Your responsibilities
• You must pay the fees for the immigration medical examination, any tests required and all postage and courier fees.
ndsl• You must tell the truth. Fal statements on a medical certificate may result in your application being declined, any visa granted being cancelled, and if you are in
New Zealand, you being required to leave the country. How do I prepare for my immigration medical examination?
• If you are mildly unwell or on a short cour of antibiotics, wait until you are better before having your immigration medical examination.
• Do not have alcohol or high fat meals 48 hours before your blood tests.
• Do not consume kava for 48 hours before your blood tests.
What do I bring?
• This certificate with ctions A and I completed, and your name at the top of each page where indicated.• Your valid passport or national identity document for identification.
• Three recent passport photographs. Photographs must be no more than six months old.
• A list of all your medications (including drug name and dosage).
• All your medical notes and reports, immunisation record, blood test results, X-rays, scans and anything el that is relevant to your health.
• Your glass (spectacles) or contact lens if you u them.• You may bring a family member or support person with you to the immigration medical examination. Plea let the physician know when you make your appointment.• You may bring an interpreter with you to the immigration medical examination. The interpreter can be from a professional rvice or a respected member of your community. Plea let the physician know when you make your appointment.
What to expect for the immigration medical examination
There are three parts to the immigration medical examination:
1. Medical history and physical examination.
2. Urine and blood tests.
3. Chest X-ray, to be completed using the form Chest
X-ray Certificate (INZ 1096); the guide Health
Requirements (INZ 1121) has more details.
The medical certificate must be completed in English.• You may complete the medical history ction (Section B) before your examination or you may complete this ction with the physician (or delegated person) at your examination. If you are not sure about an aspect of your medical history, declare it.
• The physician will complete the physical examination. He or she will check your height, weight, mental state, hearing and vision, listen to your heart, lungs, feel your
abdomen and check your reflexes, power and the rest of your nervous system.
• You will need to remove some items of clothing for the physical examination.
• Some parts of the physical examination may be completed by a nur or health care assistant.
• You will need to provide a urine sample during the immigration medical examination.
• You will also need to get blood tests, a chest X-ray and possibly some other tests if clinically necessary.
• You may need to go to different places to get some tests done.
Women
• Do not have your immigration medical examination during your period (menstruation) becau blood
may affect the results. Wait until your period is finished before you have your immigration medical examination.
• Women over 45 years will need to have a breast examination. If you prefer, you can submit a breast examination report from a breast specialist, or submit a breast ultrasound scan, MRI scan or mammogram no more than six months old.
Children
• All children including babies must have an immigration medical examination.
• Children under 11 years of age do not need a chest X-ray unless the physician declares it is necessary or one is requested by Immigration New Zealand.
• Children under 15 years of age do not need a blood test unless the physician declares it is necessary or one is requested by Immigration New Zealand.
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What happens afterwards?
• Your physician has to wait for all your test results to complete this form.
• This form is complete only when all the test results and specialist reports have been completed and attached and the physician has completed all ctions of the form.
michael phelps
• You must submit your completed immigration medical certificates, including all blood tests, and X-rays [Chest X-ray Certificate (INZ 1096)] and any other tests, within three months of the date of the physician signing this form.
• Your medical information will be assd by Immigration New Zealand, and possibly by a medical asssor.
• You may be required to get further specialist reports or tests. You are responsible for paying for the.
• Your medical information may be retained by Immigration New Zealand for u when asssing your health in the future or for audit reasons.
For more information
If you have questions about completing the form:
• e our website vt.nz
• telephone our call centre on 0508 558 855 (within New Zealand).
This form has been approved under ction 381 of the Immigration Act 2009
2 – General Medical Certificate – October 2015
A7Which visa category are you applying for a visa under:
Visitor (other than family visitor)
Student (other than dependent child)
Work/Skills
Temporary employment supported
Resident
Work to residence
Working holiday scheme
Job arch
Business/Investor
Temporary – other (specify)
Family
Partner (visitor/work/resident visa)
Child (visitor/student/resident visa)
Parent/Grandparent multiple entry (visitor visa)
Family parent (resident visa)
Parent retirement (visitor/resident visa)
Guardian (visitor visa)
Humanitarian
Refugee
UNHCR
Other (specify)
Pacific Residence
Samoa
Tonga
Kiribati
健康管理师报考要求Tuvalu
Other (specify)
A8
What is your intended occupation in New Zealand (if you are applying under the work/skills category):
Less than 1 year 1 - 2 years 2 - 3 years 3+ years Permanently
4 – General Medical Certificate – October 2015
Applicant:
• You may complete the medical history ction yourlf and discuss your history with your examining physician, or your examining physician may complete the medical history ction with your assistance.
• If this health examination is for a child under 18 years of age, the medical history ction must be completed by a parent or guardian, or the examining physician with the assistance of a parent or guardian.
• If you answer ‘yes’ to any question, plea give details and give the physician any reports, tests or other information.
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Examining physician:
If the medical history ction has been completed before the examination begins, you must confirm each of the answers with the applicant. Do not assume that the applicant has understood the questions.
No Yes Give details
B1Have you ever been diagnod
with Tuberculosis (TB)? Have
you ever had to take treatment
for TB?
No Yes Give details
即时通信工具B2Have you ever been in clo
contact at home with a person
known to have TB?
No Yes Give details
B3Have you ever had prolonged
medical treatment and/or
repeated hospital admissions
for any reason, including a
major operation or psychiatric
illness?
No Yes Give details
B4Do you suffer, or have
you ever suffered, from a
psychological or psychiatric
disorder (including major
depression, bipolar disorder or
schizophrenia)?
No Yes Give details
B5Have you ever had an abnormal
or reactive HIV blood test?
No Yes Give details
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B6Have you ever had an abnormal
or reactive Hepatitis B orconstanta
Hepatitis C blood test?
No Yes Give details
B7Do you have or have you had
cancer or malignancy in the
last 5 years?
B8Do you have diabetes? No Yes Give details
No Yes Give details
B9Do you have a heart condition
including coronary dia,
hypertension, valve or
congenital dia?
No Yes Give details
B10Do you have a blood condition
国旗下讲话 期末复习
(including thalasmia)?
No Yes Give details
B11Do you have bladder or kidney
procedure什么意思problems?
General Medical Certificate – October 2015– 5
