1. IME for Canada… the Specifics !

2. Not all IMEs are the same !

3. Presentation Outline What’s new for 2017?
Pre departure medical services
Projected immigration volumes
Up Front Medicals
Key Information for Panel Physicians
ID concerns
The physical examination
Radiology
Grading the IME
Additional investigations
Refugees and Resettlement Needs

4. New for 2017! Pre-departure Medical Services
The Government of Canada has expanded the scope of the Interim Federal Health Program to include coverage of pre-departure medical services for Canada-bound resettled refugees, to begin on April 1, 2017.
Pre-departure Medical Services include:
Immigration Medical Examinations
Selected vaccinations aligned with Canadian immunization guidelines
Medical support during travel to Canada (e.g. wheelchairs, medical escorts)
Management and control of communicable diseases in refugee camps

5. IRCC Applicant Levels for 2017
The Government of Canada is maintaining its commitment to a strong immigration program and will welcome 300,000 immigrants in This level will be the new baseline for permanent immigration going forward, allowing for future increases.

6. IRCC Levels for 2017 (continued)
Building our economy: in 2017, economic immigration programs will see an overall increase of 7% over 2016.
Reuniting more families: in 2017, levels for the family class will be increased by 5% over 2016 levels, helping to reunite more families.
Providing a place of refuge for those fleeing persecution: in 2017, IRCC will welcome one the highest numbers of refugees and protected persons in Canadian history, 40,000.
Supporting others in need: such as persons selected on humanitarian and compassionate grounds, for reasons of public policy and in the Permit Holder Class, a target of 3,500 admissions are planned.

7. Quiz!
In which of the following situations should you NOT perform an upfront medical examination?
Client has a valid passport but no IME number
Client tells the panel physician that he is being sponsored by his Canadian son and doesn’t have an IME number
Client doesn’t have any ID document
Client has IME number but refuses to uncover her face for the picture

8. When to Perform an Upfront Medical Examination?
As of December 15, 2016, Upfront Medicals (UFMs) may only be conducted for the following immigration categories:
Visitors (including SuperVisas)
Students
Workers
Express Entry- These are skilled workers applying for permanent residence. Use UMI type “Worker”
As of December 15, 2016, UFMs have been discontinued for all Family Sponsorship Class applicants
As with all medical examinations, UFMs are conducted at the applicant’s own risk… there is no guarantee of a visa!

9. Quiz!
How do you provide the clients with the proof of having completed their upfront medical examination for submission to IRCC?
Provide client with the UMI number on a piece of paper
Provide client with a print out of the information sheet from his or her eMedical file
Send client a text message or
Providing client with page 1 of IMM-1017B up-front paper form
Provide client with a receipt of payment for the medical examination

10. Creating an Upfront Medical
Classification (if any)
Creating an Upfront Medical
An upfront medical can be created in eMedical for any client using the IME or UCI number, however only certain people can undergo an upfront medical.
Before creating an upfront medical , search the client with:
Family name
Identity document number (e.g. the client’s passport number)
Select the Health case country

11. UpFront Notification Forms
Paper
eMedical

12. Quiz!
A client has an IME number and a copy of his or her passport or ID with no visa office stamp on it. What do you do?
Refuse to complete the health case and request that the client return with her original passport
Refuse to complete the exam and request that the client bring either their original passport or a copy certified by a Canadian Visa Office
Conduct and submit the medical examination; raise your concern about the client’s ID
Conduct and submit the medical examination; do not raise any concerns about the client’s ID

13. Quiz!
In which of these situations should the panel physician mention an ID concern?
Client presents a new valid passport different than the one found in eMedical
The ID document presented doesn’t have a photo
Client presents a valid UNHCR refugee document with photo.
The surname of the client on the ID document presented has a minor typing error when compared to the surname found in eMedical
The picture on the ID document presented does not resemble the person in front of you

14. ID Concerns = Fraud
ID concerns are to be identified by the panel physician during the immigration medical examination (IME)
The IRCC will manage the ID concerns once the IME has been submitted,
IME will not be processed until ID confirmation has been received

15. When to raise an ID concern?
Any adult without photo ID!
When you cannot legitimately identify the client!
If you feel you are dealing with an imposter!
Misspelling of names, regardless of how minor, and expired passports should ALWAYS be flagged as ID concerns!

16. The Physical Examination
Clinical history
Physical examination
Roughly 15 – 30 minutes
May take longer for the elderly/frail
Assess mental status, cognition, functionality during history and examination

17. The Medical Examination

18. Radiology

19. IRCC Chest Radiograph Grading Forms

20. Radiology reporting in eMedical
To be Completed by the radiologist (Attach DICOM image in eMedical)
Chest X-ray examination Required for all applicants >15 years old.
If an applicant has turned 15 since requirements have populate in the system, a 502 examination should be manually added and completed.
If radiological abnormalities < 3.5 : Grade A
If radiological abnormalities >3.5: Grade B
Always add comments to support grading.

21. Radiology – Active Tuberculosis
High suspicion of Active Tuberculosis exists if radiological abnormality graded
IF PP/PR AGREES THAT TB IS LIKELY, Panel Physician is instructed to proactively order sputum smears and cultures (x3) for TB, repeat chest x-ray after 3 months (or 6 months if no sputum) and refer to TB specialist if positive
Exam results should be submitted with a note asking RMO to send a furtherance for the information requested.
Note: If chest x-ray unremarkable but history or clinical indication of TB, PP instructed to do sputums for TB and repeat 3/12 Chest X-ray

22. Grading the IME Grade A: Normal exam
Conditions that have no impact on immigration should be noted in “general supporting comment” box at the end of medical history
Grade B:
Conditions that are worth noting should be documented in the comment box that appears when the case is graded B:
Chronic medical conditions that will require significant follow up (diabetes, hypertension, cancer less than 5 years, DD, dementia…)
Conditions of public health or public safety (suspicious TB , harmful behaviors)
Positive syphilis or HIV

23. Where to add comments: For A grade: use the “general supporting comments” box

24. Additional Investigations
Where to add comments: For B grade, Use the “general supporting comment box” after the B grading

25. IRCC’s Technical Instructions (IMEIs)
…related to process in eMedical
IMEI: Activities of Daily Living Assessment (ADL)
IMEI: Assessment of Cognitive Functioning
IMEI: Body Mass Index (BMI)
IMEI: Breast Examination
IMEI: Developmental Milestones: Chart of Early Childhood Development (CECD)
IMEI: Global Assessment of Function (GAF)
IMEI: Height/Weight/Head Circumference Percentile for Children
IMEI: Resettlement needs assessment IMM 5544
IMEI: Serum Creatinine
IMEI: Urinalysis

26. IRCC’s Technical Instructions (IMEIs)
Conditions of Significance
IMEI Cancer or Malignancy : add specialist report for diagnosis, staging, treatment needs and prognosis
IMEI Cardiac Disease: specialist report + serum creatinine if risk factors and end organ damage
IMEI Cognitive Impairment in Adults: specialist if Global Assessment of Functioning (GAF) + Activities of Daily Living (ADL) +Mini Mental status (MM) abnormal
IMEI Debilitating Conditions: specialist report if GAF + ADL +MM abnormal
IMEI Developmental Delay in Children: school, specialist reports
IMEI Diabetes: serum creatinine + fasting blood sugar + HbA1c; if abnormal add eGFR or A/ creatinine ratio and specialist report
IMEI Hearing Impairment or Deafness: add details: communication skills + specialist report

27. IRCC’s Technical Instructions (IMEIs)
Conditions of Significance (cont’d)
IMEI Hepatitis/Liver Disease : if risk factors; add serology Hep B+C and if abnormal, Liver Function Tests + specialist report
IMEI HIV Screening: if positive add CD4 + VL + specialist report (including treatment)
IMEI Hypertension: ≥ 140 or ≥ 90 : assess end organ damage + serum creatinine; Specialist report if heart disease
IMEI Psychiatric Conditions; identify risk and needs (specialist; social worker; work history; other supporting data)
IMEI Renal Disease: eGFR or A/ creatinine ratio
IMEI Syphilis Screening and Management: confirm, including treatment
IMEI Tuberculosis: x3 sputums smear and culture; in 3 months repeat x-ray. If positive: screen HIV-Hep-contacts for Latent Tuberculosis and refer for Directly Observed Treatment (DOT)

28. How to add extra tests or exams to a file?
Example: ADL, serum creatinine, Hepatitis testing, ….

30. Or….Add an Attachment:

31. Refugees and Resettlement Needs Form
Assessment of the resettlement needs for ALL overseas refugees assesses 5 areas:
Functional assessment (e.g. hearing, vision, speech, cognition, mobility and other impairments)
Special travel requirements (e.g. wheelchair, medical escort, etc)
Post-arrival service requirements (consultation with a healthcare professional upon arrival/within # weeks, long term services, etc)
Housing and daily activities or assistance requirements (e.g. wheelchair access, periodic/permanent home care, etc.)
Other resettlement needs
Select yes only if there are significant resettlement needs, or specific concerns
Note the resettlement needs that are of importance for the travel or for the immediate follow up after arrival.
Examples: oxygen, wheelchair, medical escort, urgent follow up upon arrival or within weeks of arrival

32. Questions?

33. Quiz Answers
Q. In which of the following situations should you NOT perform an up-front medical examination?
A. Client tells the panel physician that he is being sponsored by his Canadian son and doesn’t have an IME number
A. Client doesn’t have any ID document
A. Client has IME number but refuses to uncover her face for the picture
Q. How do you provide the clients with the proof of having completed their upfront medical examination for submission?
A. Providing information sheet in eMedical file
Providing page 1 on IMM1017B upfront paper form
A. Provide client with a receipt of payment for the medical examination

34. Quiz Answers (cont’d)
Q. A client has an IME number and a copy of the passport/ID with no visa office stamp on it. What would you do?
Conduct the medical examination and submit it raising ID concern
Q. In which one of these situations should the PP mention an ID concern?
A. The ID document presented doesn’t have a photo
A. The surname of the client on the ID document presented has a minor typing error when compared to the surname found in eMedical
A. The picture on the ID document presented does not resemble the person in front of you