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    Ralph Imm1017

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    Kurgee Kur
    The document provides instructions for a medical examination required as part of an immigration application. It states that the applicant must undergo the examination within 30 days and bring proper identification and any previous medical records. The examination must be completed by a doctor on the approved list, after which the results will be sent to Citizenship and Immigration Canada.

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    Ralph Imm1017

    Uploaded by

    Kurgee Kur
    146 views2 pages
    The document provides instructions for a medical examination required as part of an immigration application. It states that the applicant must undergo the examination within 30 days and bring proper identification and any previous medical records. The examination must be completed by a doctor on the approved list, after which the results will be sent to Citizenship and Immigration Canada.

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    The document provides instructions for a medical examination required as part of an immigration application. It states that the applicant must undergo the examination within 30 days and bring proper identification and any previous medical records. The examination must be completed by a doctor on the approved list, after which the results will be sent to Citizenship and Immigration Canada.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    146 views2 pages

    Ralph Imm1017

    Uploaded by

    Kurgee Kur
    The document provides instructions for a medical examination required as part of an immigration application. It states that the applicant must undergo the examination within 30 days and bring proper identification and any previous medical records. The examination must be completed by a doctor on the approved list, after which the results will be sent to Citizenship and Immigration Canada.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 2

    Citizenship and Citoyennet et PROTECTED WHEN COMPLETED - B

    Immigration Canada Immigration Canada

    Medical Examination Instructions

    These medical instructions are being issued since your application has been processed to the stage
    where medical examination results are now required. Please read these instructions carefully.

    IMPORTANT: You are required to undergo the medical examinations within 30 days of the date of this
    letter. Failure to do so could result in the refusal of your application.

    The medical examination must be performed by a doctor from the CIC list of Panel Physicians.
    You cannot choose your family doctor if his or her name is not on this list. See the list of Panel Physicians to
    find a doctor in your area at: http://www.cic.gc.ca/pp-md/pp-list.aspx

    Once you identify a panel physician in your area, book an appointment for your medical examination.
    When you schedule your appointment, please ensure that arrangements are made for your chest x-ray
    and laboratory tests as well. Once your medical has been completed the doctor will forward the medical
    results to CIC.

    Any costs related to the medical examination are your responsibility and are payable at the time of the
    examination. Should your application be refused following the completion of your medical examination
    these costs will not be refunded.

    Please bring the following to your appointment:


    - The attached Medical Report form (IMM1017E)
    - Proper identification (proof of identity must include at least one government-issued document
    with photograph and signature, such as a passport or national identity card)
    - Eye glasses or contact lenses, if worn
    - Any medical reports or test results that you may have as a result of previous or existing
    medical conditions
    - Four recent photographs (photos are not required if the panel physician is listed as eMedical
    enabled on the CIC website listed above)

    Note: It is important that you inform the panel physician of any previous or existing medical conditions.
    Failure to do so will delay the processing of your medical examination.

    IMM 1017 E (07-2015) GCMS


    Citizenship and Citoyennet et PROTECTED WHEN COMPLETED - B
    Immigration Canada Immigration Canada

    MEDICAL REPORT Required for all clients.


    CLIENT BIODATA AND SUMMARY Must be taken within six
    months of the medical
    examination.

    CLIENT INFORMATION
    Family name Given name(s)

    Butcon Ralph Gio


    Date of Birth YYYY - MM - DD Country of Birth Gender

    2001/01/05 Philippines M
    Address

    719 BRIAR CRESCENT


    MILTON ON L9T 3Z7
    Canada

    E-mail Address Telephone no.


    [email protected]
    IMMIGRATION DETAILS

    IMM Type: Non EDE IME no: 13469639


    UCI: 9237-9412
    Application no.: E000211621
    *13469639*
    IMMIGRATION MEDICAL EXAMINATION GRADING

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


    abnormal findings present. findings present.

    Comments:

    PANEL PHYSICIAN DECLARATION


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

    No Yes

    If YES, please provide details:

    No Yes

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

    Panel Physician name Panel Physician signature

    Panel Physician no. Date of IME submission YYYY MM DD

    IMM 1017 E (07-2015) GCMS

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