IMPORTANT: You are required to undergo the medical examinations within 60 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.
IMPORTANT: You are required to undergo the medical examinations within 60 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.
IMPORTANT: You are required to undergo the medical examinations within 60 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.
Citizenship and Immigration Canada Citoyennet et Immigration Canada IMM 1017 E (12-2012) GCMS 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 60 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/dmp-md/medical.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. If YES, please provide details: IME no: Do you have identity concerns? Valid identity document (passport/national ID) sighted? PROTECTED WHEN COMPLETED - B Date of Birth Country of Birth Given name(s) Family name Telephone no. Citizenship and Immigration Canada Citoyennet et Immigration Canada IMM 1017 E (12-2012) GCMS Gender E-mail Address PANEL PHYSICIAN DECLARATION Comments: Panel Physician no. Date of IME submission B. Significant abnormal history and/or significant abnormal findings present. A. No significant abnormal history or abnormal findings present. IMMIGRATION MEDICAL EXAMINATION GRADING I confirm that this immigration medical examination and report is a true and accurate record of my findings. Panel Physician name MM DD YYYY IMMIGRATION DETAILS IMM Type: UCI: No Yes No Yes Panel Physician signature CLIENT INFORMATION Required for all clients. Must be taken within six months of the medical examination. MEDICAL REPORT CLIENT BIODATA AND SUMMARY Application no.: YYYY - MM - DD Address de Paula Medeiros Marina 1991/11/12 Brazil F 203-120 Italina Pereira Motta Vitoria jardim camburi 29090-370 Brazil +552835361716 Non EDE *11638810* 11638810 91772492 S300666761