Form Imm1017E – Fill Out and Use This PDF

When you and your family members go for your medical examination, make sure you have this sheet completed for each person, along with the following items:

•passports for yourself and your family members, plus a photocopy of the bio-data page of each passport. If a passport is not available, provide an official identity document bearing the photo and date of birth of the family member;

•eye glasses or contact lenses, if you or your family members wear them;

•previous medical report(s), if any. You must tell the examining doctor about all past and present medical problems and conditions, and provide the doctor with any available documentation such as physician’s reports, treatment or prescriptions; and

•five recent pictures taken within six months preceding the date of the examination and, where applicable, a negative for yourself and your family members (see section on photos in the instructions on how to complete the Application for permanent residence).

Make an appointment with one of the doctors identified on the enclosed list. A Medical Report, Section A (form IMM 1017 EFC) will be completed at the doctor’s office for yourself and each of your family members undergoing the medical exam. A photo of the person to be examined by the doctor will be affixed on both copies of that person’s form. This form is used to match your medical file to your immigrant file.

The doctor will sign the form and mail the first copy to the Canadian Regional Medical Office (RMO) with the results of the examination. You will be given the second copy as proof you underwent the medical examination. You must include this copy with your immigrant application when you send it to your sponsor. Photocopies will not be accepted. If you lose it, you will not be able to obtain a duplicate;you will have to redo the medical examination and pay any associated fees again.

We will review the medical results to determine whether there are any medical reasons which would prevent you or your family members from coming to Canada.You and each of your family members will also have to complete your own copy of the Medical Report, Section B (form IMM 5419). You will have to write your answers to the questions on this form in the presence of the examining doctor, who will then proceed to complete Section C, D and E. The medical examination includes:

•complete physical examination for all family members;

•chest X-ray and a radiologist’s report for everyone aged 11 years and over;

•blood test for everyone aged 15 years or over;

•urinalysis for everyone aged 5 years or over;

•HIV testing for everyone aged 15 years or over, as well as for children who have received blood or blood products, or have a known HIV mother.

If your medical results prove satisfactory, they have a validity of one year from the date of examination. Therefore, you should make arrangements to have the date of your medical examination precede as closely as possible the date you will be sending your application and supporting documentation to your sponsor.

If the processing of your application for permanent residence is delayed and we cannot reach a decision about your application before the validity of your medical examination expires, you will be required to do the medical examination again.