional information). Panel members must be aware that clients from some cultures may request special accommodation during the IME.
Panel members should try to accommodate personal and cultural sensitivities, while keeping in mind that IME standards must be respected. A panel member who fails to meet the IME performance standards reflects badly on the immigration medical program.
If the panel member will have a locum tenens replacing him or her during extended absences, the panel member must give the RMO at least 14 days’ notice, preferably by email.
Panel members cannot submit IMEs if their leave information indicates that they are on leave.
Extended or repeated unapproved absences may result in termination of a panel member’s status.
For personal and program integrity, they must enter leave dates directly in their personal record.
The RMO will update the information in their record in order to track the leave in their system.
A statement from the proposed locum indicating that he or she has read this Handbook and agrees with the standards and requirements defined herein.
Note: Prior to recommending a particular physician or radiologist as a prospective locum, the panel member must be satisfied that the proposed locum has the qualifications and experience to perform IMEs. If the RMO approves the request, a written response (by letter or email) will be sent to the panel member. The panel member must give the RMO at least 14 days’ notice, preferably by email, for every period of time where the locum will be acting on behalf of the panel member. Panel members must ensure that the locum has adequate training in IME requirements, reporting procedures and any updates.
The termination of a panel member will automatically cancel prior approvals of a locum for this panel member. English and French are the official languages of Canada and panel members must be able to communicate with Canadian officials in at least one official language. Panel members should inform CIC of the official language they prefer to use in correspondence. Panel members should inform CIC of the official language and any other language they speak. Panel members should also indicate in the drop-down list in eMedical other languages they speak.
When performing IMEs, panel physicians may examine clients who speak neither of the two official languages, nor any other language that the panel physician speaks. If an interpreter is used, panel members must select and ensure that the interpreter is unbiased and has no connection to the client. The panel member’s unique identifier should be included in all correspondence with CIC.


For panel members or their locum tenens performing a paper-based IME, the unique identifier, along with their name, must be clearly readable on each Medical Report (forms IMM 1017 and IMM 5419) and on each chest x-ray.
Each photo attached to the Medical Report (IMM 1017) must be stamped to confirm the identity of the client. Panel radiologists may embed this information on the chest x-ray along with other required information about the client.
Forms, documents and results of investigations required for the completion of IMEs are the property of CIC. Panel members who perform IME-related activities must follow the procedures below for copies and files as well as for original documents and information. Original documents and information related to an IME must be forwarded to the responsible RMO electronically. Original documents and information related to an IME must be forwarded to the responsible RMO by regular mail or commercial courier and must never be given to the client for delivery to the RMO. Panel physicians are required to keep copies and records of files for at least 2 years and in compliance with their local regulatory and licensing requirements. Regular contact will be maintained between panel members and RMOs regarding both medical and administrative issues.
Written correspondence, such as letters, faxes or email, is preferred, but the telephone can be used when necessary (see Appendix I for RMOs’ addresses and contact information). Information about IME fees, services included in the fees, clinic’s address and contact information may be included in the advertisement. On occasion, the media may become interested in the IME of a particular individual and contact the panel member for information.
Panel members should never communicate confidential information they are privy to with respect to the immigration system or to individual clients. Clients may have questions about the immigration process, particularly when CIC officials request additional medical information or investigations. These questions should be addressed to the immigration or visa office responsible for the case. If panel members have non-eMedical-related questions regarding IMEs, they may contact their RMO listed in Appendix I. Panel members who have questions about eMedical should consult the eMedical System User Guides and Quick Reference Guides. Panel members in Canada should refer to Chapter 5 for instructions regarding requirements and fees for refugee claimants under the Interim Federal Health Program (IFHP). Clear and transparent procedures for responding to complaints and resolving disputes improve client service and the integrity of the immigration medical program. If, during an IME, a panel member has a disagreement with a client, or confusion arises or an event occurs that might compromise client service, panel members should report these incidents to the RMO.
The panel member feels that reporting a one of a kind situation may benefit the program or increase other panel members’ knowledge. Reports to the RMO should include the date of the incident, the client’s IME, UMI or UCI number and a brief description of the incident.
CIC’s Health Branch will consider the opinions and viewpoints of panel members and of anyone submitting a complaint or critical comment. Health Branch officers will occasionally visit panel members to ensure the quality of their work. Failure to meet performance standards may result in termination of the panel member’s designation.
Continued failure to maintain an acceptable level of performance as set out in this Handbook or in accordance with written instructions from the RMO. For serious complaints, such as harassment, sexual misconduct or illegal activities, the RMO will suspend the panel member, issue a letter summarizing the facts that gave rise to the complaint and provide the panel member with an opportunity to reply. However, if the panel member’s designation is terminated because of performance deficiencies or complaints, there is no transition period and the termination is effective as of the date of the notification letter sent by the RMO.
CIC will consider all requests for reconsideration and make every effort to provide panel members with a written reply within 30 days of the receipt of their request for reconsideration. This chapter provides panel members with a step-by-step method for completing an IME and associated forms. The IME consists of a medical history, physical examination, age-specific laboratory tests and age-specific chest x-ray. With the launch of eMedical, the IME will be conducted, where technologically feasible, in a Web-based computer program designed for the electronic recording, transmission, processing and temporary storage of the IME and its associated results. Panel members performing IMEs in a region where eMedical has been implemented must use the system to complete and submit all IMEs. Differences between the paper process and the eMedical process have been pointed out throughout this document. IME paper forms have been redesigned to ensure consistency between eMedical IMEs and paper-based IMEs.
Client photographs are essential for ensuring that there is no substitution at any time during the lifecycle of the IME and that the person who undergoes the IME is the same person who is applying for entry to Canada. The eMedical system will include the photograph on all requisitions and referrals (laboratory, radiology, specialists and others).
If the photographs do not meet the specifications, ask the client to provide new photographs before their IME can be completed. The photograph on the Medical Report (IMM 1017) must be stamped in the top right corner with the panel physician’s ID stamp. The client must submit a passport or other identification document acceptable for the Canadian Immigration medical examination.
Important: To ensure the integrity of the IME process, the same identity document must be used for all components of the IME, including laboratory, radiology and specialist referrals. If the client provides personal details that seem inconsistent with the information on the submitted identity documents, panel members must identify the concern in the eMedical system or on the IMM 1017 – Medical Report (Client Biodata and Summary) for paper-based IMEs. Photocopies of the identification document concerned must be attached to the IME and submitted to CIC.
Consent for the collection and release of IME information related to the administration of Canada’s IRPA or to the protection of the health and safety of Canadians.
If a client does not give consent, the IME cannot be carried out and the panel physician must notify the responsible RMO. Clinic staff or a panel member should review the Consent and Declaration form with the client and answer any questions. CIC has implemented one standard form, the Medical Report: Client Biodata and Summary (IMM 1017), for all immigration categories. EDE clients are those who are exempted from assessment of excessive demand on the Canadian health care system.
Note: Panel physicians must complete and submit, either electronically or on paper, the IMM 5544 Resettlement Needs Assessment Form.
Note: EDE clients include refugees, refugee claimants and certain family classes and individuals with protected person status.
The Medical Report (IMM 1017) form is typically issued by CIC with the client information and immigration information sections completed.
Clients who have been issued a Medical Report (IMM 1017) must present the form to the panel clinic when presenting themselves for their IMEs. Clinic staff will search for the client health case in eMedical using the IME# (search may also be done using client name and passport number, or UCI# or UMI#). A live photo of the client is taken and uploaded to eMedical to verify identity throughout the life cycle of the IME. Clinic staff must attach a client photo (provided by the client) to the Medical Report (IMM 1017). The Medical Report (IMM 1017) will be completed and submitted along with all other IME forms.
Clients who are being processed as refugees overseas will have a Resettlement Needs Assessment (IMM 5544) form issued to them along with their IMM 1017 by a Visa Office (VO). Refer to the IMEI on the Resettlement Needs Assessment (IMM 5544) for detailed instructions on completing the form.
UFM examinations are performed when clients report to a panel physician for their IME before a visa application has been submitted to CIC. Panel physicians must ensure that they provide the client with the proof of having completed their upfront medical examination. Since an IME is valid for 12 months, panel physicians should remind clients to submit their visa application along with the proof of having completed their upfront medical examination well before the expiration of the 12 months; otherwise, the client may have to undergo a second IME. Enter the Client personal details (mandatory fields include Title, Family name, Gender, Date of birth and Country of birth). Panel physicians will use IMM 1017B Upfront paper forms, which have been provided to them and that are pre- populated with a UMI# and a barcode (see sample form in Appendix III). Clinic staff must select the immigration category by checking the appropriate box (student, worker, visitor, family EDE or refugee claimant (in Canada only)). Note: It is very important to ensure the correct page goes to the client and the correct page goes to your RMO. Grade A indicates that there are no abnormal findings present and no significant abnormal history.
Panel physicians must provide this information in the comments section or they may attach a report to the IME.
The following table lists additional requirements when the answers to medical history questions show abnormality, whether the IME is completed in eMedical or on paper.
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We usually recommend restricted consumption of red meat in the immediate postoperative period.
They vary from pus formation in the gall bladder to jaundice and fever due to stones slipping into the bile duct, gall bladder perforation and even cancer of the gall bladder.
These responsibilities include management of the panel members (including panel physicians, panel radiologists and laboratories) who perform immigration medical examinations (IMEs) in Canada and abroad.
In providing these services, the RMOs rely on the IMEs that panel members conduct on clients for permanent residency and some categories of temporary residency in Canada.
As part of its modernization agenda, CIC has implemented an electronic IME Web-based processing system called eMedical. Panel members may include physicians, radiologists, laboratories and other designated health care professionals involved in the IME process.
All panel members must ensure that they remain familiar with it and with departmental instructions, including interim changes and updates provided by CIC. Panel members should be aware of the following legislation as it relates to immigration and the requirements with respect to medical examinations and inadmissibility on health grounds.
One of the 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. Moreover, Canadian citizens, permanent residents and other individuals present in Canada have the right of access to their own personal information held by government institutions. Subsection 8(1) states that the government institution shall not disclose personal information without the consent of the individual to whom the information relates except under the circumstances provided under subsection 8(2).
Health Branch requests that all panel physicians sign a consent form to share information with other immigration health authorities.
Panel physicians are authorized to provide clients with a copy of their own IME upon the clients’ request.
Based on CIC’s operational requirements, the number of designated panel members in any given location may be reduced or increased. They do not have the authority to assess or determine whether the medical conditions of clients are grounds for inadmissibility. They 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 their communications with CIC. Where necessary to establish compliance with the IRPA and the Immigration and Refugee Protection Regulations, clients will be asked to undergo further medical examinations. In regions where eMedical is available, panel members and their clinic staff will be required to complete all IMEs and enter the results in the eMedical system, unless otherwise specified by the responsible RMO.
Panel members are expected to exhibit professional behaviour and perform their IME-related activities in a manner that is in keeping with the principles of proper medical practice and with CIC policy. Female clients, for example, may be uncomfortable with a male examiner, in which case panel members should offer to have a chaperone present during the examination. In such cases, panel members will indicate on the examination form the type of accommodation provided and the names of other persons present during the examination. Consequently, the panel member’s inclusion in the panel member network may be terminated. The procedure for completing the IME is discussed in Chapter 4 and is also subject to performance evaluation. This will allow the RMO to activate the locum’s P number allowing him or her to use eMedical.
The panel member will then notify the locum that he or she has been authorized to provide services.
This unique identifier will replace the designated medical practitioner stamp that was previously used. For panel members, the eMedical logon information will be linked electronically to the panel member’s unique identifier. When documents are sent by courier, panel physicians must ensure that the IME forms and results are sent in appropriate order (refer to Appendix V for instructions) and should retain shipment tracking numbers for six months. It may not be used for other purposes, including research, clinical studies or investigations, without appropriate consent of the client and CIC.
RMOs are the points of contact for panel members to address inquiries, questions and comments about individual immigration medical cases, examinations and about the immigration medial program.
These officials may be seeking information about local health conditions, medical resources for consular services or help with a personal medical condition.
Under no circumstances should a panel member provide the media with information about a particular case. This section explains how CIC will deal with incidents, complaints and quality assurance concerns. Complaints regarding the IME and related services may arise from clients or other persons outside CIC. While the panel member’s designation is suspended, IME activities by the panel member cease until the panel member is notified that he or she has been reinstated by CIC.
If the response is deemed satisfactory, the panel member will be informed of the decision and be reinstated with appropriate recommendations. Panel members should send written notification to the RMO, including the anticipated date on which activity will cease. Photographs must be attached and submitted with the IME whether the IME is completed in eMedical or on paper. Clients who are eligible for UFM examinations will not have a Medical Report (IMM 1017) issued by CIC nor will they have an existing file in the eMedical system. Note: For refugee claimants in Canada, select the category family EDE, and scan and attach the document provided by the client.
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When food reaches the beginning of small intestine gall bladder ejects bile by its forceful contraction. Very commonly one also suffers from indigestion, usually described as acidity in common language.
It is a short stay procedure and post operative recovery and cosmetic results are also more acceptable. Health findings on the IMEs allow CIC medical officers to make recommendations on the medical admissibility of persons requesting entry to Canada. The information to be shared will not be related to individual clients or a specific type of care; rather it will be generic information concerning administrative (such as email, contact addresses) and operational activities (such as electronic capabilities, locations) as well as information gathered during evaluations, assessments or onsite visits by CIC officers.
Upon examination of the new location of the practice and an assessment of the operational requirement for panel members in that location, the affected panel member will be informed of a decision confirming his or her status and given an opportunity to respond. More specifically, panel members do not have authority to give clients an opinion on their medical admissibility. The panel member’s unique identifier will be embedded electronically in each IME or chest x-ray they submit through eMedical. The eMedical logon ID must not be disclosed to any other person or used by any other person to submit IMEs or chest x-rays. Such requests are not related to the immigration medical program and panel physicians may respond to these inquiries as they choose. Consequently, the fees for IMEs may vary from country to country and even within a country.
In addition, CIC personnel may provide critical comments or notifications of errors, performance issues or situations of concern regarding the IME and related services.
If the response is unsatisfactory, the panel member’s designation will be terminated. Panel physicians who are terminated because of operational needs will be notified in writing by the RMO at least 30 days prior to any such change in the network. Only in the event of a system outage should paper IMEs be used by eMedical-enabled panel members.
If the client or clinic staff completes it, the panel physician must review and confirm the information provided. When food is pushed into the duodenum from the stomach, the bile is excreted from the gull bladder, through the bile duct, into the intestines and eventually exits the body within the feces.
Panel members working in countries where eMedical is implemented will need to complete and transmit all IMEs through this Web-based system. In all cases, the online version of the Handbook will be the most current and is the version that should be consulted. Questions and information on specific cases should always include identification details, such as the IME, unique medical identifier (UMI) or unique client identifier (UCI) number along with the client’s date of birth. If a panel member is completing a paper-based IME that must be mailed to the RMO, he or she should discuss the method and cost of sending the documents with the client beforehand. Affected panel members will receive a letter of concern from the RMO and be given an opportunity to reply to the complaint. Very seldom one may come across a gall bladder stone without any clear cut symptoms as well.
To avoid possible breaches of confidentiality, information requests should never identify a client by name. In accordance with the principles of natural justice and procedural fairness, privacy rules will not be breached when sharing the content of the complaint.



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