OFFICE USE ONLY Client no.:
Date received: / /
Application no.:
February 2019
INZ 1216
New Zealand Immigration
Panel Member Instructions
Information about these Instructions
The New Zealand Immigration Panel Member Instructions
These Instructions also:
(the Instructions) have been written to assist physicians
• minimise the risk of fraudulent applications, and
and radiologists in completing medical examinations
• explain to Panel Physicians the standard of practice
on behalf of Immigration New Zealand (INZ). They have
required to complete INZ medical examinations
been written for physicians who are members of INZ’s
and reports.
Panel Physician network, and, in countries where INZ has
no Panel Physicians, a locally registered, board-certified
These Instructions are not a technical medical
or licensed physician. The collective term used in these
reference manual. Any comments regarding errors,
Instructions for panel members and those otherwise
omissions or amendments should be sent to:
registered, board-certified or licensed is Panel Physician.
[email address]
These Instructions are for Panel Physicians, they
are not
International Organization for Migration (IOM) physicians
certified immigration instructions under section 22 of the
should refer to Part 4 of these Instructions when
Immigration Act 2009. The purpose of these Instructions
completing immigration medical examinations for:
is to inform Panel Physicians of INZ’s expectations and
• UNHCR mandated refugees included in New Zealand’s
requirements when conducting immigration medical
Refugee Quota Programme, and
examinations (IMEs). If you are a panel member of an
• Refugee Quota Family Reunification (RQFR) Category
INZ Panel Physician network your ability to remain on
applicants.
the panel may be compromised if you do not follow
these Instructions.
For IOM physicians with questions about completing
INZ examinations for refugees, please contact the
These Instructions provide:
IOM Regional Office in Canberra:
• an overview of the immigration health screening
process for examinations completed in eMedical
International Organization for Migration
and paper-based examinations
PO Box 1009 Civic Square
• an outline of the roles and responsibilities of Panel
Canberra ACT 2608
Physicians within this process
Australia
• information and guidelines to assist Panel Physicians
Telephone: +612.62 67 66 00
to complete INZ medical examinations
Fax: +612.62 57 37 43
• a standardised process to obtain appropriate, accurate
Email:
[email address]
and comprehensive information.
Website:
https://australia.iom.int/
immigration.govt.nz
Introduction
Background
Supplementary
RSE Scheme
Part 5 of these
Migrants are expected to have an acceptable standard of
Medical Certificate
Supplementary
Instructions
(with 707 HIV)
Medical Certificate
health to be granted temporary entry to, or residence in,
(INZ 1143)
New Zealand.
Applicants are considered to have an acceptable standard
The IME that applicants are required to undergo depends on
of health if they are:
which visa category they are applying under and how long
they intend to stay in New Zealand. INZ will update these
• unlikely to be a danger to public health
Instructions and INZ medical examination requirements
• unlikely to impose significant costs or demands on
from time to time. eMedical will always carry up to date
New Zealand’s health or special education services
examination requirements and the INZ website will have
• able to perform the functions for which they have been
the most up to date paper-based medical certificates at
granted entry.
www.immigration.govt.nz/forms.
Applicants are required to undergo an IME to demonstrate
Health resource utilisation thresholds
they have an acceptable standard of health. There are four
INZ uses a set of criteria to assess whether an applicant has
different IMEs:
an acceptable standard of health.
eMedical
Paper-based
For examination
These criteria include some specific cost and demand
examinations
medical certificates
requirements see:
thresholds used by INZ’s medical assessors to determine
whether an applicant has an acceptable standard of health
501 Medical
General Medical
Part 2 of these
examination
Certificate (INZ 1007)
Instructions
for immigration purposes.
502 Chest X-ray
Chest X-ray
Part 3 of these
If there is a relatively high probability that an applicant is going
examination
Certificate (INZ 1096)
Instructions
to require health, disability or special education services to
levels above these thresholds, then they are not likely to be
512 Medical
Limited Medical
Part 4 of these
examination
Certificate (INZ 1201)
Instructions
assessed as having an acceptable standard of health. These
thresholds are based on the average cost of the top five per
cent of New Zealand health care users.
For further information on INZ’s immigration requirements
visit
www.immigration.govt.nz
Glossary
Applicant – A person who applies to enter or remain in
Immigration instructions – These consist of immigration
New Zealand as a permanent resident (including refugees,
policy objectives; any rules or criteria for determining the
who may also be referred to as candidates) or as a temporary
eligibility of a person for the grant of a visa; and any other
entrant (including tourists, students or temporary workers).
relevant information that should be taken into account
in assessing a person’s eligibility for a visa. Immigration
Candidate – A person mandated as a refugee by the UNHCR
instructions are certified by the Minister of Immigration
(the United Nations refugee agency) who has been selected
under section 22 of the Immigration Act 2009.
as a candidate for New Zealand’s Refugee Quota Programme.
Immigration medical examination (IME) – The medical
Conditions – Physical, mental, emotional or intellectual
examination for New Zealand immigration purposes that
disorders of the applicant that are identified by either
includes the functional inquiry for present, past, and family
the applicant or by the Panel Physician from the history,
history, the findings on physical and mental examination and
examination and subsequent tests.
the results of all relevant radiology, laboratory and diagnostic
tests including further specialist reports.
Family group – The partner of a ‘principal applicant’ and
the dependent children of a ‘principal applicant’ and/or
Incapable person – An ‘incapable person’ is defined as a
their partner.
person who is incapable of understanding the general nature,
effect of, and purpose of the requirement for providing
High cost conditions – Those conditions that exceed the
a signature. Such people may include those with an
high cost threshold.
intellectual disability.
High demand conditions – Those conditions that require
Medical assessors – See page 8.
services within New Zealand, the demand for which is currently
unmet. The availability of health services across the whole of
New Zealand is considered, not just the availability within
a particular locality.
2 – New Zealand Immigration Panel Member Instructions – February 2019
Medical certificates – INZ paper health assessment forms,
Principal applicant – The principal applicant is the person
specifically,
General Medical Certificate (INZ 1007),
Limited
who is declared to be the principal applicant on the
Medical Certificate (INZ 1201),
Chest X-ray Certificate (INZ 1096)
application form. When the application is assessed, the
and
RSE Scheme Supplementary Medical Certificate (INZ 1143).
principal applicant will be the person first assessed against
the immigration instructions. An analogous term for medical
ORS guidelines – Ongoing Resourcing Schemes guidelines.
use would be ‘index applicant’.
ORS resources are primarily to provide specialist assistance
to meet students’ special education needs throughout their
Specialist report – A written document received from the
school years. ORS resources are additional to the teacher
relevant specialist that provides a complete record of the
funding and operational grants that are paid to schools for
mental or physical condition being considered, including the
every student in New Zealand. The ORS criteria have been
history, findings on physical examination, diagnosis, current
adopted for use as a screening tool for immigration purposes.
treatment and prognosis.
Panel Physician – See page 7.
New Zealand Immigration Panel Member Instructions – February 2019 –
3
TABLE OF CONTENTS
Information
about
these
Instructions
1
Introduction
2
Background
2
Health
resource
utilisation
thresholds
2
Glossary 2
Part 1: Requirements for Panel Physicians and INZ immigration medical examinations
7
Roles and responsibilities in the immigration health assessment process
7
The
health
screening
process
7
The
Panel
Physician
7
INZ
(the
immigration
officer)
8
The
immigration
medical
assessor
8
Who can conduct an immigration medical examination?
8
New Zealand
physicians
(onshore)
8
Countries
with
Panel
Physicians
(offshore)
8
Countries
with
no
listed
Panel
Physicians 8
Locums
8
Radiologists
8
Panel
management
9
Members
9
Onsite
audit
visits
and
clinical
audits
10
Intergovernmental
Collaboration
10
Continuity
of
membership
10
Relocation
of
a
Panel
Member’s
practice
10
Retirement
and
withdrawal
of
membership
11
Suspension
from
the
Panel
11
Removal
from
the
Panel
11
Conflict
of
interest
11
Communication
12
Providing
information
for
clients 12
Record
keeping 12
Client
feedback 12
How
clients
can
provide
feedback
to
INZ
12
What a client can do if they are not satisfied with INZ’s response?
12
Complaint
Management
12
What should you do if an applicant wants to make a complaint?
12
What will INZ do if a complaint is received?
13
Client
services
13
Waiting
periods
13
Clinic
facilities
and
hygiene
13
Medical
clinics
13
Radiology
clinics
13
Cultural
and
language
aspects
of
examinations
13
Privacy
considerations
13
Chaperones
14
Duration of medical examinations
Pregnant
women
and
x-ray
examinations
14
Information
sheet
14
Setting fees for New Zealand immigration medical examinations
14
4 – New Zealand Immigration Panel Member Instructions – February 2019
Confirming
the
identity
of
applicants
16
What do I do if appropriate identification documents are not provided?
16
eMedical:
Photograph
requirements
16
Paper-based
medical
certificates:
Photograph
requirements
17
When
should
I
record
an
identity
concern?
17
Specimen
integrity
17
Disclosure
of
health
information
to
applicants 18
Further
tests
and
specialist
referrals
18
Forwarding
specialist
reports
18
Gradings
18
Submitting
electronic
IME
reports
18
Completion
of
paper-based
medical
certificates
18
Legibility
of
the
medical
certificate
19
Panel
Physician’s
initials 19
Incomplete
IME
results 19
How to contact INZ about immigration health matters
20
More
information
about
eMedical
20
Summary
20
Part 2: Completing a 501 Medical examination (General Medical Certificate (INZ 1007)) 21
Section A – Personal details (eMedical Pre-exam stage)
21
Section
B
–
Medical
history
22
Section
C
–
Client
consent
and
declaration
25
Section D – Physical examination
25
Section
E
–
Urinalysis
and
blood
tests
32
Instructions
for
standard
tests
34
Instructions
for
discretionary
tests
35
Section
F
–
Examination
Grading
36
Section
G
–
Panel
Physician’s
declaration
37
Part 3: Completing a 502 Chest x-ray examination (Chest X-ray Certificate (INZ 1007)) 39
Taking
the
chest
x-ray
39
Film
examinations
and
reporting
40
Reporting
tuberculosis
findings
40
Grading
‘A’
or
‘B’
40
Declaration
by
examining
radiologists
41
Finalising
an
immigration
medical
examination
41
Part 4: Completing a 512 Limited medical examination (Limited Medical Certificate (INZ 1201))
41
Section A – Personal details (eMedical Pre-exam stage)
41
Section
B
–
Medical
history
42
Section
C
–
Client
consent
and
declaration
43
Section
D
–
Physical
examination
43
Section
E
–Blood
tests
44
Section
F
–
Examination
Grading
45
Section
G
–
Panel
Physician’s
declaration
46
New Zealand Immigration Panel Member Instructions – February 2019 –
5
Part 5: Completing a Supplementary medical certificate (with 707 HIV)
(RSE Scheme Supplementary Medical Certificate (INZ 1201))
47
Section
B
–
Blood
test
47
Finalising
Supplementary
medical
certificate
47
Part 6: Information for eMedical enabled clinics
48
What
is
eMedical?
48
INZ
Up-front
medical
examinations
48
User
Guide
and
reference
material
48
eMedical
support
arrangements
48
Confirmation of IME case submission in eMedical
48
eMedical
and
personal
information
48
Appendix 1: Undressing for a Medical examination
49
Appendix
2:
Child
Development
Milestone
Guidelines
50
Appendix 3: Activities of Daily Living (ADL) Assessment (903)
51
6 – New Zealand Immigration Panel Member Instructions – February 2019
Part 1: Requirements for Panel Physicians and INZ immigration medical examinations
Roles and responsibilities in the immigration health
• commenting on anything identified during the examination
assessment process
that appears to contradict information provided by the
There are three key parties involved in the immigration
applicant
health assessment process. These are the Panel Physician,
• referring the applicant for standard (compulsory) blood
INZ immigration officers, and immigration medical assessors.
tests, and any other tests that may be appropriate given
Each has a clear and distinct role that contributes to the
clinical or risk factors present
health assessment process. The final decision about whether
• ensuring that pre- and post-test counselling is carried
an applicant meets the acceptable standard of health required
out in accordance with local protocols and standards.
for immigration purposes is made by INZ. Panel Physicians
For example, include advice on vaccination for close
and immigration medical assessors have key supporting
contacts of those testing positive to hepatitis B antigen
roles in this decision making process, as outlined in the
• referring the applicant for the required chest x-ray
diagram below.
• referring applicants requiring treatment, other than
emergency treatment, to their usual treating physician.
The health screening process
The Panel Physician should document the referral, the
reason for it, and, where applicable the outcome, in
the ‘General supporting comments’ field within the
‘Examination Grading’ section which is in each certificate
• recording on the medical certificate the name of any
Panel Physician
provides information
interpreter and/or chaperone present during the
on state of health
examination, and relationship (if any) to the applicant
Immigration
being examined
medical assessor
• reviewing all the information on the certificate (including
provides advice on
costs and demand
results from blood tests and chest x-ray) and provide an
on the health
impartial assessment of the applicant’s current state of
system
health and any significant conditions that may have an
impact on their future health
• remaining accountable for any part(s) of the examination/
completion of the medical certificate, that is delegated to
Immigration officer
a staff member within the practice
• advising INZ of changes to their clinic’s contact details,
operating hours, working arrangements, clinic closures
and their leave arrangements.
INZ expects Panel Physicians completing an IME to have the
Ministry of
necessary medical expertise and experience to fulfil the above
Education assesses
responsibilities.
where an applicant
would be eligible
Panel Physicians are not:
Decision on
for ORS funding
• responsible for providing opinions on immigration
acceptable standard
decisions
of health
• authorised to provide oversight of examinations conducted
by non-Panel Members
• permitted to provide treatment to applicants except in
emergencies
The Panel Physician
• authorised to make an assessment of the admissibility or
inadmissibility of the applicant or the applicant’s family
The role of the Panel Physician is to provide a comprehensive
members to New Zealand. This is the function of the
assessment of the applicant’s current state of health and
immigration officer
record this accurately on the INZ medical certificates.
• permitted to make any statement to the applicant
This includes:
which might be construed as implying a favourable or
• personally undertaking the IME, including confirming the
unfavourable immigration assessment outcome
identity of the person being examined and to whom the
• permitted to undertake an IME where the applicant is a
information on the medical certificates relate
relative of the panel member, or where the panel member
• applying the appropriate medical, ethical and professional
has a personal or financial interest in the immigration
standards during the examination and in completing the
application, in such cases the examination shall be declined
certificate
• permitted to receive or accept service or incentive fees
• ensuring that a parent or guardian is present when taking
or gratuities of any kind from third parties, including
the history and examining children under 18 years of age
migration agents or referral agencies. If panel members
• capturing the required information accurately and
accept service of fees from any third parties for these
comprehensively on the certificate
services, INZ may cancel the physician’s panel membership.
New Zealand Immigration Panel Member Instructions – February 2019 –
7
Note: Panel Physicians must not allow other physicians to
Countries with Panel Physicians (offshore)
conduct IMEs as a substitute or locum without prior written
In most countries, INZ uses a panel of reputable registered
consent of INZ (see section on locums).
medical practitioners and/or radiologists. A global register
of panel physicians can be found on the INZ website at
INZ (the immigration officer)
https://www.immigration.govt.nz/new-zealand-visas/
The role of the immigration officer is to decide whether
apply-for-a-visa/tools-and-information/tools/panel-
an applicant meets the acceptable standard of health.
physicians
This includes:
All applicants in these countries must have their medical
• reviewing the information contained on the medical
certificate and chest x-ray reports completed by a panel
certificate
physician.
• where significant issues are identified, referring the
Countries with no listed Panel Physicians
medical certificate to an immigration medical assessor
for advice on the likely costs and demands of an applicant’s
For countries where there are no INZ panel physicians,
medical condition on New Zealand’s health/special
a registered or board certified or licensed medical
education systems
practitioner or physician may conduct the immigration
• reviewing any recommendation from a medical assessor
medical examination and complete the medical certificate.
and deciding whether an applicant meets the acceptable
INZ will require details of the registration, certification or
standard of health
board licence of the medical practitioner or physician.
• determining whether an applicant does not meet the
The medical examination will not be accepted if completed
acceptable standard of health and whether a medical
by a nursing practitioner, a physician’s assistant, or by other
waiver should be considered.
health practitioners.
The immigration medical assessor
Locums
The role of INZ medical assessors and Ministry of Education
ORS assessors is to provide opinion(s) to an immigration
With approval from INZ, locum Panel Physicians can
officer on:
perform IMEs to provide coverage during periods when
Panel Physicians take leave. If a Panel Physician nominates
• whether an applicant is likely to be a danger to
a physician as their locum they should be satisfied that the
public health
physician has the qualifications, experience, knowledge
• whether an applicant has a condition that is likely
and skills to perform the IMEs. An effective handover of
to exceed cost or demand thresholds
procedures must be arranged to ensure continuity of service
• whether an applicant is able to undertake the work or study
delivery to visa applicants. Locums will have the same
that is the basis for their application
responsibilities as Panel Physicians and it is essential that
• the likely costs and demands that an applicant who
Panel Physicians ensure that locums are familiar with these
exceeds cost and/or demand thresholds will place on the
responsibilities and follow the Panel Instructions.
New Zealand health/special education systems, including
Panel Physicians taking planned leave, especially when they
eligibility for ORS funding
are the sole panel member in the clinic, should provide four
• the information contained on the medical certificate
weeks’ notice to INZ. Depending on local panel coverage,
• the additional tests and investigations they consider are
INZ may approve the membership of a locum to cover the
necessary to further understand an applicant’s medical
leave period of the Panel Physician. eMedical access will be
condition
provided to the locum Panel Physician for the period of relief.
• applying the appropriate medical, ethical and professional
The locum will need their own eMedical logon.
standards during their considerations
The documentation required to be approved as a locum Panel
• applying the appropriate cost and demand thresholds
Physician is the same as for permanent panel membership.
in their assessment of an applicant’s medical condition
• any medical matters related to the consideration of a
Where a locum is engaged to examine the patient yet is
medical waiver.
unavailable to complete the medical certificate (for example,
they may have completed their term of engagement), the
Who can conduct an immigration medical
host practitioner is to sign the medical certificate and
examination?
annotate the name of the locum.
New Zealand physicians (onshore)
Radiologists
INZ has an onshore New Zealand Panel Physician network.
Radiology clinics become Panel Members as a unit. A Chief
Only approved physicians and radiologists at clinics on the
Radiologist must be designated in each clinic as the key
onshore Panel Physician network can complete IMEs for INZ
contact for communication with INZ and with overall
visa applicants. A global register of panel physicians can
responsibility for the training and supervising of all
be found on the INZ website at
https://www.immigration.
Radiologists conducting INZ radiological examinations at that
govt.nz/new-zealand-visas/apply-for-a-visa/tools-and-
location, including ensuring the quality of reports. Under the
information/tools/panel-physicians
direction of the Chief Radiologist, Radiographers and clinic
staff are required to follow identity checking procedures and
to familiarise themselves with the procedures for submitting
radiological examination results.
8 – New Zealand Immigration Panel Member Instructions – February 2019
Where a radiology practice has multiple branches, INZ
Panel management
will usually approve membership to a single branch of the
INZ is responsible for all parts of the immigration medical
clinic. This arrangement supports the training of staff in the
process, both onshore and offshore. Fundamental to INZ is
branch clinic, specifically that related to integrity checking
ensuring consistent quality of the work carried out. INZ aims
procedures and the correct forwarding of examination results
to work with Panel Physicians to achieve INZ’s aim through:
to INZ. The inclusion of additional branches to the Panel will
be at INZ’s discretion.
• providing training
• communicating policy, procedural and clinical changes
Chief Radiologists are to:
• responding to administrative and clinical queries from
• ensure that all Radiologists undertaking INZ radiological
Panel Members
examinations are suitably qualified as a specialist in
• addressing complaints and feedback.
radiology and are registered to work in their country
of practice
INZ staff will manage the panel through quality assurance
activities such as:
• receive feedback about Panel Radiologists and staff in
their clinic and work with us to resolve cases or issues
• conducting on-site and remote auditing of the panel’s work
of concern
• addressing applicants’ complaints and feedback
• ensure that where INZ advises that individual Radiologists
• ensuring there are no conflicts of interest.
are excluded from conducting New Zealand visa radiological
Panel Members are not employees of the New Zealand
examinations that these Radiologists do not conduct
Government. They do not represent the New Zealand
radiological examinations of applicants
Government or INZ.
• ensure that radiological examinations for INZ’s applicants
are conducted only at the agreed site/s
Panel Members are required to comply with all conditions
of panel membership issued to them by INZ, including those
• put into practice and monitor the identity checking
expressed in these Instructions. These conditions may be
procedures of applicants
reissued or amended periodically and Panel Members will
• circulate INZ communications to Panel Radiologists
be advised when this occurs.
and staff
• ensure that INZ is provided with their clinic’s contact
Visa applicants attend the Panel Member of their choice and
details, capabilities and working arrangements, including
Panel membership does not guarantee a minimum amount
any changes to these
of business from INZ. The New Zealand Government and INZ
• ensure that INZ is provided with the identity details, for the
do not accept any responsibility for any costs associated with
purposes of enrolment in eMedical, of Panel Radiologists
membership to the Panel, or loss of business or patronage at
undertaking radiological examinations for applicants
a clinic, as a result of:
• for paper-based medical certificates, ensure that the x-ray
• changes to the migration program
examination forms and films are forwarded to the Panel
• applicants’ choices
Physician if the client must also undergo an INZ medical
• suspension or removal from the Panel; or
examination.
• any other reason.
Chief Radiologists and Panel Radiologists are to:
The information provided below outlines the specific roles
• provide accurate, impartial, and complete reporting,
and responsibilities of Panel Members.
including grading, on the health status of visa applicants,
determined by radiological examinations
Members
• advise applicants of any abnormalities of clinical
Membership to the Panel network is subject to approval from
significance found during the examination
INZ. For the offshore Panel Physician network, one or more
• ensure reporting of TB findings, and refer applicants
individual physicians at a clinic may apply for membership,
requiring further investigation or treatment for non–TB
but the clinic as a group identity will not be granted
findings that are significant for the visa application,
membership. For the onshore Panel Physician network, the
to an appropriate specialist or Panel Physician.
clinic is granted membership, however, individual physicians
must still apply for approval by INZ.
• refer applicants with non-TB findings that are not
significant for a visa application to their usual treating
Once physicians have been approved by INZ they must
physician
remain with the approved clinic site unless otherwise agreed.
• refer applicants with TB related findings, where a 603
INZ takes account of the integrity of the entire practice
requirement (a chest clinic investigation) has been
or entity in which the Panel Member works, even where
generated by eMedical, to a Panel Physician to arrange
membership rest with the individual physician - including
an investigation
other physicians, staff members, facilities, laboratories and
• complete and submit the 502 requirement (a chest
radiology practices. It should be noted that although the pre-
x-ray examination) for TB-related findings where a 603
examination or some aspects of the IME may be delegated to
requirement has not been generated.
nursing or other staff, the Panel Member retains responsibility
for the overall process.
New Zealand Immigration Panel Member Instructions – February 2019 –
9
Panel Members must maintain their registration and good
Note: It is expected that key Panel Members will be present
standing with their medical board and professional college
during an onsite audit and prior notification of absence of
(if issued by the relevant authority) in their country of
key personnel is advised. INZ appreciate Panel Members’
practice. Any change to registration status must be reported
flexibility when scheduling onsite audits in consideration of
immediately to us. If a Panel Member becomes unregistered
INZ’s auditor availability and itinerary considerations. Also
or restricted in their country of practice they must inform us
note that onsite liaison visits may be performed by INZ’s
immediately. Panel Members are required to provide evidence
intergovernmental partners in conjunction with or on
of their current registration or licence status during an onsite
behalf of INZ.
audit visit or at INZ’s request.
Regular remote reviews will also be undertaken as part of
Panel Members are obligated to operate within the bounds of
INZ’s quality assurance processes. This will include review of:
these Instructions and to protect the privacy of New Zealand
• completion of paper-based medical certificates (all sections
visa applicants with regards to personal information in
must be legibly completed, with records of all positive and
accordance with New Zealand’s Privacy Act 1993 (the Act).
negative findings recorded),
Under the Act ‘Personal Information’ is any information about
• screening tests (all screening tests required by INZ have
an individual (a living natural person) as long as that individual
been carried out, and the quality of the testing and the
can be identified.
identification of the applicant has been appropriate),
As Panel Members, who are conducting IMEs on behalf of
• diagnostic tests (the diagnostic tests and reports
INZ, it is important that you understand your responsibility
necessary to provide INZ with the best available evidence
to protect applicants’ privacy and rights by referring to the
upon which to assess whether the applicant has an
Act and the applicable Privacy Principles (see
www.privacy.
acceptable standard of health have been provided, and
org.nz/news-and-publications/guidance-resources/
all reports that are not in English, include an English
information-privacy-principles/).
translation of the applicant’s identity details, the test(s)
undertaken and the results), and
Onsite audit visits and clinical audits
• completeness and timeliness (that all parts of the IME
The quality of Panel Members’ work is regularly reviewed by:
process are complete and submitted in a timely fashion
• clinical audit of medical and radiological examinations
and that any additional information requested by INZ has
• onsite audit visits to clinics, and
been provided in a timely manner).
• the investigation of feedback and issues.
Intergovernmental Collaboration
The review of Panel Members’ work has the following
The New Zealand Government has close ties with its
purposes:
intergovernmental partners (Australia, Canada, United
• to maintain the integrity of IME’s
Kingdom and the United States of America) in relation to
• to ensure continuous improvement of the process, and
immigration health. Panel members, particularly offshore,
• to improve the flow of communication between INZ
should be aware that information collected by INZ about the
and Panel Physicians who undertake the IME process.
Panel network is routinely shared with the intergovernmental
partners. This may include information about panel
In accepting membership to the Panel, Panel Members
performance and audit findings, as well as Panel Physician
agree to willingly participate in such audits and reviews,
contact details. Visa application information is not shared
and be present at onsite audit visits. An onsite audit visit
without the consent of individuals.
will routinely include:
• a review of information and instructions issued to
Continuity of membership
applicants
Relocation of a Panel Member’s practice
• discussion with the Panel Members
A member is empaneled at a specific clinic location. Unless
• introduction to delegated nurses or administrative staff
approval is given by INZ, membership automatically ceases
involved in IMEs
upon that Panel Member relocating the practice or moving
• a full and thorough inspection of the clinic, x-ray facilities,
their employment to another practice. INZ is to be advised
chest clinic and laboratory (if onsite)
at least four weeks before the relocation and if acceptable
• observation of process including the physical examination
INZ will update INZ’s website and advise the INZ local office
of an applicant
of the change in circumstances.
• an inspection of associated laboratories and chest clinics.
Panel Members need to ensure that their clinic’s
Arrangements for offsite visits will be made before or
details are correct on INZ’s website and that any
during the onsite audit.
changes are advised to INZ. See clinic location lists
More information on the scope of issues and activities to be
here:
www.immigration.govt.nz/healthinfo.
evaluated will be provided before an onsite audit.
Note: If a Panel Member relocates and proceeds to conduct
IME or radiological examinations without prior authorisation,
they may be suspended or removed permanently from
the Panel.
10 – New Zealand Immigration Panel Member Instructions – February 2019
Retirement and withdrawal of membership
In cases where a Panel Member may be liable for removal as a
INZ requests a minimum of four weeks’ notice, preferably
result of clinical errors, they will be informed of the substance
longer, if a Panel Member intends to retire or withdraw their
of the issue(s) against them. A response will be sought and
membership from the Panel. Panel Members intending to
given fair consideration before a decision being made to
leave the Panel may be asked to nominate a successor, who
remove them from the Panel.
will be subject to the usual membership considerations. INZ
Removal from the Panel may also occur where there is a
is unable to guarantee that the nominated successor will be
decreased need for Panel clinics in a particular region, due
successful in their application for panel membership.
to technological developments, reduced visa application
Suspension from the Panel
volumes, alignment with intergovernmental partners or a
change in policy. INZ will make reasonable efforts to give as
When INZ has evidence of a breach of procedural integrity or
much notice as possible of any intended changes to Panel
a failure to meet performance standards or a continued failure
composition.
to meet performance standards in the completion of IMEs,
Panel Members will be notified in writing that an investigation
Conflict of interest
is being conducted by INZ.
As Panel Members provide a service on behalf of INZ, it is
Immediate suspension may occur if INZ identify a public
important to avoid both actual and perceived conflicts of
health threat, significant cost or demand for health services
interest. Conflicts of interest have been defined as a situation
that may have an impact on the New Zealand community
that has the potential to undermine the impartiality of a
resulting from a reporting error, or if an allegation of illegal
person because of the possibility of a clash between the
conduct or serious professional misconduct arises. In such
person’s self-interest and their professional interest or public
cases, INZ will provide the Panel Member with a written notice
interest. All conflicts of interest and potential conflicts of
of suspension, including the reason for suspension where
interest must be fully disclosed to us at the time a conflict
possible. In cases where an allegation of misconduct has
of interest arises.
arisen, the privacy and confidentiality of the complainant will
Therefore, when conducting IMEs for INZ, Panel Members must:
be considered in any of INZ’s correspondence.
• perform the duties of their practice impartially,
Where a Panel Member is suspended for misconduct, they will
uninfluenced by fear or favour
have 14 days from the date of the notification of suspension
• avoid situations in which their private, financial or other
to respond in writing to INZ’s Principal Medical Advisor before
interests conflict or might reasonably be thought to
a decision is made as to whether the Panel Member will
conflict with conducting IMEs for applicants
remain on the panel. INZ’s decision will be final and no further
• consider if their commercial and professional relationships
discussion will occur.
with their associated clinics and other third parties, such as
Although physicians and radiologists are empaneled
migration agencies, present an actual or perceived conflict
individuals outside New Zealand, the behaviour of everyone
of interest, and would impact on the independence and
in the practice may reflect on the integrity of the practice
reliability of medical reports provided by the Panel Member
itself. Similarly in New Zealand, the behaviour of an approved
• advise INZ of the relationship and potential conflict of
Panel Physician in an empaneled clinic may reflect on the
interest when the interests of members of their immediate
integrity of the practice also. INZ may suspend or remove, at
family are involved
its discretion, all of the Panel Members or exclude individual
• not use information obtained in the course of the IME
members or radiologists in a practice where one person
to gain, directly or indirectly, a financial advantage for
operating from that practice is under investigation.
themselves or for any other person
In the circumstance where only the Chief Radiologist is
• not be an applicant’s treating physician or family member.
suspended or removed from the panel, another panel
If the applicant does not have a treating physician and
radiologist can assume the responsibilities of Chief
wants to remain as a patient at the clinic, then the
Radiologist during the suspension period or nominate for
applicant should be referred to another physician in the
membership. Details of the acting Chief Radiologist or their
clinic. It is acceptable for the second physician to see the
replacement should be forwarded to INZ.
applicant even if they are a Panel Member, as long as they
have not participated in the IME of the applicant.
Removal from the Panel
Note:
Membership to the Panel may be revoked at any time at the
• Panel Members must advise us of any instances where
sole and absolute discretion of INZ. The decision to cancel
others may perceive that the Panel Member has a conflict
membership is final and not reviewable. INZ will usually
of interest in performing New Zealand IMEs. Examples
provide four weeks’ notice before cancellation takes effect.
might include performing IMEs for friends, relatives or work
A shorter notification period may apply if removal from the
colleagues.
Panel is for misconduct or in other instances as advised.
• Immigration New Zealand expects the immigration
Where there are reasonable grounds to believe that a Panel
medical examination process to exclude enrolment of
Member has been involved in matters related to bribery, the
visa applicants with New Zealand based panel clinics. If an
receipt of facilitation fees, criminal activity, offences relating
applicant in New Zealand does not currently have a primary
to children or unprofessional conduct, this will result in
health care provider, Immigration New Zealand strongly
immediate removal from the Panel.
recommends that enrolment is only considered by a panel
clinic following the completion of the immigration medical
examination process.
New Zealand Immigration Panel Member Instructions – February 2019 –
11
Communication
For IMEs that are recorded on paper-based medical
Panel Members are responsible for keeping themselves
certificates, Panel Members should keep adequate records
informed of the latest version of these Instructions and
including applicants’ details and whether an ‘A’ or ‘B’ grading
disseminating INZ’s communications including newsletters
was given. These records should be kept for a period of at
and support documents to clinic staff who are involved in
least 12 months. Comprehensive notes should also be kept
the New Zealand IME process. INZ anticipates and encourages
of any applicant where significant abnormalities or identity
regular contact with Panel Members.
concerns were identified during any part of the examination.
Radiology practices are encouraged to keep soft copies
Panel Members are required to be able to communicate
(electronic) of digital x-rays.
effectively in English in order to communicate with INZ’s
staff and applicants from English speaking countries. Panel
For monitoring quality assurance, clinics are advised to
Members must ensure that all reports and test results are
maintain internal data on a monthly basis on:
completed in or translated into English either by an accredited
• caseload numbers (per clinic and per Panel Member)
translator or by their clinic. Reports should clearly show the
• A/B grading ratios
visa applicant’s name, date of birth and passport number,
• detection rates for significant conditions such as HIV
and if translation is required, the name of the person who
and TB (both active and inactive).
has translated the reports.
Client feedback
Providing information for clients
INZ has a client feedback policy which allows applicants,
INZ encourages Panel Members to provide applicants with
their representatives and other stakeholders to provide
information about their services such as fees, address,
compliments, complaints, suggestions or any information
contact details, hours of operation and instructions on how
about INZ’s program delivery, services or performance.
to prepare for the IME. INZ may be able to assist you with
the content of the instructions to make sure that applicants
How can clients provide feedback to INZ?
receive current and appropriate information. INZ may ask for
Clients can provide feedback about Panel Physicians via our
copies of any written information provided to applicants and
website (
www.immigration.govt.nz/contactus), by phone
it will, usually, be reviewed as part of an onsite audit.
to the INZ Contact Centre, or with their visa application.
Panel Members wanting to assist applicants with New Zealand
What can a client do if they are not satisfied with
immigration information should refer them to INZ to ensure
INZ’s response?
that they receive accurate information. If the clinic has a
website, links to INZ’s website may be published to direct
INZ has a client complaint resolution process which can be
applicants to immigration information and information about
found at:
www.immigration.govt.nz/contact/complaints/
the IME process.
complaint-about-inz
See:
www.immigration.govt.nz
Complaints about New Zealand Panel Physicians may also be
made to New Zealand’s Health and Disability Commissioner.
Note: Panel members must not use INZ or eMedical logos
See:
www.hdc.org.nz
on any publications, products or websites to promote their
services or New Zealand immigration information. Signs,
Complaint management
stamps and signature blocks must not imply that the
What should you do if an applicant wants to make a
Panel Member is an employee of the New Zealand
complaint?
Government or INZ.
INZ relies on your expertise as a medical professional and your
Record keeping
undertaking to operate within the bounds of the
New Zealand
eMedical creates an electronic archive of all examinations
Immigration Panel Member Instructions. INZ encourages
submitted, including attachments. INZ health cases may be
you to maintain or develop a complaints policy in line with
purged from eMedical after a three-year period however the
your local governing bodies. Having a process to manage
information will continue to be electronically retained by INZ
complaints helps to resolve them and achieve learning
in its Immigration Health System.
from them.
Examination records can be viewed by Panel Members
INZ would encourage you to:
after submission by entering the applicant’s electronic ID
• take all complaints seriously in whatever form they come
(NZER or NZHR) in the eMedical search field. As long as a
• resolve the problem if you are able to (for example, do not
clinic maintains a record of the applicants that they have
insist on extra tests or referrals if they were not suggested
examined along with their electronic ID, there is no need for
in these Instructions or directly by INZ. However, please note
further medical records to be kept from INZ’s perspective.
that the test was advised but declined by the applicant)
Panel Members should observe local laws about medical
• if they are still concerned, advise the applicant to
record keeping. As eMedical records can be printed or saved
contact INZ
electronically by an eMedical user on demand, this may satisfy
• keep a detailed record of what happened and advise INZ of
your clinic’s record keeping requirements.
any incidents that are outside of routine communication
with applicants.
12 – New Zealand Immigration Panel Member Instructions – February 2019
What will INZ do if a complaint is received?
• where appropriate, heating and/or air conditioning.
INZ will request information about the complaint from the
Acceptable standards of cleanliness must be evident in the
complainant and review all of the information in order to
clinic and the amenities used by applicants.
determine if the complaint can be substantiated or not.
Information that is normally sought includes:
Medical clinics
• all the information about the complaint, including evidence
A dedicated consultation room or area must be available for
the complainant has to substantiate their complaint
the exclusive use of the Panel Member and delegated nurse if
• the complainant’s consent to disclose their personal details
used. It must not be open to the public or shared with other
to the Panel Member, if required
staff during the examination. Each consultation room or area
• obtaining a recollection of events and/or more information
must have as a minimum:
from the Panel Member.
• adequate lighting
Panel Members must not contact the complainant in relation
• an examination couch
to their complaint without prior consent from INZ.
• appropriate medical equipment for an IME
• access to a properly maintained specimen fridge
INZ will write to the Panel Member with the outcome of the
(if the pathology laboratory is offsite)
investigation and advise the complainant that action has
taken place. For privacy reasons, complainants will not be
• hand-cleaning facilities readily available
provided with specific details of the action taken against the
• facilities to protect the applicants’ privacy when applicants
Panel Member.
undress, including use of an adequate curtain or screen,
gown and privacy sheets
• Complaint details will be recorded, including any contact
INZ have had with the Panel Member to substantiate the
• preferably, a facility for safe-keeping of applicants’
issues raised.
possessions.
• If the complaint is substantiated and determined to be
Radiology clinics
significant, INZ will seek the Panel Member’s cooperation
Radiology clinics must have as a minimum:
in addressing the issue. In some serious instances, INZ may
consider suspension or permanent removal of that Panel
• adequate and well-maintained radiology equipment
Member from the Panel.
• appropriate protective equipment
• radiation safety guidelines
INZ may be approached by third party organisations asking
for information about current and former Panel Members,
• abdominal shielding
including information pertaining to their performance. Such
• facilities to protect the applicants’ privacy when applicants
organisations may include local medical councils and police
undress including use of an adequate curtain or screen,
departments. Panel Members are advised that INZ may
and gown
disclose such information, on request, to the bodies described
• preferably, a facility for safe-keeping of applicants’
above and to other statutory or regulatory bodies with an
possessions.
interest in medical professional activities. INZ will usually
Cultural and language aspects of examinations
share this information with INZ’s intergovernmental partners:
USA, UK, Australia and Canada.
Panel Members should be aware of cultural expectations
in relation to IMEs and history-taking. If applicants do not
Client services
speak the language of the Panel Member, arrangements are
to be made for an interpreter. Costs for an interpreter are the
Waiting periods
responsibility of the applicant, except in the case of refugees
Applicants should be able to schedule an appointment within
included in New Zealand’s refugee quota programme.
a reasonable timeframe, preferably within a few working
days. A delay for appointment should be no greater than
Note: The Panel Member must be satisfied as to the
10 working days.
interpreter’s impartiality, confidentiality and ability to
interpret accurately. The interpreter should not be a family
Panel Members are required to advise INZ, when timeframes
member or a representing agent due to a potential conflict of
for appointments are extended and if they are having
interest, as well as to avoid the risk of misinformation leading
capacity issues.
to a misdiagnosis.
Clinic facilities and hygiene
Privacy considerations
Clinics should make reasonable efforts to facilitate access
To prevent misunderstandings, applicants should be given
to their premises and promote the applicants’ comfort.
information about what will happen during the IME when they
As a minimum standard, Panel clinics should have the
make an appointment including the need to undress down to
following requirements:
their underwear for the physical examination.
• a reception or waiting area large enough to accommodate
Aspects of the IME may make applicants uncomfortable, such
the usual number of applicants and other people waiting
as breast examinations for women, and must be made known
• toilets with hand cleaning facilities, preferably outside of
to applicants at the time the appointment is made as well as
the toilet cubicle, located in the clinic itself. Toilets not in
on arrival at the clinic and before the examination starts.
the clinic must be adjacent to or in very close proximity
as applicants will need to be supervised when providing
urine samples
New Zealand Immigration Panel Member Instructions – February 2019 –
13
Appendix 1 provides a diagram that you may wish to include
Setting fees for New Zealand immigration medical
when giving applicant’s information about the IME and/or
examinations
to display in your clinic waiting room, change and/or
Panel Members are not paid by the New Zealand Government
examination room.
for providing IMEs. Panel clinics will charge visa applicants
Chaperones
directly for examinations conducted by Panel Members and it
is the responsibility of the applicant to pay the fee for an IME.
All physical examinations should be conducted in a
professional manner compatible with good practice and
Different payment arrangements exist for refugees who are
privacy at the expense of the Panel Member. A parent or
included in New Zealand’s annual Refugee Quota Programme,
guardian must be present when a person under the age of
which includes those refugees who have been mandated by
18 is examined or x-rayed. A chaperone must be offered and
the UNHCR (the United Nations refugee agency) and those
available during the physical examination for all applicants.
applying under the Refugee Quota Family Reunification
Particular attention should be taken with female applicants
Category. Applicants applying under the Refugee Family
and even when a female family member accompanies a female
Support Category, or who are in New Zealand and have been
applicant; it is advisable to have a female member of the
granted refugee or protection status, are required to meet
clinic staff present. Details of the offer and the name of the
the cost of their IME. Panel Members should seek clarification
chaperone must be accurately recorded in eMedical and on
from INZ if required.
paper-based medical certificates.
INZ does not prescribe a fee structure. However, it is the
Duration of medical examinations
responsibility of the Panel Member to ensure that fees
charged are consistent with local charges for similar services.
The IME should be thorough and complete, based on
Fee structures well above or below local market rates are not
reviewing the medical history, examining the applicant and
acceptable and will be investigated by INZ.
completing the required IME report (on paper or electronically
in eMedical).
Fee schedules must be transparent and should be itemised by
standard examination type – 501, 502, 512. INZ examinations
INZ anticipate the physical examination of young, healthy
include a routine number of blood tests which should be
individuals with no significant medical history to take at least
bundled into the cost of the standard examination types.
15 minutes. For an elderly person, or someone with a complex
An example template is offered below.
medical history, the examination is likely to take between 30
to 60 minutes.
Pregnant women and x-ray examinations
All women of reproductive age should be asked about the
date of their last menstrual period. This is because INZ does
not recommend x-ray exposure during pregnancy. Pregnant
applicants should be advised that they do not need to
proceed with a chest x-ray examination while pregnant.
Pregnant applicants may be required by INZ to undergo a
chest x-ray examination after giving birth, should they apply
for a further visa for New Zealand.
Information sheet
eMedical enabled clinics can provide applicants with an
information sheet which can be printed at any time.
The information sheet includes the:
• client’s photo
• INZ reference number (NZER)
• client’s personal details
• client identity details
• client visa details, and
• instructions for the client.
Please print the Information Sheet and give it to the client
before he/she leaves the clinic. This information sheet will
be used by the client as
proof that their immigration medical
examination has been initiated when they submit their
visa application.
14 – New Zealand Immigration Panel Member Instructions – February 2019
eMedical enabled clinics
Item
eMedical requirement code(s)
Fee
Example applicant
General Medical Examination which is inclusive
501 which is inclusive of the
$
Visitor, Worker, Resident
of the following tests:
following tests:
• Estimated glomerular filtration rate
• 705
(eGFR)
• 707
• HIV test
• 708
• Hepatitis B test
• 716
• Hepatitis C test
• 712
• Syphilis
• 717
• HbA1c
• 718
• Full Blood Count
Chest x-ray examination
502
$
Visitor, Worker, Student, Resident
General Medical Examination + Chest x-ray
501+502
$
Visitor, Worker, Resident
examination
Limited Medical Examination which is inclusive
512 which is inclusive of the
$
Partners and dependent children of
of the following tests:
following tests:
New Zealand citizens and residents,
• Estimated glomerular filtration rate
• 705
refugees
(eGFR)
• 718
• Full Blood Count
Limited Medical Examination + Chest x-ray
512+502
$
Partners and dependent children of
New Zealand citizens and residents,
refugees
Recognised Seasonal Employer (RSE)
707
$
Recognised seasonal workers
Supplementary examination (HIV test only)
RSE Supplementary examination + Chest x-ray
707+502
$
Recognised seasonal workers
Fees should be all inclusive without any extra charges
Applicants should be advised of standard examination fees
such as ‘administration fees’. Clinics that are not eMedical
in advance, including any posting/courier costs for paper-
enabled may charge courier costs for the delivery of paper-
based medical certificates. Fee schedules must be clearly
based medical certificates. Any charges for delivery must be
displayed in the Panel Member’s reception area and website,
itemised on the applicant’s invoice and provide the courier
if applicable, and be advised to applicants when arranging
reference number so that the applicant can track the delivery
their appointment.
of their documentation.
Panel Members are encouraged to liaise with TB laboratories
Additional standard examinations such as a 901 Mini mental
in regards to the fee to be charged for sputum collection
examination should be factored into the pricing of the
and/or processing. All testing required, including Drug
501 requirement and therefore covered by the initial fee.
Sensitivity Testing (DST) should be factored into pricing and
An extra cost should not be charged for the Mini mental
covered by the initial fee, as applicants may refuse extra tests
and ADL assessments.
if further fees are required to be paid.
New Zealand Immigration Panel Member Instructions – February 2019 –
15
Confirming the identity of applicants
Neither certified nor ordinary copies of these documents are
Panel Members and/or their clinic staff must confirm the
acceptable forms of identification because of the risk of fraud.
identity of all individuals who present for an IME and record
Note: Panel Members must also ensure that the appropriate
any identity concerns. This is done by completing the identity
identity-control mechanisms are in place at all specialist
questions included in paper-based medical certificates or
clinics to which the applicant is referred, as well as all
in eMedical.
testing laboratories.
INZ accepts the following documents to confirm an
What do I do if appropriate identification documents are
applicant’s identity:
not provided?
• Original passport (preferred form of identification)
Please remind people that they are required to provide
• Certificate of identity
an acceptable form of identification when they book their
• Refugee travel document
appointment (preferably their passport). If the applicant
• National Identity Card with photo (as long as the identity
does not provide their passport or any approved alternative
card was issued by one of the following countries and the
documentation, you should advise them that their IME
examining clinic is located in the issuing country)
cannot proceed and they must contact INZ.
Albania
eMedical: Photograph requirements
As a part of the pre-examination stage in eMedical, panel
Belgium
clinics are required to capture a digital facial image of each
Brazil
client at the time of their appointment and then upload the
image to their case in eMedical.
Bulgaria
Note: A scanned image of a photograph must not be
Canada
uploaded because a scan is not a true image of a client’s
China, People’s Republic of
facial features.
Croatia
The photographs uploaded in eMedical are used for
identification purposes during the visa application process
Czech Republic
and verified against other information held by INZ.
Egypt
It is therefore important that photographs uploaded in
eMedical are of biometric standard. The instructions below
France
will assist you to ensure your clinic’s photographs meet
Germany
INZ requirements.
Hong Kong (People’s Republic of China)
What to include when capturing a biometric quality
photograph?
Hungary
The photograph must include:
Indonesia
• the full head including hair (with a clear gap around
Italy
the sides and top of head)
• neck and shoulders
Malaysia
• both eyes (opened)
Netherlands Antilles
• nose
• mouth (closed) and
Pakistan
• neutral expressions (no frowning or smiling).
Poland
For examples of standard biometric photos see the eMedical
Portugal
Capturing Facial images tip sheet.
Russia
Are there any exceptions?
Note: Internal passports are considered equivalent to
Religious head covering – if a head covering is required
a National Identity Card.
for religious reasons make sure full facial features are not
Singapore
obscured. Face covering veils are not permitted.
South Korea
Prescription glasses – If person is wearing prescription
glasses then ensure the frame does not cover any part of
Spain
eyes and that there is no reflection. Glasses must be taken
off if they are tinted or have a heavy-rimmed frame.
Sweden
Taiwan
Thailand
Turkey
16 – New Zealand Immigration Panel Member Instructions – February 2019
What are the specifications for capturing biometric
When should I record an identity concern?
photograph?
Any identity concerns should be documented to ensure
• The person whose photo is being captured must be
further follow up by INZ.
positioned in front of a plain, smooth, flat, light
coloured background.
Identity concerns are not only in relation to applicants
• The person must be centred and face the camera
who are attempting to engage in fraud as part of their visa
straight on.
application process. You should raise an identity concern if:
• There should be no objects (e.g. furniture, other people
• the applicant provides you with a number of identity
etc.) in the background.
documents that appear inconsistent
• There should be ambient lighting in the area where the
• you are concerned about the authenticity of any/all of the
image is being captured.
identity documents provided
• The distance from centre of subject’s head to camera lens
• the applicant who is presenting for the IME does not
should be approx. 1.4 metres.
appear to be the person in the photo(s) of the identity
• Photograph must not be blurry and there should not be
documents provided, or
any shadows, red-eye or light reflected on the face.
• the applicant’s personal or identity details in eMedical are
• Photograph must be in high quality colour.
‘substantially different’ from the identity documentation
• The camera must be held in a vertical orientation (portrait)
that the applicant has provided you.
(see below).
Note: Raising an identity concern in eMedical does not mean
that any action will be taken against the applicant; it is simply
an alert for INZ to ensure that the officer processing the
applicant’s visa application will address any data or identity
issues before finalising the applicant’s visa application.
Specimen integrity
Panel Physicians should perform specimen collection onsite.
If the Panel Physician delegates this procedure to a nurse or
phlebotomist, the Panel Physician remains accountable for
the integrity of this part of the examination.
Correct specimen collection will entail:
What are the minimum camera requirements?
• confirming the identity of the applicant
Facial images must be captured using a digital camera as the
• explaining the collection procedure to applicants
image quality is far better compared to those taken with a
• using appropriate disposable equipment
web cam.
• safe storage and disposal of clinical waste including sharps
• disinfecting the area of skin for venepuncture and using
The digital camera should be set to lowest resolution in order
personal protective equipment
to capture a final image of <500KB.
• urine collection in a secure setting in very close proximity
The camera should be capable of saving images in JPEG or
to guard against specimen substitution
PNG format.
• urine dipstick testing onsite
Paper-based medical certificates: Photograph
• accurate specimen identification using non-removable
requirements
labels
• incorporating appropriate security or coding procedures
Likeness of the person presenting
into the testing process for specimens and laboratory
Clients are required to bring three colour passport-sized
requests
photographs with them to their appointment (only one
• ensuring all pathology test kits are not beyond expiration
photograph is required for the
Chest X-ray Certificate (INZ
dates
1096)). The photograph must be less than six months old.
• refrigeration of specimens or transportation to the
The image on the photograph attached to the form must be
laboratory within one hour
reasonably clear, and there should be no drastic differences
• maintaining specimen integrity during storage
between the image and the person (for example facial features,
• where necessary, ensuring secure transportation (including
facial symmetry). If the photograph attached to the medical
the container) with a laboratory request for specimens -
certificate or chest x-ray certificate is not a close resemblance
specimens must never be given to applicants for transport
of the person presenting for examination, advise the person to
provide an acceptable photograph. Do not continue the medical
• participation in external quality-assurance program.
examination until this requirement is satisfied.
New Zealand Immigration Panel Member Instructions – February 2019 –
17
Disclosure of health information to applicants
The choice of a specialist is not limited; however high-quality
In all cases Panel Physicians have a duty of care to the
reports are needed. As substandard reports will not be
applicants in relation to health information. INZ strongly
accepted by INZ, Panel Physicians should refer applicants only
encourages Panel Physicians to have a defined process
to specialists in whom they have confidence in clinical skill
for recording, tracking and informing applicants of health
and reporting.
information, including examinations, laboratory results,
Panel Physicians must advise the specialist to:
imaging reports and other clinical opinions. Panel Physicians
• confirm the identity of the applicant
must advise the applicant of any abnormal findings. There
may also be some circumstances where it is preferable to
• provide detailed reports in English, if possible, including
notify the applicant’s treating physician.
results of all necessary investigations and a description of
the recommended management and likely prognosis of the
Note: It is not appropriate for the Panel Physician to give
condition.
any form of treatment in relation to the applicant. A Panel
Physician must not enter into a therapeutic relationship
Forwarding specialist reports
with the applicant. The Panel Physician’s role is that of an
Original specialist reports are to be sent directly to the
independent examiner who is to provide INZ with an
Panel Physician, who should then scan (if hard copy) and
impartial assessment of their findings.
attach to eMedical (or attach it to the paper-based medical
certificate). Reports in other languages should be translated
However, if the Panel Member finds the applicant to be
into English by an accredited translator or by the Panel
seriously ill and in need of urgent treatment, the Panel
Member themselves. Specialist reports should clearly show
Member must inform the applicant and refer them to his or
the applicant’s name, date of birth and identity document
her usual physician, or to an appropriate specialist or medical
number.
facility. Panel Members should record any counselling and
referral action taken in relation to serious medical conditions
Gradings
in the general supporting comments field in eMedical or on
Panel Members are required to grade IMEs as ‘A’ if no
the paper-based medical certificates.
significant medical conditions were declared or found and ‘B’
Automated email
if a significant medical condition has been declared or found.
A ‘B’ grading does not automatically mean that the applicant
INZ applicants can confirm at the pre-exam stage of their
will not meet the health requirement or will be refused a visa.
examination that they wish to receive an automated email
confirming the submission of their health case to INZ and
When an abnormality is detected or declared, Panel Members
provide a personal email address for this purpose. Upon
must provide sufficient detail on the nature, severity and
submission of the applicant’s health case an automated
possible prognosis of the medical condition so INZ is able to
email will be sent to the address provided. Applicants will be
clearly understand the applicant’s state of health and the
advised to contact the clinic where their exam was completed
relative significance of the medical condition. Comments from
if they require a copy of, or further information about their
Panel Physicians are required on how each medical condition
results. Clinics can use the ‘Print Health Case’ function to
currently affects, or is likely to affect, the applicant’s normal
generate a copy to print or save as a PDF and email.
daily functioning, level of independence and fitness for work.
If an applicant has any queries in relation to their visa
Submitting electronic IME reports
application, Panel Members should advise applicants to
IMEs completed in eMedical will be submitted automatically
contact INZ.
to INZ once all required IMEs are completed – with no manual
Further tests and specialist referrals
document handling required.
Parts 2, 3 and 4 of these Instructions identify circumstances
IME results are to be submitted without delay. Cases where
where specialist reports should be initiated by Panel
eMedical does not generate additional requirements to the
Physicians as in these cases it is likely that INZ will require
standard examinations should be submitted within five
extra information. In circumstances where a delay in diagnosis
working days of the applicant attending the clinic.
or treatment will result in adverse health outcomes, such
Clinics have a responsibility to manage their pending caseload
as potential cancer, Panel Physicians should also refer to
to ensure prompt submission of cases and to avoid any delays
specialists.
and inconvenience to applicants.
When making external referrals, Panel Members must explain
to applicants why further investigation is needed.
Completion of paper-based medical certificates
Panel Members should also explain that the results will be
Panel Physicians are to ensure that all requested sections of
sent from the specialist to the Panel Physician who must
the medical certificate(s) are completed. All answers
must be
submit the reports to INZ, although applicants should also be
in English.
offered a copy. Specialist referral letters can be generated via
All paper-based medical certificates are to be submitted
eMedical. For paper-based medical certificates, the specialist
without delay, and no more than
five working days after
report will be returned to the applicant with their medical
completion of the certificate.
certificate and they will submit these to INZ with their visa
application. However, INZ is also moving towards a direct-
Clinics have a responsibility to manage their pending caseload
submission process for paper-based medical certificates and
to ensure prompt submission of cases and to avoid any delays
these Instructions will be updated accordingly.
and inconvenience to applicants.
18 – New Zealand Immigration Panel Member Instructions – February 2019
Legibility of the medical certificate
the Panel Member must:
The certificate and all documentation must be legible. Illegible
• complete the examination(s) with the information provided
or incomplete certificates or documentation will be returned
• record the relevant questions as abnormal
to the Panel Physician for clarification. If an error is made in
• state the reason/s for not completing the IME process
completing an answer, rule a single line through the error
including all attempted contact with the applicant in the
(eg. error) and make the changes immediately following and
general supporting comments field
initial the change. Do not use correction fluid or otherwise
• select ‘Finalise Incomplete’ against the relevant
erase the error. The medical certificate will be returned if it
examination in eMedical
has been altered in such a manner.
• If the eMedical case includes a 501 requirement, this
Panel Physician’s initials
will need to be submitted with a B-grading due to the
Visa applicants may have been provided with a bound medical
other requirement(s) being incomplete. Note that the
examination form by INZ. Alternatively, they may have
501 requirement cannot be completed or finalised as
accessed the form as loose-leaf pages (for example, from the
incomplete until all other examinations (eg. a 502 Chest
internet –
www.immigration.govt.nz/forms) and will have a
x-ray examination) on the IME case have been finalised.
form that is not bound as a single document.
For incomplete examinations at non-eMedical enabled clinics
using paper-based medical certificates, the Panel Member
The Panel Physician is to initial:
must clearly mark the front of the form as ‘Incomplete
• every separate sheet submitted as a part of the
IME’ and return the paper-based medical certificate to the
examination assessment, and
applicant at the address they provided. If no physical address
• each of the relevant pages in the medical certificates, and
was provided the applicant should be contacted at the
• sign the Panel Physician’s declaration section.
telephone or email address provided and advised to collect
the papers or provide an address for return.
This process is requested to ensure that individual pages have
not been substituted after the Panel Physician has completed
them and before receipt by INZ.
Where to send completed paper-based medical certificates
for non-eMedical clinics
The address to send paper based medical certificates to can
be found at
www.immigration.govt.nz/assist-migrants-
and-students/other-industry-partners/panel-physician-
network/medical-professionals
Incomplete IME results
IME documentation should not be retained indefinitely while
waiting for applicants to send new information or to complete
tests.
If an applicant:
• indicates that they are withdrawing from the application
process; or
• does not proceed with the IME due to medical conditions
which they feel will make them unlikely to meet the health
criteria; or
• has not returned to complete a repeat urinalysis, and has
not made contact with the clinic within two weeks, or
• has not returned to complete any other additional
examination requested by eMedical within four weeks; or
• has not supplied requested information (including further
test and/or specialist reports) within four weeks of the
request, and the Panel Physician has not been informed
of credible difficulties in obtaining the information,
New Zealand Immigration Panel Member Instructions – February 2019 –
19
How to contact INZ about immigration health
• performing a dipstick urinalysis for the presence of protein,
matters
glucose and blood for applicants five years of age and older
Below are INZ’s preferred methods of contact from Panel
who are undergoing an IME
Members so that your enquiry can be referred to the
• personally taking or assuming responsibility for secure
appropriate area for a response.
specimen collection in the clinic
• arranging for appropriate security or coding procedures to
All eMedical system support enquiries should be made via the
be incorporated into the testing process
support platform in eMedical.
www.emedical.immi.gov.au
• arranging for secure delivery methods for specimens that
All INZ clinical and processing enquiries should be emailed to:
need transporting to another site as specimens should
[email address]
never be given to applicants to transport
Enquiries might include:
• ensuring that all applicants requiring a chest x-ray
complete their x-ray examination with a Panel Radiologist
• access to eMedical (for example, administrator assistance
• providing accurate and complete reporting on the health
to create a new user)
status of visa applicants
• being unable to logon to eMedical (for example, system is
• reviewing the completed x-ray examination report and
‘down’ and you have tried again and still cannot access)
taking into consideration the findings when grading
• other problems with eMedical (for example, you cannot find
the IME
or submit a case, or users at your clinic do not understand
• submitting all original IME reports to INZ (except for those
how to use part of the system)
paper-based medical certificates that may still be returned
• clinical advice in relation to an INZ IME or about these
to the applicant) including:
Instructions (for example, you want advice about how to
grade a particular IME case or what medical examinations
• IME reports
are required for a particular applicant)
• radiology examination reports
• information for INZ (for example, you need to advise us
• specialist reports
about a change in your clinic details or appoint a locum).
• blood tests
For critical incidents that is, the system is ‘down’ and you
• smears and cultures or other diagnostic test results.
have tried again but you still are unable to logon to eMedical,
contact the Australian Department of Home Affairs IT support
section immediately by phone if possible.
Phone: +61 2 6264 0400
Email: [email address]
Additional contact information is set out below.
Telephone enquiries to INZ should be directed to the
INZ Contact Centre:
• +64 9 914 4100 (from outside New Zealand)
• 09 914 4100 (from Auckland)
• 04 910 9915 (from Wellington)
• 0508 558 855 (the rest of New Zealand)
Contact hours: The INZ Contact Centre is available 24 hours
a day, 7 days a week.
Website: www.immigration.govt.nz/assist-migrants-
and-students/other-industry-partners/panel-physician-
network
More information about eMedical
If you are an eMedical enabled clinic, see Part 6 of these
Instructions for advice about using the eMedical system
and support arrangements.
Summary
The Panel Physician examination of an applicant includes:
• verifying the identity of the applicant presenting for the
IME using approved identity documentation and recording
any inconsistencies in eMedical or on the paper-based
medical certificates
• a full medical history
20 – New Zealand Immigration Panel Member Instructions – February 2019
Part 2: Completing a 501 Medical examination
(General Medical Certificate (INZ 1007))
This part of the Instructions provides advice about completion
Completing a 502 Chest x-ray examination (Chest X-ray
of the:
Certificate (INZ 1096)).
• 501 Medical examination (in eMedical), and
Applicants may require an interpreter or a chaperone to be
• General Medical Certificate (INZ 1007) (in paper-format).
present. The details of the chaperone and/or interpreter must
Advice for Panel Radiologists on how to complete the
be recorded on the IME.
accompanying chest x-ray examination is provided in Part 3:
Section A Personal details (eMedical Pre-exam stage)
The questions in this section are for the purpose of
Applicant’s intended occupation
establishing the identity of the client and collecting
If the applicant is intending to come to New Zealand as a
information for INZ.
skilled worker they must enter their intended occupation.
The Panel Physician must consider if there are any findings
eMedical - 501 Medical examination
which may affect the ability of the applicant to perform the
Panel clinics will need to complete this section for INZ clients
intended work activity.
requiring an IME.
Applicant’s intended length of stay
Paper - General Medical Certificate (INZ 1007)
The applicant is required to confirm their intended length of
This section is marked ‘Section A’ and should be completed
stay in New Zealand.
by the client prior to attending the IME except for question
A1 which must be completed by the Panel Physician or a
Immigration Advisers
delegated staff member.
If the applicant has an immigration adviser and would like
them to be able to contact the clinic on their behalf, the
Identity
applicant and their adviser should complete the INZ form
See ‘Confirming the identity of applicants’ on page 16 in Part 1
Immigration Adviser Details (INZ 1160) and ask that a copy
of these Instructions.
of the form be attached to their health case records.
Applicant’s visa category
Option for automated email confirming submission of
The applicant will need to know what type of visa category
health case to INZ
they are applying under. In eMedical, the applicant’s answer to
Applicants can confirm that they wish to receive an
this question will ensure the right IME and relevant questions
automated email confirming the submission of their health
and/or tests are applied to the applicant. The applicant will
case to INZ and provide a personal email address for this
need to select from the following list:
purpose. Upon submission of the applicant’s health case an
• Temporary
automated email will be sent to the address provided.
• Visitor
eMedical information sheet
• Student
After a health case has been created, an information sheet
• Worker with job offer
can be printed for the client at any time. The information
• Worker without job offer
sheet includes the:
• Residence
• client’s photo
• Skilled/Business
• INZ reference number (NZER)
• Pacific Categories
• client’s personal details
• Family
• client identity details
• client visa details, and
• Humanitarian UNHCR
• instructions for the client.
• Humanitarian Other
Please print the information sheet and give it to the client
• Work to Residence
before he/she leaves the clinic. This information sheet will be
• Worker
used by the client as proof that their IME has been initiated
• Family of worker
when they submit their visa application.
New Zealand Immigration Panel Member Instructions – February 2019 –
21
Section B Medical history
Clients completing a paper-based medical certificate may
A Panel Physician within New Zealand, who identifies that
complete ‘Section B Medical history’ before their IME. If it has
an applicant has active TB, must refer that applicant to
not been completed, a Panel Physician (or delegated staff
the local medical officer of health for further investigation
member) must complete this section with the client. For
and contact tracing. This is a mandatory requirement
eMedical cases, these questions can only be answered during
under the New Zealand Tuberculosis Act (1948). Overseas
the IME appointment.
Panel Physicians are to apply their applicable standards
of practice. See ‘Tuberculosis’ and ‘TB investigation’ on
For a child who is younger than 18 years of age, the medical
pages 27 and 28 for further guidance.
history section must be completed by a parent or guardian,
or the Panel Physician with the parent or guardian.
B3 Have you ever had prolonged medical treatment and/or
repeated hospital admissions for any reason, including
Panel physicians must discuss the applicant’s medical history
a major operation or psychiatric illness?
with them even where the applicant has completed the
medical history questions before their IME.
Do not assume
Prolonged medical treatment may include (and details
that the applicant has understood the questions.
must be provided about the type of and length of
treatment):
These questions are designed to assist the Panel Physician
to assess aspects of the applicant’s health which are of
• conditions requiring treatment for more than two
particular relevance and importance to the New Zealand
weeks or recurrent conditions
Government’s health requirements. Nevertheless, the
• physiotherapy, speech therapy or other therapies, and
questions do not replace the need for Panel Physicians to
obtain comprehensive histories themselves. If there is no
• in-patient or out-patient care for a psychiatric illness.
medical history declared, the Panel Physician must verify
Regarding hospital admissions longer than two days,
this with the applicant.
the Panel Physician is expected to detail:
Specifically Panel Physicians must review the applicant’s
• the date/s of treatment
declaration and all questions, including hospitalisations,
• the reason/s for treatment, and
institutionalisation for physical or psychiatric conditions,
or any condition resulting in a substantial change from
• the type/s of treatment received.
the normal state of well-being. Panel Physicians must ask
Both inpatient and outpatient treatments are relevant.
applicants about TB symptoms and TB history, mental health
Hospital admissions for normal vaginal delivery do not
conditions, substance abuse, current medication as well as
need to be documented. Regarding surgery, the Panel
work capacity (physical or intellectual disability, education
Physician is expected to detail:
achievement and receipt of governmental benefits).
• the date and reason for the operation
If the applicant answers ‘Yes’ to any question, note relevant
• the operative procedure that was performed, and
details such as date of diagnosis, progress, current problems,
complications and treatment so far. Attach any reports, tests
• any pathology or staging reports where available.
and other information available (all items being attached to
Where an applicant has been recommended to undergo
a paper-based medical certificate must be signed or initialled
surgery, outline:
by the Panel Physician and securely attached).
• the reason for the recommendation
Completing the medical history section
• if the surgery is currently pending, if so when, and on
The medical history questions below are listed in
what basis?
alphanumeric order for the purposes of the paper
General
Procedures that are not considered significant include:
Medical Certificate (INZ 1007) and will generally appear in the
same order in the eMedical 501 Medical examination.
• minor fractures where operative fixation was not
required
B1 Have you ever been diagnosed with Tuberculosis (TB)?
Have you ever had to take treatment for TB?
• removal of wisdom teeth
• tonsillectomy or adenoidectomy
B2 Have you ever been in close contact at home with a
person known to have TB?
• grommets
Applicants with active TB are a risk to public health.
• appendectomy/appendicectomy
If there is any suspicion of TB, a detailed history with
• arthroscopic meniscectomy as a consequence
clinical, bacteriological and radiological examination will
of knee trauma
determine the activity of the disease. It is of particular
• minor cosmetic surgery
importance to INZ to confirm the presence of multi-
• rhinoplasty
drug-resistant tuberculosis (MDR-TB) or extensively
drug-resistant tuberculosis (XDR-TB) in any applicant.
• breast reduction
INZ may consider deferring the application for a period
• cholecystectomy/gall bladder removal unless
to allow for completion of treatment.
for cancer
• hysterectomy unless for cancer
22 – New Zealand Immigration Panel Member Instructions – February 2019
• vasectomy/tubal ligation in the absence
of heritable disorder
B9 Do you have a heart condition including coronary
disease, hypertension, valve or congenital disease?
• Caesarean section
• Fenton’s repair for episiotomy scars
Note any evidence of heart disease such as:
• circumcision
• chest pain, shortness of breath when lying down or
• incision and drainage of abscesses
with exercise, ankle swelling
• hernia repairs
• angina or ischaemic heart disease
• haemorrhoid treatment
• cardiac risk factors such as diabetes, smoking, family
history of premature heart disease
• removal of benign skin lesions such as skin tags
and strawberry naevus
• previous cardiovascular events such as angina,
myocardial infarction, percutaneous coronary
• ingrown toenail surgery
intervention, coronary artery bypass graft, severe
• cryotherapy, curettage, cauterisation
peripheral vascular disease, familial lipid disorders,
• musculoskeletal injections, or
severe diabetes with nephropathy
• varicose vein injections.
• persistent uncontrolled hypertension
• heart murmur or valve disease
B4 Do you suffer, or have you ever suffered, from a
psychological or psychiatric disorder (including major
• cardiomyopathy
depression, bipolar disorder or schizophrenia)?
• aortic aneurysm, or
Note any evidence of major psychiatric illness including
• rheumatic fever past or present.
any psychiatric condition that has required hospitalisation
B10 Do you have a blood condition (including thalassemia)?
and/or where significant support is required.
Note any evidence of a blood condition such as:
These may include bipolar disorder, schizophrenia,
psychosis, eating disorders, post-traumatic stress
• blood or blood product transfusions, indicate when
disorder, anxiety, depression, and other conditions.
and where
If there is a history of mental illness, include details of:
• haemophilia, bleeding disorder, coagulopathies
• sickle cell disease, thalassaemia or other hereditary
• the specific diagnosis
anaemias
• details of the type and duration of treatment
• haemochromatosis
• any history of non-compliance with treatment
• any haematological malignancy such as leukaemia,
• frequency of relapses
lymphoma or myelodysplastic syndrome, or
• an assessment of potential for self-harm or harm
• family history of blood conditions.
to others, or
B10 Do you have bladder or kidney problems?
• ability to maintain employment or study.
Note any evidence of bladder of kidney conditions
B5 Have you ever had an abnormal or reactive HIV
such as:
blood test?
• polycystic kidney disease, glomerulonephritis
B6 Have you ever had an abnormal or reactive Hepatitis B
or Hepatitis C blood test?
• renal failure, dialysis, renal transplant
• family history of polycystic kidney disease or other
Note relevant details such as date of diagnosis,
hereditary kidney conditions, or
progress, current problems, complications and
treatment so far.
• incontinence (urge or stress), recurrent urinary tract
infections.
B7 Do you have or have you had cancer or malignancy
B12 Do you have an ongoing physical or intellectual disability
in the last 5 years?
affecting your current or future ability to function
Provide details of malignancies of organs, skin and
independently or be able to work full-time (including
haematopoietic tissues, dates, sites and staging,
autism or developmental delay)?
histology reports, treatments, current status and
Note any evidence of physical, intellectual or
outlook for the future.
developmental conditions, such as:
B8 Do you have diabetes?
• any physical disability
Note any evidence of diabetes such as:
• any intellectual disability
• sugar in the urine, polydipsia, polyuria
• autistic spectrum disorders, or
• positive diabetes tests
• brain injury.
• need for anti-hyperglycaemic medication, or
Details of Government assistance (benefits, duration
• end organ damage such as nephropathy, retinopathy,
of payments), significant periods of time off work, date
neuropathy, peripheral vascular disease, etc.
last worked, restrictions on work ability and outlook for
the future should be provided.
New Zealand Immigration Panel Member Instructions – February 2019 –
23
INZ also wishes to establish where there may be a
• any dementia including Alzheimer’s disease
funding requirement for Ongoing Resource Scheme
• mini–mental examination (score less than 25) or
funding (Ministry of Education Ongoing Resourcing
positive Rowland Universal Dementia Assessment
Scheme). If there is a history of autism or Asperger’s
Scale (RUDAS) screening test (score 25 or less)
syndrome or special schooling, attach any existing
report that is available from a paediatrician, clinical
• poorly controlled epilepsy or complex seizure
psychologist and/or other therapists describing:
disorder
• cerebrovascular disease such as transient ischaemic
• developmental history
attacks or strokes
• psychometric testing including IQ testing and
• cerebral palsy
assessment of adaptive skills
• paraplegia, quadriplegia
• behavioural disorders
• head or brain injury
• specific diagnosis
• poliomyelitis
• school vocational training and/or work records
• Parkinson’s disease
• current and future treatment requirements,
recommendations for speech therapy, occupational
• motor neurone disease
therapy, physical therapy, special education or
• Huntington’s disease
vocational training, or
• muscular dystrophy
• current and future need for ongoing supervision or
• prion disease, or
institutional care.
• relapsing and/or progressive multiple sclerosis.
B13 Do you have an addiction to drugs or alcohol?
B17 Do you have any significant family health history?
Note any known drug addictions. Where it is uncertain
An applicant must confirm whether they have a parent
if an addiction is relevant, please detail this. If there is a
or sibling:
positive history of alcohol/drug abuse, particularly:
• with a condition such as diabetes
• any narcotic or intravenous drug use or addiction
• with cardiovascular/kidney/liver/blood/neurological
• the history of any social or occupational
disease
consequences from the abuse/addiction
• with a genetic disorder
• any history of detoxification or rehabilitation
programmes
• with cancer, or
• the duration of abstinence, and
• who died due to illness before the age of 65.
• whether there is any current use of alcohol or drugs.
If the applicant is a child under 15 years of age and either
parent is HIV positive this must also be confirmed.
B14 Are you taking any prescribed pills or medication
(excluding oral contraceptives, over-the-counter
The applicant must state their relationship to that
medication and natural supplements)?
person (eg. father, sister) and the nature of the
condition. The Panel Physician is expected to consider
Provide a complete list of all prescription and over-the-
the risks resulting to the applicant identified by their
counter medications, doses and duration.
family history.
B15 Do you have a hereditary or autoimmune condition?
B18 Are you pregnant? What is the expected date of
Provide details of any hereditary or autoimmune
delivery?
condition, such as:
If the client declares that they are pregnant enquire as
• any chromosomal, genetic, congenital or
to whether the pregnancy is progressing normally, add
familial disorder such as Huntington’s chorea,
comments if there are any complications. If the client
hyperlipidaemia, muscular dystrophies, cystic
has a letter from their own doctor or lead maternity
fibrosis, Down’s syndrome
carer (obstetrician) confirming their pregnancy, scan
• any primary or acquired immunodeficiencies
and attach it to the health case, or if not, ask the client
if they are willing to have a BHCG test added to the
• any inborn errors of metabolism
standard blood tests required. If they are unwilling
• personal or family history of Gaucher’s disease, or
to undergo the blood test they may be required to
• any autoimmune condition including arthritis, lupus,
provide a letter from their doctor or lead maternity
psoriasis, crohn’s disease or other inflammatory
carer (obstetrician) to confirm their pregnancy and the
bowel disease.
expected date of delivery (EDD).
B16 Do you have a neurological condition, including having
had a stroke or multiple sclerosis?
Panel Physician’s declaration
The Panel Physician undertaking the IME must declare that
Note any evidence of neurological, hearing or vision
they have discussed the applicant’s medical history with them
problems such as:
(or the applicant’s parent or guardian if the applicant is under
18 years of age or is an ‘incapable person’).
24 – New Zealand Immigration Panel Member Instructions – February 2019
Section C Client consent and declaration
The client consent and declaration must be signed
Paper - General Medical Certificate (INZ 1007): For paper-
and dated by the applicant in the presence of the
based medical certificates the consent and declaration
Panel Member.
document is included within the medical certificate. If the
Applicants are advised on the INZ website and in the
declaration has been signed by the applicant before their
INZ Health Requirements (INZ 1121) publication to review
appointment, the applicant must sign the form again in the
the consent before their appointment. The Panel Member
presence of the Panel Member. When signing the declaration,
must ensure that the applicant has read and understood the
the Panel Member must also stamp the document with their
declaration and the applicant must sign the declaration in the
name and address, or legibly print those details.
presence of the Panel Member.
Consequences of providing false or misleading information
A parent or guardian must sign on behalf of an applicant
The Panel Member is to be aware that the consequences
who is under 18 years of age or who is an ‘incapable person’.
for the person being examined (or their parent or guardian)
An ‘incapable person’ is defined as a person who is incapable
providing false or misleading information, or altering or
of understanding the general nature, effect of, and purpose of
changing a paper-based medical certificate may include:
the requirement for providing a signature. Such people may
include those with an intellectual disability.
• the visa application being declined
• prosecution, and
eMedical - 501 Medical examination: For eMedical IMEs,
• if convicted, imprisonment for up to seven years.
the consent and declaration must be printed, signed by the
applicant and the Panel Member, then scanned and attached
to the IME.
Section D Physical examination
Completing the physical examination
registered medical practitioner) for whose work the Panel
The physical examination questions below are listed in
Physician takes professional and legal responsibility.
alphanumeric order for the purposes of the paper
General
The following listed measurements may be performed by staff
Medical Certificate (INZ 1007) and will appear in the same
supervised by the Panel Physician on the basis that the staff
order in the eMedical 501 Medical examination
except for
member concerned uses the equivalent skills that the Panel
urinalysis and a question on
heart murmurs. In eMedical,
Physician would use to achieve the equivalent assessment
urinalysis is part of the 501 Medical examination ‘Basic
result quality.
questions’ screen, and the question on heart murmurs is part
of the ‘Miscellaneous’ grouping of questions in the ‘Detailed
questions’ screen.
1. Weight
Applicants must be asked to remove sufficient clothing for
2. Height
a full and appropriate medical examination. This includes an
assessment of general appearance (look for any suggestion
3. BMI
of poor health or a health complication that may require
further investigation), a full head to toe examination, and a
4. Head circumference
mental health assessment. This will require that all
clothing
should be removed, with the exception of underwear.
5. Visual acuity
Appendix 1 provides a diagram that you may wish to display in
your clinic waiting room, change and/or examination room.
6. Blood pressure
For more information see ‘Privacy considerations’ on page 13
in Part 1 of these Instructions.
7. Urine testing
A chaperone should be offered and their details recorded if
one was present.
Medical findings
This section must be completed in full. Paper-based medical
Where an abnormality is detected or declared, the Panel
certificates which are illegible will be returned for clarification.
Physician must provide sufficient details regarding the
nature, severity and possible/likely prognosis of the medical
The Panel Physician is accountable for the integrity of all
condition and/or disability to enable INZ to clearly understand
facets of the IME.
and appreciate the examined person’s state of health.
Delegating responsibility
The Panel Physician is to provide detailed comment on
If the Panel Physician delegates any history or measurement
examination findings where:
part of the examination (eg. height, weight or visual acuity)
• ’Yes’ has been answered to a question in the ‘Medical
this may only be performed by a registered nurse (or
history’ section
New Zealand Immigration Panel Member Instructions – February 2019 –
25
• there are pre-existing medical conditions (the applicant
that eMedical will automatically grade as ‘B’ if head
should provide any relevant reports they have)
circumference is in the third percentile), or
• abnormalities are present or are detected.
• where developmental milestones are noted to be
If reports from specialists are provided attach these to
abnormal (in which case eMedical will auto-generate
the eMedical IME, or for paper-based medical certificates,
a request to complete a chart of early childhood
authenticate these by initialling each page and attaching
development examination or see Appendix 2), or
securely to the certificate. Where INZ requires referral to an
• for any condition likely to significantly affect the
appropriate physician, a recent report less than six months is
applicant’s ability to function or perform activities of
acceptable.
daily living.
Timely medical tests
For children up to two years of age a recent report less
than three months old is acceptable.
All other medical tests required or indicated as a result of the
examination should be carried out on or about the date of the
D6 Blood pressure
medical examination.
Blood pressure must be measured in all applicants over
D2 D3
15 years using an appropriate cuff size. If blood pressure
D4 D5 Height, weight and head circumference
is elevated, repeat after the patient has rested for five
Record height in metres and weight in kilograms.
minutes and, if necessary, again after 10 minutes.
• A stadiometer fixed to the wall is recommended.
D6 Visual acuity with or without correction
• When the applicant is unable to stand then record
length on the application form.
The visual acuity of each eye must be tested separately
with corrective lenses if worn. Snellen’s, E or similar
• Adults and children must stand barefoot and wear
charts must be used.
lightweight clothing.
• Infants must be naked except for a diaper/nappy and
If a refractive defect is suspected, pinhole testing must
recorded to the nearest 0.1kg
be done.
• Record the nearest percentile for the infant and any
Corrected visual acuity must be recorded. In children
other recent weights (
http://www.health.govt.
too young to use a chart, a comment must be made on
nz/our-work/life-stages/child-health/well-child-
whether vision appears normal.
tamariki-ora-services/growth-charts) (see also
Referral to an ophthalmologist is necessary for:
below for other ethnicities).
Body mass index (BMI) must be calculated for applicants
• severe vision impairment with visual acuity of 6/60
over 18 years of age (eMedical automatically generates
or beyond after best possible correction at country
BMI to assist Panel Physicians):
of origin, where significant support is required
• apparent severe visual loss
• The formula is the weight in kg divided by the height
in m2.
• chronic eye infections, or
• BMI calculators are available online, for example:
• any condition likely to significantly affect the
www.healthnavigator.org.nz/bmi-calculator.
applicant’s ability to function at home, study or work
or perform activities of daily living.
Baby, infant and child height and weight must be
compared to standardised height and weight chart for
eMedical: If visual acuity is less than 6/18 in best eye or
the appropriate population. Growth charts supplied
a child’s vision is recorded as ‘abnormal’, eMedical will
courtesy of the respective agencies can be accessed
auto-B grade the IME.
through the following links:
D8 D9 Cardiovascular system (including heart murmurs*)
• Centre for Adoption Medicine:
www.adoptmed.org/
*In eMedical, the ‘Heart murmurs’ question is located
topics/growth-charts.html (this includes links to
under ‘Miscellaneous’ in the ‘Detailed Questions’ screen.
country specific growth charts) or
Assessment includes:
• CDC:
www.cdc.gov/growthcharts/charts.htm
Record the head circumference in all children up to two
• cyanosis, pallor, peripheral temperature and oedema
years of age:
• size and consistency of thyroid gland, including any
masses
• Assess greatest occipitofrontal circumference.
• pulse rate and rhythm
• Compare measurement with the standardised head
circumference chart for the appropriate population.
• blood pressure
All abnormalities must be noted and referral to an
• jugular venous pressure
appropriate physician is recommended:
• palpation for thrills and character of apex beat
• for a baby, infant and child who is under the third
• auscultation of heart sounds, extra sounds
centile for head circumference who is not growing
and murmurs
as expected, or with other medical concerns (note
26 – New Zealand Immigration Panel Member Instructions – February 2019
• peripheral vascular system: carotid, radial, femoral,
It is calculated by multiplying the number of packets of
posterior tibial and dorsalis pedis, and
cigarettes smoked per day by the number of years the
• carotid and femoral bruits, and
person has smoked:
• ECG if any abnormalities found on history or
(Packs of twenty cigarettes per day) x (number of years
examination. All abnormalities must be noted.
smoked) for example:
Applicants with heart murmurs or evidence of
• 10 cigarettes per day for 10 years = ½ x 10 = five pack
heart valve disease or cardiomegaly require an
year history
echocardiogram.
• 40 cigarettes per day for 30 years = 2 x 30 = 60 pack
Referral to a cardiologist is necessary for any
year history.
applicant with:
All respiratory abnormalities must be noted.
• a five-year cardiovascular risk of ≥ 20 per cent, using
Referral to an appropriate physician is necessary for:
local/own country cardiovascular risk calculations.
• previous cardiovascular event such as angina,
• tuberculosis (TB), suspected or confirmed (see below
myocardial infarction, percutaneous coronary
for further information on TB)
intervention, coronary artery bypass graft,
• severe and/or progressive restrictive (including
severe peripheral vascular disease, diabetes with
interstitial) lung disease:
nephropathy (albumin: creatinine ratio >30mg/mmol
• progressive exertional dyspnoea, dry or productive
or urinary albumin >200mg/L)
cough lasting longer than three weeks, chest
• persistent uncontrolled hypertension
pain, haemoptysis, decreased exercise tolerance,
• cardiomyopathy
recurrent chest infections, severe fatigue, or
• aortic aneurysm
• spirometry is suggestive: FEV1/FVC ratio is normal
or high and FVC is reduced for height, weight and
• unstable, progressive, symptomatic or complicated
ethnicity
conditions, or
• severe and/or progressive obstructive lung disease:
• any condition likely to significantly affect the
applicant’s ability to function at home, study or
• history of breathlessness, wheeze, night-time
work or perform activities of daily living.
cough, personal or household smoking, use of
inhalers, nebulisers or oral medications, time off
D10 Respiratory system
work or school, limitation of physical activities,
Assessment includes:
hospital admissions
• severe chest deformity
• respiratory rate
• clubbing, cyanosis, respiratory distress, or
• any respiratory distress, cyanosis and accessory
muscle use
• 40 per cent or less of predicted FEV1
• position of trachea
• use of oxygen at home
• cervical lymphadenopathy
• cystic fibrosis
• chest shape and expansion
• unstable, progressive, symptomatic or complicated
conditions, or
• percussion of the chest
• any condition likely to significantly affect the
• auscultation of breath sounds
applicant’s ability to function at home, study or work
• finger clubbing
or perform activities of daily living.
• peak expiratory flow rate
Tuberculosis
• good quality spirometry if possible, and
• smoking history (for applicants with 20 pack year
The IME places particular emphasis on the detection of TB
or more smoking history, note the peak expiratory
which must be considered in any applicant who:
flow rate)
• is from a country with a high risk of TB
If the applicant is a current cigarette smoker or has ever
• has a history of cough persisting longer than three weeks,
regularly smoked cigarettes for a period of six months or
night sweats, haemoptysis, chest pain, unexplained weight
longer, the number of cigarettes smoked, the frequency,
loss, HIV, close contacts with TB, abnormal chest X-ray,
and the duration of smoking need to be documented.
abnormal sputum, skin or blood tests, etc, or
If the applicant is an ex-smoker, the number of
• has abnormalities on auscultation.
years they have been ‘cigarette-free’ should also be
Maintaining high suspicion for TB is vital to the diagnosis.
documented.
If a history of TB is elicited, full treatment records, including
The Panel Physician is to use these details to calculate
drug regimens, duration of and response to treatment, and
the pack year history. Pack year is a way to measure the
ongoing follow-up, should be obtained.
amount a person has smoked over a long period of time.
New Zealand Immigration Panel Member Instructions – February 2019 –
27
eMedical will present a
502 Chest X-ray examination where
Latent TB Infection (LTBI)
this requirement exists, though if such a requirement does
LTBI is ‘latent’ because live, dormant (not reproducing)
not exist but is indicated on clinical grounds, it can be
Mycobacterium tuberculosis organisms are sequestered in
manually added by the panel clinic.
the tissues, although they are not clinically apparent. In LTBI
Further plain films with alternative views may be necessary
the chest X-ray (CXR) is normal or shows trivial and stable
to determine the nature of an abnormality. Old chest films
evidence of past TB (eg, a small scar or patch of calcium).
should be obtained if possible, as comparison with the
The number of TB organisms is low. If the applicant is
current film will help in determination of disease stability.
asymptomatic, HIV-negative and without radiological signs of
If these are made available by the applicant, a comment
active TB, and/or has a history of previous TB treatment with
about the comparison should be added to the report but
no indication of active disease currently, the case should be
the original films, if in hardcopy format, must be returned to
graded ‘B’ and submitted to INZ without sputum collection
the applicant. It is very important that other conditions that
or further investigation.
may mimic the appearance of TB be excluded (for example,
An INZ Medical Assessor may ask for more information if
sarcoidosis or lung cancer).
concerned about disease activity.
Applicants with suspected or proven TB, past TB, or recent
D11 Nervous system: Sequelae of stroke or cerebral palsy,
close contact with a person who has active TB should be
other neurological disabilities
graded as ‘B’. Recent close contact is defined as prolonged
or repeated direct contact (such as occurs with family or
Assessment includes:
household members) in the past two years. Applicants who
• cranial nerves (visual assessment, face sensation and
have had distant contact or non-direct exposure (such as
movement, hearing, tongue)
persons working in healthcare) should not be ‘B’ graded
• tone
for this reason. eMedical will automatically ‘B’ grade cases
where applicants have declared a history of TB.
• power
• reflexes
Any symptomatic and/or HIV-positive applicant with signs
of TB, even with a normal chest x-ray, should be assumed
• sensation to light touch, pin prick
to have active disease until proven otherwise. These cases
• plantar responses
should always be graded ‘B’.
• coordination
TB investigation
• gait
If tuberculosis is suspected then three sputum samples must
• Romberg’s test
be obtained, preferably early in the morning. The applicant
Where the applicant has evidence of cognitive or
should be advised to fast before collection and not to brush
memory deficit, or is over 70 years of age, a Mini Mental
their teeth that morning.
examination must be completed. This must be done
Panel members are to provide the applicant with a mouth
in the applicant’s own language or with a professional
rinse of distilled water before collection. If distilled water
interpreter. Where the nervous system is noted to be
is not available bottled water can be used, although this
abnormal in the
501 Medical examination, eMedical will
is an inferior alternative.
auto-generate a request to complete a
903 Activities
of Daily Living and a
901 Mini Mental exam. Panel
• These samples should be sent as soon as possible
physicians completing a paper-based medical certificate
prior to the specialist visit.
may complete a Mini Mental examination or a
• The sputum samples must be collected at least
RUDAS test.
24 hours apart.
• The collection of sputum samples must be supervised
All abnormalities must be noted. Referral to an
in a clinic or laboratory.
appropriate physician is necessary for:
• The sputum samples must be promptly transported to
• significant hypertonia or hypotonia
the laboratory by appropriate transport (not the applicant).
• any dementia including Alzheimer’s disease
• Specimens must be cultured for between six to eight weeks
• Mini Mental examination (with score less than 25)
with a final report provided at the end of the culture period.
or positive RUDAS (with score less than 25)
• Drug sensitivity testing must be performed on all
• cerebrovascular disease
positive cultures.
• cerebral palsy
If TB is diagnosed, INZ requires the applicant to be treated
according to the Guidelines for Tuberculosis Control in
• paraplegia, quadriplegia
New Zealand 2010 (http://www.health.govt.nz/publication/
• poliomyelitis
guidelines-tuberculosis-control-new-zealand-2010).
• Parkinson’s disease
If the applicant is outside New Zealand, INZ requires that
• motor neurone disease
the applicant shall be smear and culture negative following
completion of a course of treatment. After which a review
• Huntington’s disease
by an INZ Medical Assessor and/or a Respiratory Physician
• muscular dystrophy
will be required.
• prion disease
28 – New Zealand Immigration Panel Member Instructions – February 2019
• relapsing and/or progressive multiple sclerosis
D14 Endocrine system
• unstable, progressive, symptomatic or complicated
conditions, or
Examination of the endocrine system should include
• any condition likely to significantly affect the
thyroid examination and review of signs and symptoms
applicant’s ability to function at home, study or
of diabetes. Applicants known to have benign thyroid
work or perform activities of daily living.
disease do not need additional investigations such as
thyroid function tests and should be ‘A’ graded.
D12 Gastrointestinal system
If thyroid disease is detected on examination, or
Assessment includes:
glycosuria, or evidence of diabetes mellitus then referral
• stoma sites
to an appropriate physician is necessary.
• ascites, distension
D15 D16 Mental and cognitive status and Intellectual ability
• tenderness, masses, guarding
Mental health conditions can be at times particularly
• liver, spleen, kidneys
difficult to identify. Referral for psychiatric assessment
• bowel sounds
and determination of prognosis, treatment needed,
including hospital admissions, work history, ability to
• hernias
carry out activities of daily living, and social history
• femoral pulses and bruits, or
is necessary when there is a recent history or current
• any unexplained weightloss.
clinical evidence of the following:
Abnormalities must be noted. Referral to an appropriate
• schizophrenia
physician is necessary for:
• bipolar or depressive affective psychosis
• evidence of cirrhosis, portal hypertension or liver
• personality disorder
impairment
• paranoid disorder
• inflammatory bowel disease: Crohn’s disease or
• autism
ulcerative colitis
• chronic alcohol abuse
• masses or evidence of malignancy
• drug dependence or substance abuse
• unstable, progressive, symptomatic or complicated
conditions, or
• eating disorders
• any condition likely to significantly affect the
• chronic neurosis (for example, chronic anxiety or
applicant’s ability to function at home, study or work
depression, obsessive compulsive disorder, phobias).
or perform activities of daily living.
Dementia
D13 Musculoskeletal system
If an abnormal mental and cognitive state is recorded in
Assessment includes:
eMedical, additional examinations will be generated for
you to complete. For paper-based medical certificates,
• inspection of joints, muscle and the skeletal system
you must perform an ADL assessment available at
looking for erythema, swelling, tenderness, nodules,
Appendix 3 of these Instructions. You must also assess
lumps, range of motion, any deformities and ability
the mental state of the client with a Mini Mental
to stand from squatting
examination or RUDAS test.
• mobility and locomotion, limping, and
Note: The protocol should be adapted, as appropriate,
• use of accessories such as braces, walking aids or
linguistically and culturally. The test questions should
wheelchairs.
be performed in the applicant’s own language or
All abnormalities must be noted. Referral to an
with the assistance of a professional interpreter.
appropriate physician is necessary for:
If a language barrier to assessment is present, this
should be recorded. The Mini Mental examination is a
• any musculoskeletal disease or disorder with a high
screening tool. If it suggests a problem, a psychiatrist’s
probability of surgery in the next five years
or geriatrician’s opinion should usually be sought.
• any musculoskeletal problem which requires a
These cases will be automatically ‘B’ graded in eMedical.
mobility aid
If a mini mental assessment is not appropriate e.g. for
• unstable, progressive, symptomatic or complicated
young children / babies, please finalise incomplete the
conditions, or
mini mental examination in eMedical and include an
• any condition likely to significantly affect the
explanation as to why this is being done.
applicant’s ability to function at home and work or
perform activities of daily living.
A 903 Activities of Daily Living (ADL) examination should
be added to eMedical if there are musculoskeletal
conditions that interfere with activities of daily
living. For paper-based medical certificates, the ADL
assessment can be found in Appendix 3.
New Zealand Immigration Panel Member Instructions – February 2019 –
29
Intellectual ability
• apparent significant deafness
Referral for psychological or psychiatric assessment,
• congenital or genetic hearing impairment, or
as appropriate, is needed if there is clinical evidence of
• any condition likely to significantly affect the
an intellectual disability whether this is borderline, mild,
applicant’s ability to function at home, study or work
moderate or severe.
or perform activities of daily living.
The purpose is to determine:
D20 Developmental milestones
(children under five years of age)
• behaviour
If the relevant questions in the medical history indicate
• need for long-term supported or special education
that developmental milestones are abnormal, eMedical
• level of independence and need for assistance or
will automatically generate a 904 Chart of Early
institutional care
Childhood Development Examination. For paper-based
• employment capacity and occupation history.
medical certificates Appendix 2 provides guidelines for
Note that eMedical will automatically grade as ‘B’ for
child development milestones.
an abnormal mental and cognitive status or intellectual
Assessment includes the following critical
ability.
developmental milestones:
D17 Eyes (including fundoscopy)
• cannot hold head up unsupported at eight or more
See also D7 Visual acuity with or without correction
months (normal four months)
• cannot sit unsupported at nine months (normal
Examination should include physical inspection of the
eight months)
eye for deposits in the iris, xanthelasma, lid issues and
eye motility.
• cannot walk at 18 months (normal 13 months)
• no words by 18 months (normal 15 months)
D18 Ear/nose/throat/mouth
• no two–three-word phrases by 24 months and
Assessment includes:
40 months respectively (normal 21 and 36 months
• external ear, auditory canal, ear drums, general
respectively), and
hearing
• moro reflex persisting at six or more months.
• nasal obstruction and discharge
All abnormalities must be noted. Referral to an
• oral cavity, tongue (including under) and pharynx
appropriate physician is necessary for severe
developmental disorders or cognitive impairments
• teeth (including under dentures if any) and gingiva,
where significant support is required, including:
or
• any masses, leukoplakia and other abnormalities.
• physical disorders
All abnormalities must be noted.
• intellectual disability
• autistic spectrum disorders
Referral to an appropriate physician is necessary for:
• brain injury
• any masses or evidence of malignancy
• significant hypertonia or hypotonia at any age, or
• unstable, progressive, symptomatic or complicated
• any condition likely to significantly affect the
conditions, or
applicant’s ability to function or perform activities
• any condition likely to significantly affect the
of daily living.
applicant’s ability to function at home, study or work
D21 Skin and lymph nodes
or perform activities of daily living.
D19 Hearing
Assessment includes:
Assessment includes:
• scars (the presence of operative scars must be
correlated with the applicant’s history. It is not
• either grossly or with an audiogram where possible
necessary to record scars associated with routine
• each ear must be tested separately, and
surgical procedures, such as hernia repair or
• in young children, a comment must be made on
appendectomy, hysterectomy or Caesarean section,
whether hearing appears normal.
if the procedure was uncomplicated and/or the
condition resolved).
All abnormalities must be noted.
• tattoos – As INZ screen for various infectious
Referral to an appropriate physician is necessary for:
diseases, including Hepatitis C, it is not necessary
• severe 71-90 decibel hearing loss or profound
to comment on tattoos and B grade the medical.
bilateral sensorineural hearing loss after best
Please only provide details relating to tattoos if
possible correction at country of origin, where
there are specific concerns. Otherwise tattoos
significant support is required
can be considered as A graded.
• cochlear implants – if no recent letter from a
• skin conditions and lesions
specialist is available
• lymph nodes: cervical, axillary, inguinal, and
30 – New Zealand Immigration Panel Member Instructions – February 2019
• cervical nodes in children: submental,
independent living and/or employment, and provide full
submandibular, anterior and posterior cervical, pre-
details. Assessment includes:
and post-auricular, suboccipital and supraclavicular
lymph nodes are not usually palpable. If they are
• eating, drinking, dressing, washing, toileting, bladder
palpable, this may indicate tuberculosis and if TB is
and bowel control, mobility and locomotion
suspected appropriate follow up must be arranged
• communication, comprehension, expression
(see D10 Respiratory system).
• social cognition, social interaction
Abnormalities must be noted. Referral to an appropriate
• memory, and
physician is necessary for:
• need for devices, aides or assistance.
• palpable cervical lymph nodes in children
All abnormalities must be noted.
• unexplained lymphadenopathy
A 903 Activities of Daily Living (ADL) Assessment needs
• unstable, progressive, symptomatic or complicated
to be completed for any applicant where there is concern
conditions, or
about their ability to carry out the activities of daily
• any condition likely to significantly affect the
living, including the frail elderly. eMedical will generate
applicant’s ability to function at home, study or work
a request for an ADL assessment if the Panel Physicians
or perform activities of daily living.
responds ‘yes’ to this question. For paper-based
Note:
medical certificates the ADL Assessment can be found
at Appendix 3. Where there is concern about capacity
• In male and female applicants, examination of the
for full employment, full details of the applicant’s
external genitalia is not required unless clinical
work history must be provided for the previous five
evidence is presented to indicate a condition
years as well as details of any anticipated employment
requiring notification.
restrictions and any pensions or government assistance
• Rectal examination is rarely if ever indicated.
currently being received. In either case, full details must
be provided of any required rehabilitation services
• Gynaecological examination (vaginal or pelvic
currently being provided to the applicant, or which will
examination) is never indicated in the context of the
be needed in the future. If an ADL assessment is not
IME. If there has been a history or clinical suspicion
appropriate e.g. for young children / babies, please
of gynaecological malignancy, refer the applicant to
finalise incomplete the ADL in eMedical and include an
a gynaecologist.
explanation as to why this is being done.
D22 Breast examination in women over 45 years of age
Referral to an appropriate physician is necessary for any
Examinations must be conducted with sensitivity and,
condition likely to significantly affect the applicant’s
in the case of a male Panel Physician, in the presence of
ability to function at home, study or work or perform
a chaperone.
activities of daily living.
If the applicant prefers, acceptable alternatives include:
eMedical will auto B-grade if the Panel Physician
• examination of the breasts by a breast specialist
answers ‘yes’ to this question.
• mammogram, or
D24 Evidence of drug-taking
• breast ultrasound or magnetic resonance scan.
Assessment includes:
Assessment includes:
• puncture marks, phlebitis
• nipple symmetry, eversion and discharge
• mental state
• evidence of peau d’orange or skin changes around
• smell of alcohol on the breath, signs of chronic liver
the nipple
disease in the context of alcohol dependence
• breast lumps or cancers, and
• any other indicators of drug-taking or addiction.
• axillary lymph nodes.
All abnormalities must be noted.
All abnormalities must be noted. Benign breast lesions
Referral to an appropriate physician, such as a
such as fibroadenoma or fibrocystic disease do not
psychiatrist, is necessary for:
need to be recorded and can be ‘A’ graded if a pathology
report is sighted and attached.
• any evidence of drug-taking
Referral to an appropriate physician is necessary for
• any condition likely to significantly affect the
any breast lumps, nipple abnormalities or axillary
applicant’s ability to function at home, study or work
lymphadenopathy.
or perform activities of daily living.
D23
eMedical will auto B-grade if the Panel Physician
Any physical or mental conditions which may prevent
confirms evidence of drug-taking.
this person from attending a mainstream school,
gaining full employment or living independently now
or in the future?
Consider any condition or finding that has current or
likely future impact, on the applicant’s capacity for
New Zealand Immigration Panel Member Instructions – February 2019 –
31
Section E Urinalysis and blood tests
E1 Urinalysis
Do not record additional dipstick results, for example,
white cells or ketones.
Dipstick is required as the initial urine screening test.
Although eMedical allows microscopy to be selected
Any additional pathology reports relating to urine
for initial urine screen, this should not be used for
testing should be attached to the IME. For paper-based
applicants in the first instance.
medical certificates, as with all attached documentation,
laboratory report sheets must all be initialled for
Every applicant five years of age or older who is having
authenticity and securely attached.
an examination for an INZ 501 Medical examination
(General Medical Certificate (INZ 1007)) must have their
This section cannot be completed until all results are
urine tested for the presence of albumin or protein,
received from the testing laboratory.
sugar and blood. Children younger than five years of age
should be tested either as a ‘clean catch’ or bag urine
E2 Blood tests
if there is a significant clinical indication, for example a
The Panel Physician is to select and recommend trusted
history of recent tonsillitis or a history of kidney disease.
laboratories to perform the tests required by INZ.
Women should be advised at the time of making an
For a 501 Medical examination (
General Medical
appointment not to attend during menstruation.
Certificate (INZ 1007)) the following blood tests are
However if this occurs, the dipstick should be delayed
required for all applicants 15 years of age and over or
until menstruation is completed.
where clinically indicated.
Urine should be passed at the time and place of the
• HbA1C (exam code 717 in eMedical)
IME in a secure collection area in the Panel Physician’s
• Estimated glomerular filtration rate eGFR
rooms, not in the laboratory (see ‘Specimen integrity’ in
(exam code 705)
Part 1 of these Instructions). To maintain the integrity of
the test, we recommend that the applicant is escorted
• Hepatitis B surface antigen (Hep B sAg) (exam code
and supervised during their access to the toilet. The use
708 in eMedical)
of a blue toilet dye is recommended to prevent toilet
• Hepatitis C antibody test (exam code 716 in eMedical)
water being used. Appropriately minimise the applicants
• HIV (exam code 707 in eMedical)
clothing and provide gowns, restricting access to
• Syphillis test (VDRL or RPR) (exam code 712 in
personal items such as handbags.
eMedical)
Panel Physicians should immediately check
• Full blood count (exam code 718 in eMedical)
for ‘freshness’ of the specimen (37ºC, bubbles,
Where applicable the Panel Physician should explain:
condensation on the jar). Specimens requiring referral
to a laboratory for further testing must be labelled with
• that these tests are required as a part of the IME
a de-identified label before transporting.
• the nature of infection/s with hepatitis B, C, HIV and
Recording urinalysis results
syphilis
• the nature of blood count and creatinine
Urinalysis results should be recorded as negative or
examinations
quantitatively, as:
• the nature of any discretionary tests requested
• Trace
• that the results will be provided to INZ.
• 1+
The Panel Physician must discuss the nature of testing
• 2+
with the applicant or, if the applicant is a person under
• 3+, or
18 years of age, with the applicant’s parent or guardian.
• Abnormal
Each of these tests requires a whole number value
Abnormalities will generate a repeat urinalysis in
(with the exception of the White Cell Count which should
eMedical. This should be done immediately before the
be recorded to one decimal place) or ‘non-reactive/
applicant leaves the premises.
reactive’ response by the Panel Physician.
Repeat urinalysis
When reviewing the laboratory tests, ensure that
the person collecting the blood, and/or receiving the
If a trace or more of protein, blood or glucose is
laboratory specimens has confirmed the applicant’s
detected, the urine dipstick test should be repeated
identity to confirm that the samples were collected from
immediately on a new specimen.
the individual identified on the IME. This is important
If the test is still positive, follow the requirements
to ensure there is no applicant substitution resulting in
that eMedical generates, which will depend on the
false negative tests.
abnormality identified. The table on pages 34 and 35
The laboratory reference standard ranges for each test
includes further instructions.
must be included in the results attached to the IME.
32 – New Zealand Immigration Panel Member Instructions – February 2019
Where the test(s) are serological for antibodies or
The following points need to be covered in discussion
antigens, the laboratory test used must be specified.
with the applicant, bearing in mind local ethical
standards and requirements:
This section cannot be completed until all results are
received from the testing laboratory.
• Information about the tests.
See the following table ‘Instructions for standard
• Implications and possible prognosis.
tests’ for further instructions about abnormal
• Ways of transmission of the organism/s.
or reactive blood tests. If the Panel Physician is
• Ways of protecting others from infection with the
requesting additional tests in eMedical, the exam code
organisms, in particular, the vaccination of close
125 Specialist’s report should be used if the relevant
contacts of hepatitis B carriers.
test does not exist in eMedical, with the examination
description amended to request the required test(s).
• Ways of minimising future complications.
• Referral for further information and support.
Paper - General Medical Certificate (INZ 1007)
A Laboratory Referral Form (Sections H and I) is included
• Referral for medical intervention.
and comprises one double-sided page (or two single-
The Panel Physician is to detail any referral in the
sided pages where the applicant has an unbound form),
‘General supporting comments’ field.
which must be detached from the medical certificate for
If asked about the effect that a positive test result may
the applicant to take to the laboratory for completion.
have on an applicant’s likelihood of meeting the INZ
The Panel Physician is to sign and date the form
definition of an acceptable standard of health, the Panel
including adequate address details where the results
Physician should state that this is a matter for INZ to
and the completed ‘Section I: Confirmation of identity
consider. Any further enquiries by the applicant should
and declaration’ are to be returned.
be referred to INZ.
Please provide these pages of the form to the applicant
Discretionary laboratory tests
along with directions to the laboratory. Where a second
battery of laboratory investigations are requested,
The Panel Physician is to consider any additional tests
the Panel Physician is to provide another laboratory
that they may advise, in any age group, because of any
identification form for identity confirmation purposes.
indication in the history, or examination or known local
A copy may be downloaded from
www.immigration.
conditions and risks (eg. the local risks of Trypanosoma
govt.nz/forms, or sought from INZ.
cruzi for Latin America and Spain) at the time of
completing the Laboratory Referral Form (sections H
It is acceptable for Panel Physicians to use their own
and I). Panel Physicians are expected to use their local
laboratory forms/process, with the proviso that ‘Section
knowledge of risk conditions and any recent information
I: Confirmation of identity and declaration’ is still
on disease incidence when selecting these tests:
completed by the applicant and the person taking the
specimens at the time of collection.
• lipids
The NHI number in Section H, is a New Zealand unique
• liver function tests
patient identifier. If a patient does not have such a
• creatinineMicroalbumin ratio
number this may be left blank.
• Trypanosoma cruzi antibody
Laboratory report sheets, as with all documentation
• faeces culture
attached to paper-based medical certificates, must be
• any other tests deemed necessary by the Panel
initialled for authenticity and securely attached.
Physician.
Positive tests
For further instructions, refer to the following table.
If an applicant’s blood tests are positive the Panel
Where discretionary tests are indicated, but not
Physician should either:
requested, INZ is likely to subsequently request these
tests, possibly with or without other assessments.
• arrange for a second consultation; and/or
The Panel Physician is to bear in mind, where clinically
• refer the applicant to his or her own doctor for
indicated tests are not provided, the additional time
appropriate follow-up.
that might be required to complete the application
and the possible consequences to the applicant of the
additional delays.
New Zealand Immigration Panel Member Instructions – February 2019 –
33
Instructions for standard tests
Test
Instructions
HbA1C (in mmol/mol)
• Enter value as a whole number
• If >80mmol/mol an Endocrinologist assessment is required
Estimated glomerular filtration
• Include creatinine test result in submission
rate – eGFR (in mL/min/1.73m2)
• Use paediatric eGFR calculators for applicants under the age of 18
• If eGFR<30 a Nephrologist report is required.
• Enter value as a whole number.
• If the exact eGFR value is provided this should be entered. If eGFR is indicated as being greater than
90 enter 91.
• Where a client is pregnant the serum creatinine test result should be completed and attached to the
examination and the eGFR test finalised incomplete.
Hepatitis B surface antigen
Add:
positive
• Hepatitis B e-antigen
• HBV DNA
• LFTs
• AFP, if over 30 years of age
• Liver Fibroscan scan report (this can be dated / performed within the preceding 3 years)
• If a Liver Fibroscan is not available in your country, then a current Liver Ultrasound should be provided
as an alternative
A Specialist report is required if:
• ALT >40
• HBV DNA >2,000 IU/mL
• AFP positive
• Liver Fibroscan >8.5kPA
• Any evidence of severe fibrosis or cirrhosis on Liver Fibroscan or Liver Ultrasound
Any history consistent with severe fibrosis or cirrhosis
Hepatitis C serology positive
Add HCV-RNA.
HIV positive
Add confirmatory tests such as Western Blot test or line-blot test.
HIV tests in children <15 years
Are required if:
of age
• mother is HIV positive, or
• child has history of blood or blood product transfusion.
Syphilis screening
Local screening test for syphilis should be done. All positive tests must be confirmed with
a treponemal specific test:
• treponema pallidum particle agglutination test (TP-PA), or
• fluorescent treponemal antibody absorption test (FTA-ABS), or
• microhaemagglutination for treponema pallidum (MHA-TP).
If positive then please provide specific details regarding any management required or given
(including drug names, doses and dates).
Full blood count
• Where results show significant anaemia [HGB<110 for men and HGB<90 for women] then repeat
The following tests are
test after a period of two weeks. When repeating FBC add ferritin.
required:
• If applicants have significantly abnormal values [HGB<60 for men and women, WBC>50] urgent
• Haemoglobin (HB in g/L)
medical follow-up should be provided by your clinic or an appropriate professional.
• White Blood Cells
• Enter values as whole numbers with the exception of the White Blood Cells which should be recorded
(WBC in cells x 109/L)
to one decimal place.
• Platelets (PLT in cells
x 109/L)
34 – New Zealand Immigration Panel Member Instructions – February 2019
Dipstick urinalysis positive
Add mid-stream urine sample. Send to laboratory for examination of red cell casts or dysmorphic
for albumin, protein, red
cells on microscopy.
cells, glucose AND the female
If positive for glucose only then check HBA1C and add albumin:creatinine ratio.
applicant does not have her
period (menstruation)
Haematuria Greater than 10
Repeat if repeat urine red cells>20 cells per high power field:
cells per high power field AND
• All males require referral to urologist.
the female applicant does not
• Females less than 40 years of age require three x urine cytology specimens and renal ultrasound scan.
have her period (menstruation)
• Females older than 40 years of age require three x urine cytology specimens, renal ultrasound scan and
referral to urologist.
Liver function tests
These should only be done if requested by INZ.
LFTs should include:
• total bilirubin
• alkaline phosphatase
• AST – aspartate aminotransferase (SGOT)
• ALT – alanine aminotransferase (SGPT)
• GGT – gamma glutamyltransferase
• Albumin
• total protein
If there are concerns during the assessment regarding the applicant’s Liver Function e.g. severe fibrosis,
cirrhosis, then a Gastroenterology assessment is required.
Lipids
These should only be done if requested by INZ.
These do not need to be fasting lipids.
A full Lipid Profile should be provided: Total cholesterol; LDL; HDL; Triglycerides; Chol:HDL ratio.
Faeces culture
Consideration should be given for intestinal parasite transmission risk from public health and occupational
perspectives (for example, chefs), for organisms such as ascaris, etc.
Thalassaemia screening
If the applicant has known Thalassemia, please include this information including the type e.g. Major / Minor.
Thalassemia screening is not routinely required, unless the examining physician deems them necessary.
Thyroid investigations
Thyroid Function Tests (TFTs) are not routinely required for Hypo- or Hyperthyroidism.
Large goitre, obstructing the airway:
• add a Thyroid Ultrasound.
Thyroid Nodules:
• No previous investigations – add a thyroid Ultrasound.
• Previous investigations – provide a copy of the previous reports.
Thyroid Cancer:
• A Specialist assessment is required.
Activities of Daily Living (ADLs)
This is required for any applicants with functional impairment.
Consider the need for a formal ADLs assessment for all applicants ≥70years of age.
New Zealand Immigration Panel Member Instructions – February 2019 –
35
Section F Examination Grading
This is section F in the paper
General Medical Certificate
• the Panel Physician has any concerns about the quality
(INZ 1007)
of the interpreting or the ability of any interpreter to act
appropriately or independently in fulfilling their role
The ‘A’/’B’ grading system is designed to allow rapid
identification of applicants who may have significant
• the applicant has not completed the tests required within
conditions or findings. eMedical assists by automatically
the required time frame, without credible explanation, or
grading ‘B’ in some cases, where the client’s history or
• there were any test(s) or examination(s) from the INZ
examination indicates certain findings.
protocol that were declined or not completed and any
stated reason(s) for this.
Panel Physicians must complete this section in accordance
with the following guidelines:
Note: the grading of the IME is not an assessment of whether
or not the applicant has met INZ’s requirements for having an
‘A’ Grade: No significant or abnormal findings present.
acceptable standard of health.
‘B’ Grade: Significant or abnormal findings present.
When is a condition or finding significant?
Panel Physicians take responsibility for the 501 Medical
Any condition is considered significant if it:
examination (
General Medical Certificate (INZ 1007)) at the
• represents a possible public health risk
time of grading even if other staff have performed data entry
• is likely to require substantial medical treatment now or
for some aspects of the case. Panel Physicians should ensure
in the future
that they have reviewed the applicant’s history, examination
results, x-ray and laboratory tests before grading and
• negatively impacts the applicant’s capacity for
submitting the health case. Where there is a 502 Chest x-ray
independent living
examination (
Chest X-ray Certificate (INZ 1096)) required, this
• negatively impacts the applicant’s intended work activity
must be completed by the Panel Radiologist before the health
in New Zealand, or
case can be submitted by the Panel Physician.
• presents a barrier to travel.
Where the Panel Physician disagrees with the grading of
Where significant abnormalities are detected, the Panel
the chest x-ray examination, this should be discussed with
Physician must refer the applicant to an appropriate
the Panel Radiologist. The 502 Chest x-ray examination
specialist. All test and investigation results and all specialist
(
Chest X-ray Certificate (INZ 1096)) grading should reflect
reports must be attached to the IME. This will ensure the
the 501 examination.
medical assessor will have the best available information
when making recommendations.
When deciding whether to grade ‘A’ or ‘B’, the most important
decision is whether or not a condition or finding is significant.
When is a condition or finding not significant?
A significant finding is one that should be further reviewed by
A condition is not significant if it does not have current or
an INZ medical assessor.
future implications for the applicant’s health. Minor past
If a B-grade is given, comments are a mandatory requirement
surgery, tattoos, incidental anatomical variations, trivial
under General Supporting Comments. If an A-grade is given,
medical conditions and previous illnesses with no ongoing
comments are optional. Comments on A graded medicals
implications are not significant. Routine medications for
should be pertinent to the applicant’s medical conditions
uncomplicated disorders of mild severity (for example,
and explain why they are or are not a concern. Do not write
salbutamol inhaler for mild asthma) are not significant.
comments such as “normal examination” or “normal Chest
In the absence of heritable disorders, the following are not
X-ray examination”.
considered to be significant:
The Panel Physician is to record any relevant summary
• appendicectomy
information that they wish to communicate to INZ, in
• tonsillectomy or adenoidectomy in childhood
particular whether:
• haemorrhoidectomy
• there is a significant family history
• herniorrhaphy
• there is any diagnosis or diagnoses and substantiate the
• Fenton’s repair
basis for these
• arthroscopic meniscectomy as a consequence of knee
• the applicant is hosting an infectious disease or there is
trauma
an immunisation or vaccination issue that might place the
• carpal tunnel release
New Zealand public’s health at risk
• rhinoplasty
• the Panel Physician has identified a serious illness and has
• minor cosmetic surgery, and
referred the applicant to their own physician for further
• vasectomy/tubal ligation.
investigation and treatment
• the Panel Physician is concerned about the use of other
The box ‘no significant or abnormal findings’ should be
substances of abuse or misuse eg cannabis, kava, khat,
ticked when:
amphetamines, narcotics, anabolic steroids, etc
• there is no family history of any heritable disorder
• there are inconsistencies in the history and the
• there is no history or existing chronic infection such as
examination
tuberculosis or HIV etc
36 – New Zealand Immigration Panel Member Instructions – February 2019
• the physical findings are completely normal, no significant
• no medical or surgical or psychiatric condition is present
recent weight loss, BMI in a normal range and less than
which would require further investigation or treatment,
or equal to 30, BP at or below the thresholds stated, no
now or in the future
significant cardiac murmurs, normal urinalysis, and a visual
• the applicant has complied with all of the Panel Physician’s
acuity no less than 6/18 in the best eye, corrected where
recommended examinations or procedures and the Panel
necessary
Physician has not recommended any further examination
• the applicant is not taking any regular medication or course
be performed and the applicant has not declined any
of antibiotics or undergoing any other regular therapy
recommendation or expectation.
• the chest x-ray and laboratory investigations (where
If in doubt contact INZ at
indicated) are all within normal limits
[email address]
Section G Panel Physician’s declaration
This is section G in the paper
General Medical Certificate
Validity
(INZ 1007).
INZ will accept the IME as valid for a period of three months
The Panel Physician responsible for the examination
from the date that the Panel Physician signed the declaration
completes the declaration after he or she has received and
or submitted the case on eMedical. In normal circumstances,
considered all the mandatory tests and reports, and all the
and where the health status of the applicant is unchanged,
supplementary tests and reports initiated as a consequence
the applicant may reuse the IME for up to 36 months in
of history or examination.
subsequent applications, at the discretion of INZ.
In completing the declaration, the Panel Physician is
Requests for further information by INZ
acknowledging responsibility for the integrity and quality
Following submission of an IME, INZ may consider that
of the entire IME process. INZ will regularly audit IMEs and
further medical information is required to establish whether
any evidence of failure to maintain integrity or quality of the
an applicant has an acceptable standard of health.
examination will result in closer scrutiny and possible removal
from the Panel.
Applicants requiring further investigations will be provided
with a letter from INZ asking them to return to the Panel
For paper-based medical certificates we require the Panel
Physician. For paper based clinics, the applicant must return
Physician to enter their New Zealand Medical Council’s
to the clinic where the original IME was done. For eMedical
unique registration identifier. Doctors not registered with
cases, the applicant is advised that they should return to
the New Zealand Medical Council are to state their equivalent
the original Panel clinic; however eMedical allows that they
current unique registration identifier and to append the name
may attend a different Panel clinic. In these situations, the
of the registering authority that has granted the registration.
‘new’ clinic must search for the applicant in eMedical once
Finalising an immigration medical examination
the applicant has made contact and progress the referral/
additional investigation(s) listed on the letter and/or
eMedical – Once the examination has been graded it may
eMedical. The case will then be locked to the new clinic’s inbox
be submitted. An applicant may have indicated at the pre-
in eMedical. For this reason clinics should not search for cases
exam stage of their IME that they wished to receive email
unless the applicant has made contact with the intention of
confirmation that that their health case has been completed.
the further investigation being completed through the clinic.
If so, then on submission of the applicant’s IME, an automated
email will be sent to them at the email address they provided,
Further investigations, reports or opinions, as requested by
confirming completion of their health case. Applicants will be
INZ, are to be provided by a specialist of the Panel Physician’s
advised to contact the clinic where their exam was completed
recommendation. As it is inappropriate for the Panel
if they require further information about their results.
Physician to act as a patient advocate, INZ also relies upon
any referred specialist assessment as being independent,
Paper-based medical certificates - Following grading and
objective, and providing an opinion that might be reasonably
signing of the certificate, the Panel Physician is to send the
obtained from any equivalent medical specialist. Within
certificate directly to INZ. More information about these
New Zealand, additional tests and specialist reports are not
requirements and the address to be used, will be provided at
available through the publicly funded health services provided
www.immigration.govt.nz/assist-migrants-and-students/
by the district health boards (DHBs). All specialist reports for
other-industry-partners/panel-physician-network/
immigration purposes are to be funded by the applicant.
medical-professionals
New Zealand Immigration Panel Member Instructions – February 2019 –
37
The specialist reports and investigations should be those
If no more information has been received after three months
that enable:
following referral for sputum collection, the Panel Physician
• a diagnosis to be made
should contact the applicant. If the applicant is undergoing
• a condition to be assessed as to whether it is mild,
TB treatment, they still need to attend the Panel clinic to
moderate or severe
submit sputum results, the treating physician’s report and
undergo a repeat chest x-ray. If the applicant states that they
• a prognosis to be determined.
do not want to complete the additional investigation, follow
When arranging for further investigation and reports, advise
the ‘finalise incomplete’ process outlined under ‘Incomplete
the specialist or consultant that:
IME results’ on page 19.
• the investigations or reports are required for the purposes
of INZ
• the specialist or consultant report must list their
qualifications and memberships
• the specialist or consultant must confirm that the person
who attends is the person who was referred
• the specialist or consultant must confirm identity
by referring to a passport or other document with
photographic identification
• the passport number or other identity document number
must be recorded on the report.
When arranging for further investigation and reports, advise
the applicant that they will need to attend the specialist
consultation with their passport or other acceptable
identification.
Time frame for further information
Once an applicant contacts a Panel clinic to follow up on the
additional requests, they should be allowed 28 days to do
so, unless it relates to TB investigation which takes longer.
If nothing is received from the applicant within two weeks
of making contact, they should be contacted by the clinic
to remind them of the outstanding requirement(s). If the
applicant states that they are not interested in continuing,
the additional requirement(s) should be finalised as
incomplete. If the applicant states an ongoing intention to
follow-up on the request, they should be allowed a further
week before a second contact is made. If nothing has been
received a week later (that is, four weeks from initial contact)
and the applicant has not provided a reason to justify further
delay, the additional requirements should be finalised as
incomplete. Doing so will result in submission of the IME case.
In cases where TB is suspected and the applicant is required
to undergo further investigation (requirement 603), the
timeframe will exceed 28 days.
Note: Applicants who need a 603 investigation and have
done only a chest x-ray previously should be referred to a
Panel Physician to initiate and coordinate these investigations
through a designated laboratory, where available. See
the Australian Department of Home Affairs Australian
Immigration Panel Member Instructions for locations:
https://www.homeaffairs.gov.au/Panelphysicians/
Documents/panel-member-instructions.pdf
The Panel Physician should review and attach the chest x-ray
report and sputum test results when available. Along with
a new chest x-ray image, these need to be attached to the
603 requirement in eMedical in order that the case can be
submitted.
38 – New Zealand Immigration Panel Member Instructions – February 2019
Part 3: Completing a 502 Chest x-ray examination (
Chest X-ray Certificate (INZ 1096))
This part of the Instructions provides advice about completion
• images should be free from applicant’s artefacts
of the:
(for example, hair and jewellery) and technical artefacts.
• 502 Chest x-ray examination (in eMedical), and
Special views
• Chest X-ray Certificate (INZ 1007) (in paper-format).
An apical lordotic view should be done for suspicious opacities
A chest X-ray examination must be undertaken by applicants
over ribs, clavicles or other structures and a lateral decubitus
who are applying for:
view for costophrenic angle blunting to exclude pleural
• a residence visa, or
effusion.
• a temporary entry class visa and intend to stay longer
CT scans should not be routinely performed unless clearly
than 12 months, unless they are applying for a military visa,
clinically indicated (for instance where malignancy is
diplomatic, consular or official visa, or a visa related to the
suspected) or if requested by INZ.
Antarctic Treaty, or
• a temporary entry class visa and intend to stay between
Radiation safety
six to 12 months and are from, or have visited, a place that
Radiation safety should be maximised by:
is not on INZ’s list of countries, areas and territories with
• routine use of lead shielding for all applicants
a low incidence of TB. The guide
Health Requirements
(INZ 1121) has more details and includes the full list.
• storing lead shields appropriately – not folded as this
may crack the lead and allow radiation leakage
Children under 11 years of age and women who are pregnant
• testing the integrity of lead shields annually by exposing
are not required to undergo a chest x-ray examination unless
them in front of an x-ray plate
requested by INZ. An applicant who has submitted the results
• selection of correct film size
of a chest x-ray examination to INZ within the previous
36 months may not need a new chest X-ray certificate.
• x-ray beam collimation (narrowing of the beam so that
The guide
Health Requirements (INZ 1121) provides further
only the target area is exposed)
information.
• ensuring correct radiography procedures and machine
settings are used to minimise repeat exposures being
Chest x-ray examinations are completed by uploading
asked for technical reasons
the compressed x-ray image in DICOM format in eMedical,
• avoiding unnecessary additional x-rays or scans,
or by using the paper
Chest X-ray Certificate (INZ 1096).
in particular Computerised Tomography (CT) scans,
Applicants may require an interpreter or a chaperone to
unless clearly clinically indicated or requested by INZ
be present. The details of the chaperone and/or interpreter
• minimising radiographer exposure
must be recorded on the IME.
• ensuring all staff in the radiography working area wear
dosimeters (radiation badges).
For the following sections in the chest x-ray examination,
refer to the equivalent requirements in Part 2: Completing
X-ray image identification
a 501 Medical examination (
General Medical Certificate
The x-ray image must bear the:
(INZ 1007)):
• date of the examination
• Section A - Personal details (see Section A
• applicant’s full name in English
– Personal details (eMedical Pre-exam stage))
• Section B
• applicant’s date of birth
- Client consent and declaration
(see Section C – Client consent and declaration)
• the name of the x-ray clinic
Taking the chest x-ray
The NZER ID may be included. eMedical enabled Panel clinics
should refer to the agreed naming conventions for mandatory
Radiographic technique
attachments in Module 8 of the eMedical User Guide, found in
Chest x-rays should be taken in the PosteroAnterior (PA)
eMedical, in relation to chest x-ray images.
projection to reduce cardiac magnification. Panel Radiologists
Film size for paper-based medical certificates
should ensure:
For paper-based medical certificates, full-size 14” x 17”
• penetration should be such that the first four vertebral
(35cm x 42cm approximately) PA films should be submitted
bodies well (T1-T4) and the ribs are visible, while the rest
for routine x-ray examinations of the chest. If this is
of the vertebrae should be just visible through the heart
unavailable, contact INZ. Image files on CD’s are not
shadow
accepted in lieu of hardcopy prints.
• chest x-rays should be taken in full inspiration, evidenced
by the diaphragm lowered to the level of the 10th or 11th
X-ray images for eMedical
rib posteriorly
eMedical images should be submitted as DICOM files with
• that the applicant should be positioned perpendicular
a file size of approximately 5mb. The type of x-ray image
to the x-ray beam so that the medial ends of the clavicles
(for example, PA view, lateral view) should be recorded in
are equidistant from the spinous processes of the thoracic
the ‘details’ section at the time of attachment. eMedical
vertebrae
images must not be submitted as JPEG files unless directly
• scapulae should be clear of the lung fields and both apices
asked by us.
and costophrenic angles visible
New Zealand Immigration Panel Member Instructions – February 2019 –
39
Women
The 603 examination includes a pulmonologist/chest
Women of reproductive age may be unknowingly pregnant
physician opinion, sputum testing (smear and culture) and
at the time of the x-ray and must be provided with protective
a repeat x-ray at the end of cultures. More information is
lead shielding in preparation for x-ray exposure.
provided under ‘Tuberculosis’ on page 27 in Part 2: Completing
a 501 Medical examination (
General Medical Certificate
Panel Radiologists have an ethical obligation to ensure that
(INZ 1007)) of these Instructions.
all applicants are adequately protected and must be vigilant
in avoiding unnecessary radiation exposure.
For paper-based medical certificates where there is a high
suspicion of active TB (Question C8), the Panel Radiologist
All female applicants who declare they are pregnant should be
or Panel Physician should immediately refer the applicant for
advised that INZ does not require a chest x-ray examination
sputum testing and a chest physician referral.
and that their chest x-ray examination will be set aside.
Reporting tuberculosis findings
Children
Any findings consistent with new or old TB should be marked
Children under 11 years of age are not required to undergo
as ‘present’ on Question 6 (evidence of TB) and recorded
a chest X-ray examination unless requested to do so by
in the text field that accompanies it. This will generate an
INZ, or where the Panel Physician detects respiratory signs
automatic ‘B’ grade of the case once prepared for grading.
which may be indicative of a significant medical condition
(such as pneumonia). In this case the Panel Physician may add
Findings that are highly suggestive of active TB should be
a 502 examination in eMedical. Indications should be clearly
marked accordingly on Question 7. Please note that this field
outlined in the medical examination section.
should only be marked ‘yes’ when the findings are convincing
for active disease (for example, extensive infiltration or
Radiation exposure should be kept to a minimum. Film size
cavitation). This question should not be answered ‘yes’ simply
should be adequate to include the chest only. Abdominal
if a suspicion of active disease exists, or if active disease
shielding and correct collimation should be used.
cannot be excluded. Use of this function should be restricted
Film examinations and reporting
to findings that are convincing for new lesions in potentially
infectious applicants.
The x-ray film is to be read by the Panel Radiologist who
must also complete the findings. The correct name, date
Answering ‘yes’ to Question 7 will auto-generate requirement
and anatomical side markers should be included. Look at
603 when the case is prepared for grading. This requirement
the so-called ‘hidden’ areas:
needs three items for completion, two document
attachments and one x-ray image as follows:
• behind the heart
• apices
• sputum results (including culture and DST where positive,
when finalised)
• costophrenic angles
• chest physician report
• both hila
• chest x-ray obtained at completion of culture.
• paratracheal regions
• below the diaphragms.
Please note that if the 603 requirement has been auto-
generated, it can only be completed by the clinic which
Sometimes a nodule in the lower zones may be difficult
started the eMedical case. This is different to cases where INZ
to differentiate from a nipple shadow. Repeat x-ray with
has requested further information (including 603 or any other
nipple markers to confirm. The extent and likely activity of
requirement), where the client is able to attend a different
any disease present should be described and any necessary
clinic if they have changed location.
further investigations recommended. Panel Radiologists
should report all abnormalities on an x-ray film and their
If an applicant indicates that they do not want to undergo
possible interpretation and cause in the 502 comments field
further investigation relating to the 603 requirement, this
in eMedical.
requirement can be marked as incomplete and the IME case
submitted (after grading) without it. When submitting cases
If the Panel Radiologist reports x-ray findings which are
with incomplete requirements, these cases need to be graded
highly suspicious of active TB (Question 7 in eMedical), then
‘B’ and comment made that the applicant declined further
eMedical will automatically generate a 603 referral for further
investigation.
investigation. Such changes would include cavitation, effusion
or soft infiltrate. In these cases, Question 7 (Are there findings
Grading ‘A’ or ‘B’
which are highly suspicious of active TB?) should be answered
eMedical assists Panel Members by automatically grading
‘yes’. Question 7 must not be answered ‘yes’ where TB is
cases as ‘B’ if significant fields are marked abnormal.
merely suspected. High suspicion must exist, such as occurs
in findings consistent with new, infectious lesions. If Question
The following findings are not considered significant and
7 is answered ‘yes’ and the applicant is in New Zealand, the
should be ‘A’ graded, with all fields on the 502 requirement
Panel Radiologist is required to refer that applicant to the
(Chest X-ray Certificate (INZ 1096)) marked normal. If a Panel
local medical officer of health for further investigation and
Radiologist wants to note such findings, they can be included
contact tracing. This is a mandatory requirement under the
as a general supporting comment next to the ‘A’ grading:
Health Act 1956 (section 74).
• aortic calcification
• apical capping (with smooth border)
40 – New Zealand Immigration Panel Member Instructions – February 2019
• azygous fissure/lobe or other accessory fissures
• breast implants
• cardiomegaly, mild (CTR < 60%)
• dextrocardia or situs inversus
• nipple shadows
• pectus excavatum
• raised hemi-diaphragm
• rib abnormalities (for example: cervical ribs, previous
rib fractures, bifid ribs and congenital rib fusion)
• scoliosis
All other abnormalities, including evidence of current or
previous infectious disease (including old TB), as well as
significant extra-pulmonary abnormalities (such as evidence
of heart disease) must be ‘B’ graded. Do not include
unnecessary comments such as “Normal Chest study”
or “Normal Examination”.
In cases where evidence exists of previous significant surgery,
then the Panel Radiologist should provide details and grade
the case ‘B’. Examples include:
• cardiac valve replacement
• sternal wiring
• vascular stents/shunts
• absent breast/s.
Cardiomegaly should only be reported if the cardio-thoracic
ratio is greater than 60 per cent (0.60) on well inspired film
and/or the cardiac shadow or vasculature indicates suspicion
of heart disease (such as atrial enlargement or pulmonary
hypertension).
Declaration by examining radiologists
In making the declaration, Panel Radiologists must ensure:
• that all information is accurate before submitting the
IME case in eMedical
• for paper-based medical certificates that the date, place
of examination and the Panel Radiologist’s name are
clearly stated.
Panel Radiologists should submit the case, or sign the
declaration, after the results of the radiological examination
are recorded fully and in consideration of the examination and
any additional investigation which may have been performed.
In submitting the case on eMedical, or signing the declaration
for paper-based medical certificates, the Panel Radiologist
is acknowledging responsibility for the integrity and quality
of the radiological examination process. INZ routinely and
randomly audits all radiological examinations and any
evidence of failure to maintain integrity and quality of
the examination will result in closer scrutiny of the Panel
Radiologist and possible removal from the Panel.
Finalising an immigration medical examination
Please refer to ‘Finalising an immigration medical
examination’ in part 2: Completing a 501 Medical examination
(
General Medical Certificate (INZ 1007)) for further information
as this information is applicable to both examination types.
New Zealand Immigration Panel Member Instructions – February 2019 –
41
Part 4: Completing a 512 Limited medical examination (
Limited Medical Certificate (INZ 1201))
This part of the Instructions provides advice about completion
Advice for Panel Radiologists on how to complete the
of the:
accompanying chest x-ray examination is provided in Part
• 512 Limited medical examination (in eMedical), and
3: Completing a 502 Chest x-ray examination (Chest X-ray
• Limited Medical Certificate (INZ 1201) (in paper-format).
Certificate (INZ 1096)).
This examination is only for partners and dependent children
Applicants may require an interpreter or a chaperone to be
of New Zealand citizens and residents, refugees and people
present. The details of the chaperone and/or interpreter must
with protection status in New Zealand. It only screens for
be recorded on the IME.
those conditions for which INZ cannot grant a medical waiver.
Section A Personal details (eMedical Pre-exam stage)
The questions in this section are for the purpose of
• is applying under the Refugee Quota Family Reunification
establishing the identity of the client and collecting
(RQFR) Category.
information for INZ.
Selecting Humanitarian ‘UNHCR’ will ensure that the ‘Medical
eMedical - 512 Limited medical examination
history’ section does not appear in the eMedical examination,
as these applicants are not expected to answer the ‘Medical
Panel clinics will need to complete this section for INZ clients
history’ questions. When undertaking a 512 Limited medical
requiring an IME.
examination for a Humanitarian UNHCR or RQFR applicant,
Paper - Limited Medical Certificate (INZ 1201)
a 707 HIV test must be manually added by the Panel Physician
for all applicants regardless of their age. Do not add a chest
This section is marked ‘Section A’ and should be completed
X-ray examination requirement in eMedical for Humanitarian
by the client prior to attending the IME except for question
UNHCR applicants in the pre-exam stage (or complete
A1 which must be completed by the Panel Physician or a
a paper-based chest x-ray examination). INZ will advise
delegated staff member.
you when an x-ray examination is required.
Identity
Refugees diagnosed with HIV/AIDs will not be excluded from
See ‘Confirming the identity of applicants’ on page 16
resettlement in New Zealand. However, it is important for INZ
in Part 1 of these Instructions.
to know whether refugees have HIV or AIDS before they come
to New Zealand, so that New Zealand medical services are able
Applicant’s visa category
to prepare for their care and treatment.
As the applicant requires a 512 Limited medical examination,
The ‘Humanitarian other’ option is for applicants who have
one of the following visa category and visa type options
been granted refugee or protection status in New Zealand
will be applicable. In eMedical, the applicant’s answer to
and are now applying for residence. The refugee’s partner
this question will ensure the relevant questions and/or
and/or dependent child(ren) should also be included under
tests are applied to the applicant. The applicant will need
this option. These applicants must answer the ‘Medical
to select from the following list:
history’ section and are not required to undergo an HIV test.
• Temporary
• Visitor
Immigration Advisers
• Student
If the applicant has an immigration adviser and would like
• Worker with job offer
them to be able to contact the clinic on their behalf, the
• Worker without job offer
applicant and their adviser should complete the INZ form
Immigration Adviser Details (INZ 1160) and ask that a copy
• Residence
of the form be attached to their health case records.
• Skilled / Business
• Pacific Categories
Option for automated email confirming submission of
• Family
health case to INZ
• Humanitarian UNHCR
Applicants can confirm that they wish to receive an
• Humanitarian other
automated email confirming the submission of their health
• Work to Residence
case to INZ and provide a personal email address for this
• Worker
purpose. Upon submission of the applicant’s health case
an automated email will be sent to the address provided.
• Family of worker
Applicants will be advised to contact the clinic where their
* The ‘Humanitarian UNHCR’ option must be selected where
exam was completed if they require further information about
the applicant:
their results.
• is mandated as a refugee by the United Nations Refugee
Agency and is included in INZ’s Refugee Quota Programme,
or
42 – New Zealand Immigration Panel Member Instructions – February 2019
eMedical information sheet
• client identity details
After a health case has been created, an information sheet
• client visa details, and
can be printed for the client at any time. The information
• instructions for the client.
sheet includes the:
Please print the Information Sheet and give it to the client
• client’s photo
before he/she leaves the clinic. This information sheet will
• INZ reference number (NZER)
be used by the client as proof that their immigration medical
• client’s personal details
examination has been initiated when they submit their visa
application.
Section B Medical history
This section does not need to be completed by:
a paper-based medical certificate must be signed or initialled
• mandated refugees who have been selected as candidates
by the Panel Physician and securely attached).
for New Zealand’s Refugee Quota Programme, or
B5 Are you pregnant? What is the expected date of
• applicants under the Refugee Quota Family Reunification
delivery?
(RQFR) Category.
For the Limited medical examination this question is
Clients completing a paper-based medical certificate may
only required in order to establish whether a chest
complete ‘Section B Medical history’ before their IME. If it
x-ray examination can be undertaken. If the applicant
has not been completed, a Panel Physician (or delegated
is pregnant, INZ does not require a chest X-ray
staff member) must complete this section with the client.
examination. Answering ‘yes’ to this question will
For eMedical cases, these questions can only be answered
automatically set aside any chest x-ray examination
during the IME.
requirement in eMedical.
For a child who is younger than 18 years of age, the medical
If the client declares that they are pregnant they should
history section must be completed by a parent or guardian,
provide a letter from their own doctor or lead maternity
or the Panel Physician with the parent or guardian.
carer (obstetrician) confirming their pregnancy. This
Panel physicians must discuss the applicant’s medical history
letter should be scanned and attached to the health
with them even where the applicant has completed the
case. Otherwise the client should be asked if they are
medical history questions before their IME.
Do not assume
willing to have a BHCG test added to the standard blood
that the applicant has understood the questions.
tests required. If they are unwilling to undergo the blood
test they may be required to provide a letter from their
These questions are designed to assist the Panel Physician
doctor or lead maternity carer (obstetrician) to confirm
to assess aspects of the applicant’s health which are of
their pregnancy and the expected date of delivery (EDD).
particular relevance and importance to the New Zealand
Government’s health requirements.
Panel Physician’s declaration
If the applicant answers ‘Yes’ to any question, note relevant
The Panel Physician undertaking the IME must declare that
details such as date of diagnosis, progress, current problems,
they have discussed the applicant’s medical history with them
complications and treatment so far. Attach any reports, tests
(or the applicant’s parent or guardian if the applicant is under
and other information available (all items being attached to
18 years of age or is an ‘incapable person’).
Section C Client consent and declaration
The client consent and declaration must be signed
Please refer to ‘Section C - Client consent and declaration’
and dated by the applicant in the presence of the
in Part 2: Completing a 501 Medical examination (
General
Panel Member.
Medical Certificate (INZ 1007)) for further information as
this requirement is applicable to both examination types.
Section D Physical examination
The physical examination questions below are listed in
the health of the applicant in relation to questions in this
alphanumeric order for the purposes of the paper
Limited
section. This may require that all clothing is removed, with
Medical Certificate (INZ 1201) and will appear in the same
the exception of underwear. Appendix 1 provides a diagram
order in the eMedical 512 Limited medical examination.
that you may wish to display in your clinic waiting room,
change and/or examination room.
Applicants must be asked to remove sufficient clothing in
order to enable the Panel Physician to adequately assess
New Zealand Immigration Panel Member Instructions – February 2019 –
43
For more information see ‘Privacy considerations’ in Part 1
If yes, a 115 Nephrologist’s Report is required and will
of these Instructions.
be auto-added in eMedical. If a paper-based medical
certificate is being completed, refer to an appropriate
A chaperone should be offered and their details recorded if
specialist.
one was present.
D3 Are there any indications that this applicant has
This section must be completed in full. Paper-based medical
haemophilia?
certificates which are illegible will be returned for clarification.
Examples: spontaneous or pathological bruising,
The Panel Physician is accountable for the integrity of all
swelling, bleeding into joints, muscles and soft tissues;
facets of the IME.
history of blood or blood product transfusion.
Medical findings
If yes, attach relevant specialist reports or refer to an
The Panel Physician is to provide detailed comment on
appropriate specialist.
examination findings regarding the nature, severity and
possible/likely prognosis of the medical condition and or
D4 Are there any indications of a physical, intellectual,
disability to enable INZ to clearly understand and appreciate
cognitive and/or sensory incapacity which may
the examined person’s state of health where:
require full-time care?
• ’Yes’ has been answered to a question in the ‘Medical
Examples: any medical, health, education or disability
history’ section, or
services input?
• examples listed next to the physical examination questions
If yes, a 112 Neurological Report is required and will
are present.
be auto-added in eMedical. If a paper-based medical
If reports from specialists are provided attach these to the
certificate is being completed, refer to an appropriate
eMedical IME, or for ppaper-based medical certificates,
specialist.
authenticate these by initialling each page and attaching
D5 Does the person have any symptoms or signs of
securely to the certificate. Where INZ requires referral to an
previous or current tuberculosis, of any form?
appropriate physician, a recent report less than six months is
acceptable.
• Tuberculosis must be considered in any applicant
who presents with:
If abnormalities indicate a specialist report is necessary for a
UNHCR refugee or RQFR applicant, the IOM physician should
• a history of cough lasting longer than three
contact the IOM Regional Office in Canberra, which will consult
weeks, night sweats, haemoptysis, chest pain,
with INZ’s Refugee Quota Branch regarding the availability
unexplained weight loss, HIV, close contacts with
and necessity of recommended reports.
TB, abnormal chest X-ray, abnormal sputum, skin
or blood tests, etc, or
Timely medical tests
• focal abnormalities on auscultation.
All other medical tests required or indicated as a result of the
If yes, a 603 Chest Clinic TB Investigation is required
examination should be carried out on or about the date of the
and will be auto-added in eMedical. Review and follow
medical examination.
the information provided under ‘Tuberculosis’ and ‘TB
investigation’ on pages 27 and 28 in Part 2: Completing
D2 Are there any indications that this applicant requires
a 501 Medical examination (
General Medical Certificate
or will require dialysis in the next five years?
(INZ 1007)) as the requirements are the same.
Examples: severe diabetes, renal surgery scars or
stomas, shunts, hypertension, abnormal renal tests,
or polycystic kidney disease.
Section E Blood tests
Standard laboratory tests
Quota Family Reunification (RQFR) Category, an HIV test
The Panel Physician is to select and recommend trusted
(exam code 707 in eMedical) is also required, regardless of the
laboratories to perform the tests required by INZ.
applicant’s age.
For a 512 Limited medical examination (
Limited Medical
Where applicable the Panel Physician should explain:
Certificate (INZ 1201)) the following blood tests are required
• that these tests are required as a part of the IME
for all applicants 15 years of age and over or where clinically
• the nature of blood count and creatinine examinations
indicated:
• the nature of infection/s with HIV
• Estimated glomerular filtration rate (eGFR - exam code
• that the results will be provided to INZ.
705 in eMedical)
The Panel Physician must discuss the nature of testing with
• Full blood count (exam code 718 in eMedical).
the applicant or, if the applicant is a person under 18 years of
For all ‘UNHCR’ mandated refugees included in INZ’s Refugee
age, with the applicant’s parent or guardian.
Quota Programme and applicants applying under the Refugee
44 – New Zealand Immigration Panel Member Instructions – February 2019
eGFR and full blood count tests require a value response by
Positive tests
the Panel Physician. An HIV test requires a ‘non-reactive/
If an applicant’s blood tests are positive the Panel Physician
reactive’ response.
should either:
When reviewing the laboratory tests, ensure that the
• arrange for a second consultation; and/or
person collecting the blood, and/or receiving the laboratory
• refer the applicant to his or her own doctor for appropriate
specimens has confirmed the applicant’s identity and to
follow-up.
confirm that the samples were collected from the individual
identified on the IME. This is important to ensure there is no
The following points need to be covered in discussion with
applicant substitution resulting in false negative tests.
the applicant, bearing in mind local ethical standards and
requirements.
The laboratory reference standard ranges for each test must
• Information about the tests.
be included in the results attached to the IME.
• Implications and possible prognosis.
Where the test(s) are serological for antibodies or antigens,
• Ways of transmission of the organism/s.
the laboratory test used must be specified.
• Ways of protecting others from infection.
This section cannot be completed until all results are received
• Ways of minimising future complications.
from the testing laboratory.
• Referral for further information and support.
• Referral for medical intervention.
See the table ‘Instructions for standard tests’ on page 34
for further instructions about abnormal or reactive blood
The Panel Physician is to detail any referral in the ‘General
tests. If the Panel Physician is requesting additional tests
supporting comments’ field.
in eMedical, the exam code 125 Specialist’s report should be
If asked about the effect that a positive test result may have
used if the relevant test does not exist in eMedical, with the
on an applicant’s likelihood of meeting the INZ definition of
examination description amended to request the required
an acceptable standard of health, the Panel Physician should
test(s).
state that this is a matter for INZ to consider. Any further
Paper - Limited Medical Certificate (INZ 1201) - A Laboratory
enquiries by the applicant should be referred to INZ.
Referral Form (Sections H and I) is included and comprises
Where significant abnormalities are detected, the Panel
one double-sided page (or two single-sided pages where the
Physician must refer the applicant to an appropriate
applicant has an unbound form), which must be detached
specialist. All test and investigation results and all specialist
from the medical certificate for the applicant to take to the
reports must be attached to the IME. This will ensure the
laboratory for completion. The Panel Physician is to sign and
medical assessor will have the best available information
date the form including adequate address details where the
when making recommendations.
results and the completed ‘Section I: Confirmation of identity
and declaration’ are to be returned.
Requirement for a 502 Chest x-ray examination
Please provide these pages of the form to the applicant along
(Chest X-ray Certificate (INZ 1096))
with directions to the laboratory. Where a second battery of
Applicants who are undertaking a 512 Limited medical
laboratory investigations are requested, the Panel Physician is
examination (
Limited Medical Certificate (INZ 1201) will
to provide another laboratory identification form for identity
generally also need to undergo a chest x-ray examination.
confirmation purposes. A copy may be downloaded from
Do not add a chest X-ray examination requirement in
www.immigration.govt.nz/forms, or sought from INZ.
eMedical (or complete a paper Chest X-ray Certificate
(INZ 1096)), however, for ‘UNHCR’ mandated refugees
It is acceptable for Panel Physicians to use their own
or Refugee Quota Family Reunification (RQFR) Category
laboratory forms/process, with the proviso that ‘Section I:
applicants until requested to do so by INZ.
Confirmation of identity and declaration’ is still completed by
the applicant and the person taking the specimens at the time
Please refer to Part 3: Completing a 502 Chest x-ray
of collection.
examination (
Chest X-ray Certificate (INZ 1096)) for further
The NHI number in Section H, is a New Zealand unique patient
information about chest X-ray examination requirements.
identifier. If a patient does not have such a number this may
be left blank.
Laboratory report sheets, as with all documentation attached
to paper-based medical certificates, must be initialled for
authenticity and securely attached.
New Zealand Immigration Panel Member Instructions – February 2019 –
45
Section F Examination grading
This is section F in the paper
Limited Medical Certificate
The examination may be A-graded unless it appears that
(INZ 1201)
the applicant:
Panel Physicians take responsibility for the 512 Limited
• may require dialysis in the next five years
medical examination (
Limited Medical Certificate (INZ 1201))
• has haemophila
at the time of grading even if other staff have performed
• has a physical, intellectual, cognitive and/or sensory
data entry for some aspects of the case. Panel Physicians
incapacity which may require full-time care, including
should ensure that they have reviewed the applicant’s history
care in the community
(where applicable), examination results, x-ray and laboratory
• has symptoms or signs of previous or current TB of
tests before grading and submitting the health case. Where
any form.
there is a 502 Chest x-ray examination (
Chest X-ray Certificate
(INZ 1096)) required, this must be completed by the Panel
Where UNHCR refugees and RQFR applicants are found to be
Radiologist before the health case can be submitted by the
HIV positive, a B-grade should be given. This is not for the
Panel Physician (except in case of ‘UNHCR’ mandated refugees
purpose of excluding them from resettlement in New Zealand,
and RQFR Category applicants who undergo chest x-ray
but to ensure they are quickly brought to INZ’s attention for
examinations at a later stage).
planning purposes.
Where the Panel Physician disagrees with the grading of
If a B-grade is given, comments are a mandatory requirement
the chest x-ray examination, this should be discussed with
under ‘General Supporting Comments’. If an A-grade is given,
the Panel Radiologist. The 512 Limited medical examination
comments are optional.
(
Limited Medical Certificate (INZ 1201)) grading should reflect
If in doubt contact INZ at:
the 512 examination.
[email address]
The 512 Limited medical examination (
Limited Medical
Note: the grading of the IME is not an assessment of whether
Certificate (INZ 1201)) has been designed so that only those
or not the applicant has met INZ’s requirements for having an
medical conditions which would prevent INZ granting a
acceptable standard of health.
medical waiver are identified. If the answer is ‘Yes’ to any
of the ‘Physical examination’ questions, eMedical will auto-B
grade the examination.
Section G Panel Physician’s declaration
This is section G in the paper
Limited Medical Certificate
(INZ 1201).
Please refer to ‘Section G – Panel Physician’s declaration’
in part 2: Completing a 501 Medical examination (General
Medical Certificate (INZ 1007)) for further information as
this requirement is applicable to both examination types.
Finalising an immigration medical examination
Please refer to ‘Finalising an immigration medical
examination’ in part 2: Completing a 501 Medical examination
(
General Medical Certificate (INZ 1007)) for further information
as this requirement is applicable to both examination types.
Requests for further information by INZ
Please refer to ‘Requests for further information by INZ’
in part 2: Completing a 501 Medical examination (
General
Medical Certificate (INZ 1007)) for further information as
this requirement is applicable to both examination types.
46 – New Zealand Immigration Panel Member Instructions – February 2019
Part 5: Completing a Supplementary medical certificate (with 707 HIV) (
RSE Scheme
Supplementary Medical Certificate (INZ 1143))
This part of the Instructions provides advice about completion
eMedical - When creating an Up-Front medical examination
of the:
for a Supplementary medical certificate, select the following
• Supplementary medical certificate (with 707 HIV)
options under the ‘Proposed Visa Application details’ section:
(in eMedical), or
• Visa category – Temporary
• R
SE Scheme Supplementary Medical Certificate (INZ 1143)
• Visa type – Worker with job offer
(in paper-format).
Then under the ‘Required certificates’ section, select the
This examination is only for seasonal workers who are
following:
travelling to New Zealand on a temporary limited visa under
• Medical – Supplementary
the Recognised Seasonal Employment scheme. This scheme
• Radiology – X-ray (if required)
allows New Zealand’s horticulture and viticulture industries
to recruit workers over the age 18 from overseas for seasonal
For the following sections in the Supplementary medical
work where New Zealand workers are not available. The only
certificate, refer to the equivalent requirements in Part 2:
examination requirement is an HIV test.
Completing a 501 Medical examination (
General Medical
Certificate (INZ 1007)) for other relevant information:
A chest X-ray examination may also be required if the
applicant will be staying in New Zealand between six to
• Section A - Personal details (see Section A – Personal
12 months and are from, or have visited, a place that is not
details (eMedical Pre-exam stage))
on INZ’s list of countries, areas and territories with a low
• Section C - Client consent and declaration (see Section C
incidence of TB. The guide
Health Requirements (INZ 1121)
– Client consent and declaration)
has more details and includes the full list.
Applicants may require an interpreter or a chaperone to
be present. The details of the chaperone and/or interpreter
must be recorded on the IME.
Section B Blood test
The Panel Physician should explain to the applicant:
Laboratory report sheets, as with all documentation attached
• that this test is required as a part of the IME
to paper-based medical certificates, must be initialled for
• the nature of testing for HIV
authenticity and securely attached.
• that the result will be provided to INZ.
Positive test
An HIV test requires a ‘non-reactive/reactive’ response.
If the initial test is positive, a second confirmatory test
When reviewing the laboratory test, ensure that the
is required. Acceptable confirmatory tests are enzyme
person collecting the blood, and/or receiving the laboratory
immunoassays, including core-antigen tests, immunoassays,
specimens has confirmed the applicant’s identity to confirm
including Western blot and line-blot tests, or nucleic
that the sample was collected from the individual identified
acid tests. If the confirmatory test gives an equivocal or
on the IME. This is important to ensure there is no applicant
indeterminate result, the test should be repeated and a
substitution resulting in false negative tests.
nucleic acid test performed.
Paper –
RSE Scheme Supplementary Medical Certificate
Where an HIV diagnosis is made, the Panel Physician must
(INZ 1143)
ensure that post-test counselling is carried out in accordance
with local protocols and standards.
A Laboratory Referral Form (Sections E and F) is included and
comprises one double-sided page (or two single-sided pages
Finalising a Supplementary medical certificate
where the applicant has an unbound form), which must be
There is no option to grade a Supplementary medical
detached from the medical certificate for the applicant to
certificate – just to record the result of the HIV test, any
take to the laboratory for completion. The Panel Physician is
relevant comments and the 502 Chest x-ray examination
to sign and date the form including adequate address details
results, if it is a required examination. The Panel Physician
where the results and the completed ‘Section F: Confirmation
must then submit the IME (if being undertaken in eMedical).
of identity and declaration’ are to be returned.
For paper-based medical certificates refer to ‘Finalising an
It is acceptable for Panel Physicians to use their own
immigration medical examination’ in Part 2: Completing a 501
laboratory forms/process, with the proviso that ‘Section I:
Medical examination (
General Medical Certificate (INZ 1007))
Confirmation of identity and declaration’ is still completed by
for further information as these requirements are applicable
the applicant and the person taking the specimens at the time
to both examination types.
of collection.
New Zealand Immigration Panel Member Instructions – February 2019 –
47
Part 6: Information for eMedical enabled clinics
What is eMedical?
Telephone enquiries should be directed to:
eMedical is an electronic processing system that is used by
• +64 9 914 4100 (from outside New Zealand)
clinic staff and Panel Members to record the results of IMEs,
• 09 914 4100 (from Auckland)
and submit the results to INZ. eMedical is currently used by
• 04 910 9915 (from Wellington)
the Australian Department of Home Affairs, Citizenship and
• 0508 558 855 (the rest of New Zealand)
Immigration Canada (CIC) and INZ.
For critical incidents that is, system is ‘down’ and you have
All eMedical enabled clinics must use eMedical where
tried again but you still are unable to logon to eMedical,
technically possible. eMedical clinics should not complete
contact the Australian Department of Home Affairs IT
paper-based medical certificates at the request or direction
support section immediately by phone if possible.
of applicants or their representatives and they should be
directed to contact INZ if they have concerns. Using the
Phone: +61 2 6264 0400
available electronic IME processing technology will become
Email: [email address]
a key requirement in terms of continuing as a member of the
New Zealand panel network.
Confirmation of IME case submission in eMedical
Further general information about the eMedical system and
INZ applicants can confirm at the pre-exam stage of their
electronic processing is available on the INZ’s website: See:
examination that they wish to receive an automated email
www.immigration.govt.nz/assist-migrants-and-students/
confirming the submission of their health case to INZ and
other-industry-partners/panel-physician-network
provide a personal email address for this purpose. Upon
submission of the applicant’s health case an automated
Non-eMedical enabled clinics with questions relating to the
email will be sent to the address provided. Applicants will be
technical requirements or implementation should contact INZ.
advised to contact the clinic where their exam was completed
INZ Up-front medical examinations
if they require further information about their results.
INZ clinical are ‘Up-front’ medical cases, this means that there
eMedical and personal information
will not be a record of the applicant in eMedical when they
The information sheet
Preparing your clinic for eMedical
arrange their appointment, except where their health case
implementation is available via the ‘support page’ in eMedical
has already been submitted and they have been requested
for Panel Members and clinic staff and explains the use and
to provide further information by INZ. Therefore clinics will
storage of personal information.
have to create a new health case for each applicant. When
creating a new health case, a Unique Medical Identifier (NZER)
Part 1 of the
New Zealand Immigration Panel Member
will be generated for the applicant. The applicant will require
Instructions contains further information on INZ’s
their NZER number as proof that their immigration medical
Privacy Principles.
examination has been initiated. An information sheet with the
applicant’s health case summary and the NZER number can be
printed for the applicant.
User Guide and reference material
Detailed information on the use of eMedical is contained in
the eMedical User Guide and associated tip sheets and quick
reference guides. This information is provided as part of the
training package to Panel clinics and is updated regularly. The
most recent versions of these documents are available via
the ‘support page’ in the eMedical system itself. Any requests
or enquiries related to this information, or by non eMedical
enabled clinics, can be made via the contact details below.
eMedical support arrangements
eMedical system support enquiries should
be made via the support platform in eMedical.
https://www.emedical.immi.gov.au/
INZ clinical and processing enquiries should be emailed to:
[email address]
48 – New Zealand Immigration Panel Member Instructions – February 2019
Appendix 1: Undressing for a Medical Examination
From
Australian Immigration Panel Member Instructions:
www.homeaffairs.gov.au/Panelphysicians/Documents/panel-member-instructions.pdf
New Zealand Immigration Panel Member Instructions – February 2019 –
49
Appendix 2: Child Development Milestone Guidelines
This is one of the most difficult parts of any examination, especially if you have never met the child before and the child is
anxious. Much can be achieved by observing the child; talking to the parents/guardians and having the child perform some
simple tasks. It is especially important to have a high index of suspicion of developmental problems in adoption cases,
for the adoptive parents as well as for the New Zealand Government. These are average dates for the milestones.
Milestones given
Milestones given
Gross motor
Cognitive
Chin up
1 month
Shows anticipatory excitement
3 months
Lifts head
4 months
Plays with rattle
4 months
Rolls - prone to supine
4 months
Plays peek-a-boo
8 months
Rolls - supine to prone
5 months
Finds hidden object
9 months
Sits unsupported
8 months
Pulls string to obtain toy
14 months
Pulls to stand
9 months
Activates mechanical toy
20 months
Cruises
10 months
Pretend play
24 months
Walks alone
13 months
Seeks out others for play
36 months
Walks up stairs
20 months
Rides tricycle
36 months
Expressive language
Hops on one foot
60 months
Coos
3 months
Babbles
6 months
Fine motor
Da-da - inappropriate
8 months
Unfisting
3 months
Da/Ma - appropriate
10 months
Reach and grasp
5 months
First word
11 months
Transfer
6 months
Two to six words
15 months
Thumb-finger grasp
9 months
Two-word phrases
21 months
Tower of two cubes
16 months
Speech all understandable
27 months
Handedness
24 months
Names one colour
30 months
Scribbles
24 months
Uses plurals
36 months
Tower of four cubes
26 months
Names four colours
42 months
Tower of eight cubes
40 months
Gives first and last names
44 months
Names two opposites
50 months
Social/self help
Strings sentences together
60 months
Social smile
6 weeks
Recognises mother
3 months
Receptive language
Stranger anxiety
9 months
Gesture games
9 months
Finger feeds
10 months
Understands ‘no’
9 months
Uses spoon
15 months
Follows one-step command
12 months
Uses fork
21 months
Points to animal pictures
19 months
Assists with dressing
12 months
Points to six body parts
20 months
Pulls off socks
15 months
Follows two-step command
24 months
Unbuttons
30 months
Buttons
48 months
Ties shoelaces
60 months
Dresses without supervision
60 months
(Developmental guidelines drawn from General practice, 3rd edition, John Murtagh, McGraw-Hill, Sydney, 2003)
50 – New Zealand Immigration Panel Member Instructions – February 2019
Appendix 3: Activities of Daily Living (ADL) Assessment (903)
Applicant’s name:
Applicant’s DOB:
Self-care
Intact
Limited
Helper
Unable
Note performance without help
Note degree of assistance
With ease, no devices or
With difficulty or with
Some help
Totally dependent
prior preparation
devices or prior preparation
Food/drink
□
□
□
□
Dress upper body
□
□
□
□
Dress lower body
□
□
□
□
Puts on brace/prosthesis
□
□
□
□
Wash/bathe
□
□
□
□
Perineum (at toilet)
□
□
□
□
Sphincters’ control
□
□
□
□
Note control without help
Note frequency of accident
Complete voluntary
Control but with urgency, or Occasionally some help
Frequent or often wet/
use of catheter, appliance
needed
soiled
Bladder control
Bowel control
Mobility/locomotion
With ease, no devices or
With difficulty, or with
Some help needed
Totally dependent
prior preparation
device or prior preparation
Transfer bed
□
□
□
□
Transfer Chair/wheelchair
□
□
□
□
Transfer toilet
□
□
□
□
Transfer bath/shower
□
□
□
□
Transfer car
□
□
□
□
Walk 50 metres – level
□
□
□
□
Stairs, up/down one floor
□
□
□
□
Walk outdoors – 50 metres
□
□
□
□
Wheelchair – 50 metres
□
□
□
□
NB: In the context of the functional assessment, devices include such aids as feeding-cuffs, special cutlery dishes, dressing-aides, transfer boards/poles.
Full
Moderate
Minimal
None
Communication
□
□
□
□
Comprehension
□
□
□
□
Expression
□
□
□
□
Social cognition
□
□
□
□
Social interaction
□
□
□
□
Memory
□
□
□
□
Current residence
Own home □
Relative’s home □
Personal care □
Hospital □
Other (please specify) □
Time at above:
Years:
months:
Current caregiver Designation
Printed name and signature of examining physician
Date (dd/mm/yyyy)
From
Australian Immigration Panel Member Instructions
New Zealand Immigration Panel Member Instructions – February 2019 –
51
52 – New Zealand Immigration Panel Member Instructions – February 2019
