Panel Member Instructions July 2020 - Home Affairs

Australian Panel Member Instructions

Immigration Medical Examinations July 2024

Issued by the Department of Home Affairs Australia, July 2024

These Instructions are prepared in accordance with Australian laws and are for the benefit of the Australian Government. The Department of Home Affairs must be advised if any of these instructions contravene or appear to contravene any laws in the Panel country.

Table of Contents

Part A: Being a Panel Member for Australian Immigration Medical Examinations ...........................7

1.

Panel Management......................................................................................................................7

1.1 The Department of Home Affairs .......................................................................................7

1.2 Role of the Department's offices outside of Australia ........................................................8

2.

How to Contact Us ......................................................................................................................8

3.

Use of eMedical ...........................................................................................................................9

3.1 User Guide and reference material ....................................................................................9

3.2 eMedical Roles...................................................................................................................9

3.3 My Health Declarations and multiple HAP IDs.................................................................10

3.4 eMedical support ..............................................................................................................10

4.

Australia's Immigration Medical Examination process.........................................................10

4.1 The health requirement ....................................................................................................10

4.2 How to determine which examinations are required ........................................................11

4.3 Age milestones.................................................................................................................11

4.4 Assessment of Immigration Medical Examinations..........................................................12

5.

Panel Membership.....................................................................................................................12

5.1 Relocation of a Panel Member clinic................................................................................13

5.2 Retirement or withdrawal of membership ........................................................................13

5.3 Suspension from the Panel ..............................................................................................13

5.4 Removal from the Panel...................................................................................................14

5.5 Use of accredited laboratories .........................................................................................14

5.6 The role of Panel Physicians............................................................................................15

5.7 The role of Chief Radiologist/Panel Radiologists.............................................................16

5.8 Use of locum physicians and radiologists ........................................................................17

5.9 Medical registration ..........................................................................................................17

5.10 Conflicts of interest...........................................................................................................18

5.11 Professional development................................................................................................18

5.12 Disclosure of abnormal serious unrecognised medical conditions to applicants (Duty of Care) 18

5.13 Communication with the Department ...............................................................................19

5.14 Providing information to the applicant ..............................................................................19

5.15 Record keeping ................................................................................................................19

5.16 Quality assurance.............................................................................................................20

5.17 Intergovernmental collaboration.......................................................................................21

5.18 The Code of Conduct for Panel Members .......................................................................22

6.

Applicant feedback ...................................................................................................................22

6.1 How applicants can provide feedback to the Department ...............................................22

6.2 Managing complaints .......................................................................................................22

6.3 What the Department does with complaints ....................................................................23

7.

Client service .............................................................................................................................23

7.1 Waiting periods.................................................................................................................23

7.2 Incidents involving applicants...........................................................................................23

7.3 Clinic facilities and hygiene ..............................................................................................23

7.4 Duration of medical examinations ....................................................................................24

7.5 Cultural, gender and language aspects of examinations .................................................24

7.6 Chaperones......................................................................................................................25

7.7 Children for adoption ........................................................................................................25

7.8 Setting Fees for Australian IMEs......................................................................................25

7.9 Costs associated with further TB testing and treatment ..................................................26

8.

Maintaining the integrity of the medical examination ...........................................................27

8.1 Informed Consent.............................................................................................................28

8.2 Digital Photo .....................................................................................................................28

8.3 Confirming identity............................................................................................................28

8.4 Imposters and identity fraud.............................................................................................31

8.5 Specimen Integrity............................................................................................................32

9.

Further tests and specialist referrals ......................................................................................32

10. Submitting Immigration Medical Examination results ..........................................................33

10.1 Submitting in eMedical .....................................................................................................33

10.2 Submitting paper forms ....................................................................................................34

10.3 Incomplete Immigration Medical Examinations................................................................35

10.4 Declaration by the examining Panel Member ..................................................................35

11. Other Panel Physician roles.....................................................................................................36

11.1 Immunisation ....................................................................................................................36

11.2 Communicable disease ....................................................................................................37

11.3 DNA testing ......................................................................................................................37

11.4 The Departure Health Check (DHC) ................................................................................37

11.5 Public Health Risk Screening...........................................................................................38

Part B: The Medical Examination .........................................................................................................39

12. Medical History..........................................................................................................................39

12.1 Refugee and humanitarian visa applicants ......................................................................39

13. Physical Examination ...............................................................................................................40

14. Height, weight and head circumference .................................................................................40

15. Eyes ............................................................................................................................................41

16. Serum creatinine and estimated glomerular filtration rate ...................................................41

16.1 eGFR results and grading ................................................................................................42

16.2 Risk factors for chronic kidney disease in children ..........................................................42

17. Cardiovascular Disease............................................................................................................42

17.1 Hypertension ....................................................................................................................43

17.2 Other cardiac conditions (including cardiac murmurs and ischaemic heart disease)......43

18. Respiratory system ...................................................................................................................43

18.1 Respiratory conditions......................................................................................................43 19. Nervous system (including sequelae of stroke or cerebral palsy) ......................................44 20. Brain and cognition (mental and cognitive status and intellectual ability).........................44

20.1 Dementia ..........................................................................................................................44 20.2 Intellectual ability ..............................................................................................................45 21. Early Childhood Development .................................................................................................45 22. Gastrointestinal system............................................................................................................46 23. Musculoskeletal system (including mobility).........................................................................46 24. Skin and lymph nodes ..............................................................................................................46 25. Evidence of drug-taking ...........................................................................................................47 26. Breast examination ...................................................................................................................47 27. Endocrine system .....................................................................................................................47 28. Ear, nose, throat and mouth ....................................................................................................48 29. Conditions preventing attendance at mainstream School, full employment or living independently .........................................................................................................................................48 30. Human Immunodeficiency Virus (HIV) testing .......................................................................48 30.1 Pre-test counselling..........................................................................................................49 30.2 Acceptable screening tests for HIV ..................................................................................49 30.3 Confirmatory and supplementary tests ............................................................................49 30.4 Positive results and post-test counselling for HIV............................................................50 31. Hepatitis B and C.......................................................................................................................50 32. Venereal Diseases' Reference Laboratory (VDRL) test.........................................................52 33. Grading `A' or `B'.......................................................................................................................53 33.1 Conditions or findings that are significant ........................................................................53 33.2 Conditions or findings that are not significant ..................................................................53 33.3 `A' Grades.........................................................................................................................54 33.4 `B' Grades.........................................................................................................................55 34. Additional health examinations and deferral requests .........................................................55 34.1 Health undertakings .........................................................................................................55 Part C: Completing an immigration CXR examination .......................................................................56 35. Taking the CXR..........................................................................................................................56 35.1 CXR images for eMedical ................................................................................................56 35.2 Film size for paper cases .................................................................................................56 35.3 Radiographic technique ...................................................................................................56 35.4 Additional views................................................................................................................57 35.5 Radiation safety................................................................................................................57 35.6 CXR image identification..................................................................................................58 35.7 Female applicants ............................................................................................................58 35.8 How to manage CXRs deferred until after childbirth........................................................59 35.9 Children ............................................................................................................................59 36. Film Examinations and Reporting ...........................................................................................59 36.1 Reporting TB findings.......................................................................................................59

36.2 Strong suspicion of active TB...........................................................................................60 36.3 Grading `A' or `B' ..............................................................................................................61 37. Declaration by Examining Radiologists..................................................................................61 Part D: Technical Instructions for Tuberculosis Screening and Treatment ....................................62 38. Screening ...................................................................................................................................62 38.1 Why we screen for TB......................................................................................................62 38.2 Medical history .................................................................................................................62 38.3 Risk factors for reactivation of TB ....................................................................................64 38.4 Indications for additional testing and Management of Latent TB Infection ......................64 38.5 Health Care Worker and Health Care Student Screening ...............................................65 38.6 Tuberculin Skin Test and Interferon Gamma Release Assay Tests ................................66 39. Diagnostics ................................................................................................................................67 39.1 Sputum testing .................................................................................................................67 39.2 Sputum collection guidelines............................................................................................68 39.3 Administrative arrangements ...........................................................................................68 39.4 Sputum collection .............................................................................................................68 39.5 Sputum sample storage and transport requirements.......................................................70 39.6 Sputum smear ..................................................................................................................71 39.7 Sputum Culture ................................................................................................................71 39.8 First line Drug Susceptibility Testing (DST) .....................................................................71 39.9 Second line Drug Susceptibility Testing (DST) ................................................................71 39.10 Use of molecular testing.............................................................................................71 39.11 Submitting Results and TB alerts.................................................................................72 40. Treatment ...................................................................................................................................72 40.1 Quality TB Management ..................................................................................................72 40.2 Decision to initiate Tuberculosis treatment ......................................................................73 40.3 Isolation of applicants.......................................................................................................73 40.4 Treatment .........................................................................................................................73 40.5 Monitoring during treatment .............................................................................................75 40.6 Treatment completion and certification ............................................................................76 40.7 Health Clearance at end of Treatment.............................................................................76 41. Contact Tracing .........................................................................................................................77 41.1 Index case ........................................................................................................................77 41.2 Which contacts must be traced ........................................................................................77 41.3 Notification of relevant authorities ....................................................................................77 41.4 Panel Physician responsibilities .......................................................................................77 41.5 Further evaluation ............................................................................................................77 41.6 Latent TB Infection ...........................................................................................................78 42. Notification.................................................................................................................................79 42.1 Notification of local public health authorities ....................................................................79 42.2 Post-arrival medical follow up ..........................................................................................79 Appendix A: Psychosocial Management of TB Patients....................................................................80

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