October 24, 2023

Medical Examination Instructions

These medical instructions are being issued as your immigration application has reached the stage where medical
examination results are now required. Please read these instructions carefully.

When to complete your Immigration Medical Examination

You are required to undergo the medical examination within 30 days of the date of this letter.

Who may complete your Immigration Medical Examination

Your medical examination must be performed by a doctor from the IRCC list of Panel Physicians. The list of Panel
Physicians to find a doctor in your area:http://www.cic.gc.ca/pp-md/pp-list.aspx

How to complete your Immigration Medical Examination

Book an appointment with a Panel Physician in your area as soon as possible. If you are unable to complete your
medical examination within the 30 day timeframe provided, it is your responsibility to inform the IRCC office responsible
for processing your application as soon as possible.

Once your medical examination has been completed the Panel Physician will submit medical results to IRCC for
assessment. To obtain a copy of your Immigration Medical Examination please ask the panel physician at the time of
your appointment.

Paying for your Immigration Medical Examination

Any costs related to the medical examination are your responsibility and are payable to the Panel Physician at the time of
the examination. This payment is for the Panel Physician’s services and cannot be refunded even if your immigration
application is refused or the validity period of your immigration medical examination expires.

Note: If you are eligible for coverage under the Interim Federal Health Program (IFHP), the costs related to your
immigration medical examination may be covered by the IFHP. Please confirm with the Panel Physician in your area that
they are registered with the IFHP.

What must I bring to my appointment?

IMPORTANT: If you have a previous or existing medical condition, bring any medical reports, test results or prescriptions
that you may have with you to your appointment. This may help reduce the time it takes for your application to be
processed.

• The attached Medical Report form (IMM1017E)

• Identification, including your passport if one is available. Proof of identity must include at least one
government-issued document with photograph and signature, such as a passport
• Eye glasses or contact lenses, if worn
• Four recent photographs. You will need to bring these only if the doctor you select from the list of panel physicians
does not work with IRCC via the eMedical system. Please check with the doctor’s office when you book your
appointment
• For individuals eligible for Immigration Medical Examination (IME) coverage under the Interim Federal Health Program
(IFHP), please bring one of the following documents:
• Refugee Protection Claimant Document (RPCD) – IMM 1442
• The Interim Federal Health Certificate (IFHC) – IMM 5695
• Acknowledgement of Claim and Notice to Return for Interview (AOC) – IMM 5985

If available, you may be offered vaccinations by the Panel Physician. Receiving these vaccinations is not mandatory. If
you are considering being vaccinated, please bring records of any past vaccinations.

Go to the following website to find out what to expect during your exam :
https://www.canada.ca/en/immigration-refugees-citizenship/services/application/medical-police/medical-exams/
requirements-temporary-residents.html#exam

IMM 1017 E (06-2023) GCMS (DISPONIBLE EN FRANÇAIS - IMM 1017 F)

 PROTECTED WHEN COMPLETED - B
Page 1 of 1

MEDICAL REPORT
CLIENT BIODATA AND SUMMARY

Required for all clients.

Must be taken within six months
of the medical examination.

CLIENT INFORMATION
Family name Given name(s)
Galope Arisval Mathew
Date of Birth YYYY - MM - DD Country of Birth Gender
2007/04/10 Philippines M
Address
PH OFFICE ADD: 2ND FLOOR, TWO MANGO AVENUE MALL, G
ENERAL MAXILOM AVENUE C/O KENNETH ZIEGLER - ENHANC
CEBUAddress
E-mail CITY CEBU 6000 Telephone no.
Philippines
k.ziegler@enhanceimmigration.com
IMMIGRATION DETAILS
IMM Type: EDE IME no: 21445757
UCI: 11-2612-1567
Application no.: F001140480
*21445757*
IMMIGRATION MEDICAL EXAMINATION GRADING

A. No significant abnormal history or abnormal findings present. B. Significant abnormal history and/or significant abnormal findings present.

Comments:

PANEL PHYSICIAN DECLARATION

Valid identity document (passport/national ID) sighted? Do you have identity concerns?

No Yes No Yes

If YES, please provide details:

I confirm that this immigration medical examination and report is a true and accurate record of my findings.

Panel Physician name Panel Physician signature

Panel Physician no. Date of IME submission YYYY MM DD

IMM 1017 E (06-2023) GCMS (DISPONIBLE EN FRANÇAIS - IMM 1017 F)

NATIONWIDE HEALTH SYSTEMS, INC. 21445757
E-MEDICAL ID: _____________________ PRIORITY NO.
FILL IN DOTTED BOXED AREAS DATE: ____________________________
November 11, 2023

USE PASSPORT INFORMATION Height in meters: MEDICAL EXAMINATION FLOW

Weight in Kg:
Last Name: Galope BMI: I. REGISTRATION
First Name: Arisval Mathew II. PRE-EXAM
Middle Name: EYE TEST:
III. CASHIER
Age: 16 Birth date with year: April 10, 2007 Uncorrected Corrected
Civil Status: Single Gender: Male IV. URINE COLLECTION

Email Address: k.ziegler@enhanceimmigration.com OS V. BLOOD EXTRACTION

Embassy: Canada Australia New Zealand OD VI. CHEST X-RAY

VII. PHYSICAL
Visa Type / Category: Temporary Permanent EXAMINATION

Passport Number: P1295598C Date Issued: August 13, 2022 Date of Expiry: August 12, 2027
(If Passport is not applicable) Other Valid ID: N/A Spouse/Partner Name: N/A

PREFERRED PHILIPPINE CONTACT NUMBER AND ADDRESS:

Mobile Number: 09171276154 / Telephone Number: ( )
Permanent Philippine Address: A Bonifacio St. Baybay City, Leyte

DECLARATION BY EXAMINEE
1. I declare that the person named in BOX 1 above has never had a previous medical examination ANYWHERE
as p
evaluation for visa of Immigration purpose).
2. I declare that the information given above are TRUE and CORRECT.

Signature over Printed Name

PERTINENT HISTORY OR PHYSICAL EXAMINATION:

ADDITIONAL TEST/S: CXR RESULT / NOTES:

RECOMMENDATION / COMMENTS: