Formulaire INZ1263 Instructions Nouvelle-Zélande
Nouvelle-Zélande Immigration Settlement Health Instructions
Instructions à l'intention des médecins qui remplissent les évaluations de santé de l'établissement des réfugiés pour les réfugiés mandatés par le HCR qui ont été approuvés pour un visa de résident de Nouvelle-Zélande.
OFFICE USE ONLY Client no.:
Date received:
/
/
Application no.:
May 2022
New Zealand Immigration
Settlement Health Instructions
(INZ 1263)
INFORMATION ABOUT THESE INSTRUCTIONS
The settlement health instructions provide:
›
an overview of the settlement health service for United Nations High Commissioner for Refugees (UNHCR) –
mandated refugees who have been approved for a New Zealand resident visa under New Zealand’s Refugee
Quota Programme or the Refugee Quota Family Reunification Category
›
›
›
an outline of your role and responsibilities within this service as a service provider
information and guidelines to assist physicians to complete eMedical or paper settlement health forms
a standardised process to obtain appropriate, accurate and comprehensive health information
The settlement health instructions explain the standard of practice required to complete Immigration New Zealand’s
(INZ) settlement health forms. The settlement health instructions are not a technical medical reference manual.
The settlement health service only applies after the UNHCR-mandated refugee has been approved for a New Zealand
resident visa. Physicians should refer to the New Zealand Panel Member Instructions (INZ 1216) when completing
immigration medical examinations as part of the visa decision process.
INTRODUCTION
Settlement Health Services
UNHCR-mandated refugees who have been approved for a New Zealand resident visa under New Zealand’s Refugee
Quota Programme or the Refugee Quota Family Reunification Category are referred to as Humanitarian UNHCR visa
holders. Settlement health services are part of INZ’s resettlement services offered to Humanitarian UNHCR visa holders.
Well-managed resettlement services, including health services, facilitate better outcomes for Humanitarian UNHCR visa
holders and instil confidence in the receiving community in New Zealand.
INZ offers a settlement health service for Humanitarian UNHCR visa holders. While settlement health services are not
mandatory for Humanitarian UNHCR visa holders, they are strongly recommended. INZ encourages settlement health
service providers to establish a process by which all Humanitarian UNHCR visa holders are able to access, and are provided
with, settlement health services.
INZ’s settlement health checks and services are outlined in the four forms listed below:
eMedical examination name
948 Settlement health assessment
956 Settlement Additional Information
953 Settlement Vaccinations
Paper-format examination name
For examination requirements see:
Part 1 of these Instructions
Part 2 of these Instructions
Part 3 of these Instructions
Part 4 of these Instructions
Settlement Health Assessment (INZ 1260)
Settlement Additional Information (INZ 1364)
Settlement Vaccinations (INZ 1251)
949 Departure Health Check
Departure Health Check (INZ 1262)
immigration.govt.nz
When filling in this form, please write clearly using CAPITAL LETTERS.
INZ will update these settlement health instructions
and INZ settlement health processes from time to time.
Updated settlement health instructions can be found
network. eMedical will always carry up-to-date forms.
Up-to-date paper forms are available on the INZ website
Immigration medical examination (IME) – the medical
examination for INZ visa determination purposes that
includes the functional inquiry for present, past, and
family history, the findings on physical and mental
examination and the results of all relevant radiology,
laboratory and diagnostic tests including further
specialist reports.
Incapable person – a person who is incapable of
understanding the general nature, effect of, and
purpose of the requirements for providing a signature.
Such people may include those with an intellectual
disability.
Glossary
Medical certificates – INZ health forms used for
determining if an applicant meets visa health
requirements. Specifically, the General Medical
Certificate (INZ 1007) /501 Medical Examination,
Limited Medical Certificate (INZ1201) / 512 Limited
medical examination, Chest X-ray Certificate (INZ 1096)
/ 502 Chest x-ray examination and RSE Scheme
Supplementary Medical Certificate (INZ 1143).
Applicant – a person who applies to enter or remain
in New Zealand as a permanent resident (including
refugees who may be referred to as candidates) or as
a temporary entrant (including tourists, students or
temporary workers).
Candidate – a person mandated as a refugee by the
UNHCR (the United Nations refugee agency) who has
been selected as a candidate for New Zealand’s Refugee
Quota Programme.
Refugee Health Liaison Team (RHLT) – a clinical
team at INZ who support the health and wellbeing
of New Zealand refugees throughout their journey
and settlement in New Zealand.
Client - UNHCR-mandated refugees who have been
approved for a New Zealand resident visa under New
Zealand’s Refugee Quota Programme or the Refugee
Quota Family Reunification Category.
Settlement health services – offshore health services
available to approved UNHCR-mandated refugees.
Services include a comprehensive health screening and
assessment, vaccinations and a departure health check.
Conditions – physical, mental, emotional or intellectual
disorders of the client that are identified by either the
client or by the physician from the history, assessment
and subsequent tests.
Settlement health forms – INZ health forms used to
assess settlement health status for approved UNHCR-
mandated refugees. Specifically, Settlement Health
Assessment (INZ 1260), and Departure Health Check
(INZ 1262).
Family group – where applicable, will include a principal
client, his or her partner and their dependent children.
In most cases, all of the family group will have been
included within a single visa application.
Specialist report – a written document received from
the relevant specialist that provide a complete record
of the mental or physical condition being considered,
including the history, findings on physical examination,
diagnosis, current treatment and prognosis.
Immigration instructions – these consist of
immigration eligibility of a person for the grant of a visa;
and any other relevant information that should be taken
into account in assessing a person’s eligibility for a visa.
Immigration instructions are certified by the Minister
of Immigration under section 22 of the Immigration
Act 2009.
2 – Settlement Health Instructions – May 2022
TABLE OF CONTENTS
INFORMATION ABOUT THESE INSTRUCTIONS ...........................................................................................................1
INTRODUCTION........................................................................................................................................................1
Settlement Health Services.........................................................................................................................................................1
Glossary..................................................................................................................................................................................... 2
TABLE OF CONTENTS............................................................................................................................................... 3
PART 1: PHYSICIANS AND INZ SETTLEMENT HEALTH SERVICES................................................................................. 5
Roles and responsibilities for INZ settlement Health Services ................................................................................................... 5
Physician....................................................................................................................................................................................................7
Refugee Health Liaison Team................................................................................................................................................................... 5
Clients ....................................................................................................................................................................................................... 5
Specialists................................................................................................................................................................................................. 6
Who can complete an INZ Settlement Health Form ....................................................................................................................6
Countries with panel physicians.............................................................................................................................................................. 6
Countries with no listed panel physicians............................................................................................................................................... 6
Client Services............................................................................................................................................................................6
Cultural and language aspects of assessments ..................................................................................................................................... 6
Privacy considerations ............................................................................................................................................................................. 6
Chaperones............................................................................................................................................................................................... 6
Pregnant women...................................................................................................................................................................................... 6
Information sheet .....................................................................................................................................................................................7
Confirming the identity of clients.............................................................................................................................................................7
Disclosing of health information to clients..............................................................................................................................................7
Automated email.......................................................................................................................................................................................7
Specialist Referrals....................................................................................................................................................................................7
Submitting Settlement Health Forms......................................................................................................................................................7
How to contact INZ about settlement health services............................................................................................................................7
PART 2: COMPLETING A 948 MEDICAL RESETTLEMENT NEEDS / SETTLEMENT HEALTH ASSESSMENT (INZ 1260)....... 8
Section A: Personal details (eMedical pre-exam stage) ..............................................................................................................8
Client visa category .................................................................................................................................................................................. 8
Client identity ........................................................................................................................................................................................... 8
Section B: Client consent ...........................................................................................................................................................8
Section C: Medical history..........................................................................................................................................................9
Section D: Pregnancy ................................................................................................................................................................13
Section E: Physical examination................................................................................................................................................13
Delegating responsibility........................................................................................................................................................................ 13
Medical findings ...................................................................................................................................................................................... 13
Timely medical tests................................................................................................................................................................................ 13
Section F: Settlement vaccinations........................................................................................................................................... 17
Section G: Laboratory tests....................................................................................................................................................... 17
Abnormal laboratory tests......................................................................................................................................................................18
Standard laboratory tests.......................................................................................................................................................................18
Following up abnormal laboratory test results .....................................................................................................................................18
Discretionary laboratory tests................................................................................................................................................................19
Settlement Health Instructions – May 2022 – 3
When filling in this form, please write clearly using CAPITAL LETTERS.
PART 3: COMPLETING A 956 SETTLEMENT ADDITIONAL INFORMATION /
SETTLEMENT ADDITIONAL INFORMATION (INZ 1364) ..............................................................................................19
Section: Record results .............................................................................................................................................................19
Exam date: Record the date the exam was completed. ........................................................................................................................19
Section: Attachments ...............................................................................................................................................................19
PART 4: COMPLETING 953 SETTLEMENT VACCINATIONS / SETTLEMENT VACCINATIONS (INZ 1251) .......................... 20
Section: Settlement Vaccinations ............................................................................................................................................ 20
PART 5: COMPLETING 949 DEPARTURE HEALTH CHECK / DEPARTURE HEALTH CHECK (INZ 1262) ............................. 21
Section A: Personal details........................................................................................................................................................21
Client visa category ................................................................................................................................................................................. 21
Client identity .......................................................................................................................................................................................... 21
Section B: Client consent ..........................................................................................................................................................21
Section C: General Medical Examination................................................................................................................................... 22
Delegating responsibility........................................................................................................................................................................22
Medical findings ......................................................................................................................................................................................22
Timely medical tests................................................................................................................................................................................22
Section D: Chest x-ray and TB screening .................................................................................................................................. 24
Section E: Laboratory tests ...................................................................................................................................................... 25
Abnormal laboratory test results ...........................................................................................................................................................25
Standard laboratory tests.......................................................................................................................................................................25
Discretionary laboratory tests............................................................................................................................................................... 26
Section F: Travel requirements................................................................................................................................................. 26
Section G: Post – arrival requirements......................................................................................................................................27
Section H: Personal requirements.............................................................................................................................................27
Section I: Settlement vaccinations............................................................................................................................................27
Section J: Settlement medications ........................................................................................................................................... 28
APPENDICES......................................................................................................................................................... 29
Appendix 1: Undressing for a Settlement Health Physical Examination.................................................................................... 29
Appendix 2: Activities of Daily Living Index (ADL).....................................................................................................................30
Appendix 3: Child Development Milestones Guidelines.............................................................................................................31
4 – Settlement Health Instructions – May 2022
• attaching all documentation provided by the client
• it is essential to provide copies of all original
vaccination records if available
• remaining accountable for any part(s) of the
examination/ completion of the settlement health
forms, that is delegated to a staff member within
the practice.
PART 1: PHYSICIANS AND INZ
SETTLEMENT HEALTH SERVICES
Roles and Responsibilities for INZ Settlement
Health Services
There are four key parties involved in settlement health
services. These are the physician, INZ’s Refugee Health
Liaison Team (RHLT), specialists and clients. Each has a
clear and distinct role that contributes to the settlement
health process.
INZ requires physicians providing settlement services
to have the necessary medical expertise and experience
to fulfil the above responsibilities.
For more information on the roles and responsibilities
of panel physicians, refer to New Zealand Immigration
Panel Member Instructions (INZ 1216). Please note that
these Settlement Health Instructions do not supersede
the Panel Member Instructions.
Physicians
provide information
on Humanitarian
UNHCR visa holders
health
Refugee Health Liaison Team
The role of the RHLT is to support the health and
wellbeing of the client throughout their resettlement
journey. This includes:
With RHLT
approval
• prescribing and reviewing all settlement health forms
• requesting further information or tests from the
physician or for referral to a specialist when required
Specialists
Clients
– approved
Humanitarian
UNHCR visa
holders
RHLT
provide further
information on
client condition or
management
plan
provides liaison
and support for all
refugees health
services
Further
advice for
ongoing
• working with offshore and onshore health services
to plan ongoing care for clients so that health
services are accessible and meet the client’s needs
throughout the resettlement journey
• initiating and expanding health promotion,
prevention and early intervention work with clients
and refugee health services before and after
resettlement
management
Physician
The role of the physician is to inform the client about
the purpose of the assessment and to provide a
comprehensive assessment of the client’s current state
of health and provide detail of their medical history as
told by the client. All information observed and received
is to be recorded as it is observed or told. This includes:
• providing liaison and support for all refugee health
services and ensuring quality and consistency of
advice and services.
• applying appropriate medical, ethical and
professional standards during the assessments and
in completing any documentation
• ensuring that a parent or guardian is present when
completing assessments for children under 18 years
of age, or for incapable persons
• organising professional interpreters and/or
chaperones if required
• capturing all information provided accurately and
completely
Clients
The role of the client is to participate as fully with the
settlement health services as they are comfortable.
This includes:
• sharing their health history as accurately and with
as much detail as they can
• supplying copies of all previous health
documentation, including vaccination records,
if available
• referring the client for standard blood tests as well as
specific tests recommended in these panel physician
instructions and discussing any other tests that may
be appropriate given clinical or risk factors present
with the RHLT
• arranging additional tests and specialist referrals as
advised by the RHLT and transferring results and/or
reports once completed
• asking for clarification if they are uncertain about
what is required or don’t understand any part of the
settlement health process
The assessments and vaccinations are voluntary and the
client can choose to participate as they wish.
• ensuring that pre- and post-test counselling is
carried out in accordance with local protocols and
standards.
Settlement Health Instructions – May 2022 – 5
When filling in this form, please write clearly using CAPITAL LETTERS.
Specialists
Privacy considerations
A specialist assessment may be requested by the RHLT
based on information provided during the settlement
health process. If required, the role of the specialist will
be to provide further assessment of the client to help
plan the client’s health management. This would usually
include:
To prevent misunderstandings, clients should be
given information about what will happen during
the settlement health process when they make an
appointment including the need to remove clothing
for the physical examination.
Aspects of the settlement health forms may make
clients uncomfortable, such as breast examinations
for women, and must be made known to clients at the
time the appointment is made as well as on arrival at
the clinic and before the physical examination starts.
• a comprehensive assessment of the client’s health
condition
• a detailed report of the client’s health condition and
the specialist’s recommendations for management
• communication with the referring physician and RHLT
about a client’s condition and management plan
Appendix 1 provides a diagram that you may wish
to include when giving clients information about the
settlement health forms and/or to display in your clinic
waiting room, change and/or examination room.
Who can complete an INZ Settlement Health
Form
Chaperones
All physical examinations should be conducted
in a professional manner compatible with good
practices and privacy at the expense of the physician.
A chaperone must be offered and available during
physical examinations for all clients. Details of the offer
and the name of the chaperone must be accurately
recorded in eMedical and on paper-based settlement
health forms.
Countries with panel physicians
In most countries, INZ uses a panel of reputable
registered medical practitioners and/or radiologists.
A global register of panel physicians can be found on the
INZ website at https://www.immigration.govt.nz/new-
tools/panel-physicians. All clients in these countries
must have their settlement health forms completed by
a panel physician.
A parent or guardian must be present when a client
under the age of 18, or an incapable person, is examined
or x-rayed.
For more information on panel physicians and INZ panel
management, please refer to New Zealand Immigration
Panel Member Instructions (INZ 1216).
Particular attention should be taken with female clients.
Even when a female family member accompanies a
female client, it is advisable to have a female member
of the clinic staff present.
Countries with no listed panel physicians
For countries where there are no INZ panel physicians,
a registered or board certified or licensed medical
practitioner or physician may complete the settlement
health form. INZ will require details of the registration,
certification or board licence of the medical practitioner
or physician.
Pregnant women
All women of reproductive age should be asked if they
are or might be pregnant and about the date of their
last menstrual period.
Pregnant women and vaccinations
Settlement health forms will not be accepted if
completed by a nursing practitioner, a physician’s
assistant, or by other health practitioners.
• Live vaccinations are not recommended for women
who are pregnant, however, other vaccinations
should be encouraged.
• Do not give MMR to women who are pregnant
or planning pregnancy. Advise women that they
should not get pregnant 4 weeks after MMR.
Client Services
Cultural and language aspects of assessments
Pregnant women and x-ray examinations
Physicians completing the settlement health forms
should be aware of cultural expectations for health
assessments and history-taking. If clients do not speak
the language of the physician, a professional interpreter
who is not related to the client must be provided.
• INZ does not recommend x-ray exposure during
pregnancy. Pregnant clients should be advised that
they do not need to proceed with a chest x-ray
examination.
Note: the physician must be satisfied as to the
interpreter’s impartiality, confidentiality and ability
to interpret accurately. The interpreter should not be
a family member or representing agent to avoid the
risk of misinformation leading to a misdiagnosis.
6 – Settlement Health Instructions – May 2022
Physicians must advise the specialist to:
• confirm the identity of the client
• provide results of all necessary investigations
• provide detailed reports including a description
of the likely prognosis of the condition and
recommended management
Information sheet
eMedical-enabled clinics can provide clients with an
information sheet for each settlement health form.
The information sheets can be printed from eMedical
at any time. The information sheet includes the:
• client photo
• provide reports in English or an original with an
English translation
• INZ reference number (NZER)
• client personal details
• client identity details
• client visa details
Specialist reports should clearly show the client’s name,
date of birth and identity document number. Original
specialist reports are to be sent directly to the physician
who should scan / upload and attach to eMedical or to
a paper settlement health form.
• instructions for the client
The front page of the paper settlement health forms can
also be detached and provided to the client if required.
Reports should be provided in English if possible.
Reports in other languages should be translated into
English by an accredited translator or by the physician
themselves.
Confirming the identity of clients
Physicians, and/or their clinic staff, must confirm the
identity of all individuals who present for settlement
health services. This is done by completing the identity
questions included in eMedical or on paper settlement
forms. For more information on how to confirm the
identity of the individuals including photograph
requirements, please refer to New Zealand Immigration
Panel Member Instructions (INZ 1216).
Submitting Settlement Health Forms
Physicians are to ensure that all requested sections of
the form are completed. All answers must be in English.
No grading is required on settlement health forms.
Settlement health forms completed in eMedical will be
submitted automatically to INZ once all required forms
are completed. Cases where there are no additional
requirements should be submitted within five working
days of the client attending the clinic.
Disclosing of health information to clients
In all cases, physicians have a duty of care to clients in
relation to health information. INZ strongly encourages
physicians to have a defined process for recording,
tracking and informing clients of health information,
including assessments, laboratory results, imaging
reports and other clinical opinions. Physicians must
advise the client of any abnormal findings.
Paper settlement health forms should also be submitted
without delay, no more than five working days after the
completion of the form. All documentation provided
must be legible and each page initialled by the physician.
For further information about completing paper forms,
please refer to New Zealand Immigration Panel Member
Instructions (INZ 1216).
Automated email
There is no automated email functionality available in
eMedical for settlement health services. Clients will be
advised to contact the clinic where their assessments
were completed if they require a copy of, or further
information about their results. Clinics can use the
’Print Health Case’ function within eMedical to generate
a copy to print or save as a PDF and email to a client.
Clinics have a responsibility to manage their caseload
to ensure prompt submission of cases and to avoid any
delays and inconvenience to clients.
How to contact INZ about settlement health
services
All eMedical system support enquiries should
be made via the support platform in eMedical:
Specialist Referrals
The cost of specialist review will only be covered by INZ
when the specialist referral has been approved by the
RHLT. When making external referrals, physicians must
explain to clients why further investigation is needed.
Physicians should also explain that the results will be
sent from the specialist to the physician who must
then submit the reports to INZ, though clients should
also be offered a copy. Specialist referral letters can be
generated via eMedical.
All INZ clinical and processing enquiries relating to
settlement health process should be emailed to:
Please note that all INZ clinical and processing
enquiries relating to the initial medical examination
(visa medical processing) should continue to be emailed
The choice of a specialist is not limited; however high-
quality reports are needed. Substandard reports will not
be accepted by INZ. Physicians should refer clients to
specialists in whom they have confidence in clinical skill
and reporting.
Settlement Health Instructions – May 2022 – 7
When filling in this form, please write clearly using CAPITAL LETTERS.
• National Identity Card with photo (as long as the
identity card was issued by one of the following
countries and the examining clinic is located in the
issuing country)
PART 2: COMPLETING A 948
MEDICAL RESETTLEMENT
NEEDS / SETTLEMENT HEALTH
ASSESSMENT (INZ 1260)
This part of the instructions provides advice about
completion of the settlement health assessment for
UNHCR-mandated refugees:
Albania
Belgium
Brazil
Bulgaria
Canada
China People’s Republic of
Croatia
Czech Republic
• eMedical enabled clinics must use the 948 Medical
Resettlement Needs form
• non-eMedical clinics will need to use the Settlement
Health Assessment (INZ 1260) form (paper format)
Egypt
France
Clients may require a professional interpreter or
a chaperone to be present (please see ‘privacy
considerations’ and ‘chaperones’ in Part 1). The details
of the interpreter and/or chaperone must be recorded
on the form.
Germany
Hong Kong (Special Administrative Region of the
People’s Republic of China)
Hungary
Indonesia
The sections and questions below are listed in the order
of the paper Settlement Health Assessment (INZ 1260).
The order may differ in the eMedical 948 Medical
Resettlement Needs.
Italy
Malaysia
Netherlands Antilles
Pakistan
Poland
Portugal
SECTION A: PERSONAL DETAILS (eMEDICAL
PRE-EXAM STAGE)
Russia - Note: Internal passports are considered
equivalent to a National Identity Card
Singapore
South Korea
Spain
The questions in this section are for the purpose of
confirming the identity of the client and their contact
details.
Sweden
Taiwan
Thailand
Turkey
Client visa category
Settlement health assessment forms should only be
completed for clients who have been approved for
a New Zealand resident visa under New Zealand’s
Refugee Quota Programme or the Refugee Quota
Family Reunification Category.
SECTION B: CLIENT CONSENT
For eMedical enabled clinics, the 948 Medical
Resettlement Needs form will be prescribed for
approved clients. For clinics without eMedical,
the Settlement Health Assessment (INZ 1260) form
is available for download from the INZ website
The client consent must be signed and dated by the
client in the presence of the physician. The physician
must ensure that the client has read and/or had it read
to them in their preferred language. This may require
a professional interpreter.
There are two components of this assessment that
the client can consent to:
• settlement health assessment, and any further tests
as a result of this assessment
Client identity
The examining physicians and/or their clinic staff must
confirm the identity of all individuals who present
for a settlement health assessment. INZ accepts the
following documents to confirm an applicant’s identity:
• vaccinations.
The client may choose to consent to both or only one
of these components.
If there are any parts of the consent that the client
doesn’t understand, the physician will provide the
information in vocabulary and language the client does
understand so that informed consent can be gained.
The physician must ensure the client understands the
entire consent before witnessing the client signing
• Original passport
• Certificate of identity
• Refugee travel document
8 – Settlement Health Instructions – May 2022
the consent. A parent or guardian must sign on behalf
of a client who is under 18 years of age or who is an
incapable person.
C1. HAVE YOU EVER HAD PROLONGED MEDICAL
TREATMENT AND/OR REPEATED HOSPITAL ADMISSIONS
FOR ANY REASON, INCLUDING A MAJOR OPERATION OR
PSYCHIATRIC ILLNESS?
eMedical: 948 Medical Resettlement Needs – the
consent must be printed, signed by the client and the
physician, then scanned and attached within eMedical.
Prolonged medical treatment may include:
• treatment for recurrent conditions
Paper: Settlement Health Assessment (INZ 1260) – the
consent is included within the form. The client must
sign the form in the presence of the physician. When
signing the consent, the physician must also stamp the
document with their name and address, or legibly print
those details.
• treatment for conditions requiring treatment for
more than two weeks
• physiotherapy, speech therapy or other therapies
• inpatient or outpatient care for a psychiatric illness.
Details must be provided about the type and length
or treatment.
If a client does not consent to the settlement health
assessment and/or vaccinations, the reason for this
must be recorded.
Regarding hospital admissions, the physician is
expected to detail:
If the client does not consent to the settlement
assessment and vaccinations, and does not travel to
the responsible clinic, the ‘Decline in absentia’ form
needs to be completed by the physician. It is available
for download from the INZ website www.immigration.
• the date/s of treatment
• the reason/s for treatment
• the type/s of treatment received.Document
all procedures. Both inpatient and outpatient
treatments are relevant. Hospital admissions
for normal vaginal delivery do not need to
be documented but all other obstetric and
gynaecological history should be documented.
This must then be submitted to the RHLT so they are
aware that the client has opted out of the settlement
health assessment at this time.
Regarding operations, the physician is expected
to detail:
• the date and reason for the operation
• the operative procedure that was performed
• any available pathology or staging reports.
SECTION C: MEDICAL HISTORY
A physician must complete this section with the client.
For a child who is younger than 18 years of age, or an
incapable person, the medical history section must be
completed by the physician together with a parent or
guardian.
C2. DO YOU HAVE A HEART CONDITION INCLUDING
CORONARY DISEASE, HYPERTENSION, VALVE OR
CONGENITAL DISEASE?
Note any evidence of heart disease such as:
These questions are designed to assist the physician to
complete an in-depth health screening of the client, with
the view to:
• chest pain, shortness of breath when lying down
or with exercise, ankle swelling
• angina or ischaemic heart disease
• identifying the client’s health concerns and planning
health care early
• cardiac risk factors such as diabetes, smoking,
family history of premature heart disease
• managing communicable diseases
• facilitating a smooth transition into the New Zealand
Health system.
• previous cardiovascular events such as angina,
myocardial infarction, percutaneous coronary
intervention, coronary artery bypass graft, severe
peripheral vascular disease, familial lipid disorders,
severe diabetes with nephropathy
• persistent uncontrolled hypertension
• heart murmur or valve disease
• cardiomyopathy
Be guided by the client’s concern and document these
even if they do not strictly fit within the parameters of
the questions.
If the client answers ‘Yes’ to any question, note relevant
details such as date of diagnosis, progress, current
problems, complications and treatment so far. Attach
any reports, tests and other information available.
All items being attached to a paper settlement health
form must be signed or initialled by the physician and
securely attached.
• aortic aneurysm
• rheumatic fever, past or present.
Settlement Health Instructions – May 2022 – 9
When filling in this form, please write clearly using CAPITAL LETTERS.
C3. DO YOU HAVE A RESPIRATORY CONDITION,
INCLUDING ASTHMA, COPD, INTERSTITIAL LUNG
DISEASE?
C7. DO YOU SUFFER, OR HAVE YOU EVER SUFFERED,
FROM A PSYCHOLOGICAL OR PSYCHIATRIC DISORDER
(INCLUDING MAJOR DEPRESSION, BIPOLAR DISORDER
OR SCHIZOPHRENIA)?
Note any evidence of respiratory disease such as:
• cough
• wheeze
Note any evidence of major psychiatric illness
including any psychiatric condition that has required
hospitalisation and/or where significant support is
required. This may include (but not limited to):
• shortness of breath
• recurrent respiratory infections.
• bipolar disorder
• schizophrenia
• psychosis
• eating disorders
• post-traumatic stress disorder
• anxiety or depression.
C4. DO YOU HAVE ANY GASTROINTESTINAL CONDITIONS,
INCLUDING CROHN’S AND ULCERATIVE COLITIS, OR
LIVER DISEASE?
Note any evidence of gastrointestinal disease such as:
• nausea and/or vomiting
• heartburn
If there is a history of mental illness, include details of:
• the specific diagnoses including personality disorders
• diarrhoea
• per rectal bleeding
• loss of appetite
• details of the type and duration of treatment
including non-pharmacological treatment
• weight loss.
• any history of non-compliance with treatment
• frequency of relapses
• an assessment of potential for self-harm or harm
to others.
C5. DO YOU HAVE ANY MUSCULOSKELETAL
CONDITIONS?
Note any evidence of musculoskeletal problems such as:
• gait abnormality
C8. DO YOU HAVE BLADDER OR KIDNEY PROBLEMS?
Note any evidence of bladder of kidney conditions
such as:
• muscle and joint pain and/or swelling
• muscle weakness and/or wasting
• history of injuries including fractures
• mobility aids.
• polycystic kidney disease, glomerulonephritis
• renal failure, dialysis, renal transplant
• family history of polycystic kidney disease or other
hereditary kidney conditions
If present, note impact of symptoms on function.
• incontinence (urge or stress)
• recurrent urinary tract infections.
C6. DO YOU HAVE A NEUROLOGICAL CONDITION,
INCLUDING HAVING HAD A STROKE OR MULTIPLE
SCLEROSIS?
C9. DO YOU HAVE A BLOOD CONDITION (INCLUDING
THALASSAEMIA)?
Note any evidence of neurological problems such as:
• any cognitive impairment or dementia, including
Alzheimer’s disease
Note any evidence of a blood condition such as:
• blood or blood product transfusions, indicate when
and where and if any complications
• poorly controlled epilepsy or complex seizure
disorder
• haemophilia, bleeding disorder, coagulopathies
• sickle cell disease, thalassaemia or other hereditary
anaemias
• cerebrovascular disease such as transient ischaemic
attacks or strokes
• cerebral palsy
• haemochromatosis
• any haematological malignancy such as leukaemia,
lymphoma or myelodysplastic syndrome
• paraplegia, quadriplegia
• head or brain injury
• poliomyelitis
• Parkinson’s disease
• motor neurone disease
• Huntington’s disease
• muscular dystrophy
• prion disease
• family history of blood conditions.
• relapsing and/or progressive multiple sclerosis.
10 – Settlement Health Instructions – May 2022
C10. DO YOU HAVE A HEREDITARY OR AUTOIMMUNE
CONDITION?
C18. DOES THE TINNITUS CAUSE YOU STRESS OR
ANXIETY? (ONLY TO BE ANSWERED IF ANSWERED
YES IN C17)
Provide details of any hereditary or autoimmune
condition, such as:
If the answer is yes, provide details including:
• Ear/s affected
• Date of onset and progress of symptoms
• Causative or contributing factors
• Impact on function
• any chromosomal, genetic, congenital or
familial disorder such as Huntington’s chorea,
hyperlipidaemia, muscular dystrophies, cystic
fibrosis, Down’s syndrome
• any primary or acquired immunodeficiencies
• any inborn errors of metabolism
• Treatment/s.
• personal or family history of Gaucher’s disease
C19. HAVE YOU EVER HAD ANY OPERATIONS ON
YOUR EYES? IF YES PROVIDE DETAILS OF TREATMENT
INCLUDING REASON, EFFECTIVENESS AND DATES
• any autoimmune condition including arthritis, lupus,
psoriasis, Crohn’s disease or other inflammatory
bowel disease.
C20. HAVE YOU EVER HAD TO SEE AN EYE DOCTOR
BEFORE?
C11. DO YOU HAVE A THYROID CONDITION?
C21. DOES ANYONE IN YOUR FAMILY HAVE ANY
PROBLEMS WITH EYES? DESCRIBE PROBLEM AND
TREATMENT.
Provide details of any thyroid condition including:
• date of diagnosis
• progress
• current problems
• complications
If the answer is yes, provide details including:
• Reason for presentation
• Eye/s affected
• treatment so far.
• Date/s of assessment
• Treatment/s.
C12. DO YOU HAVE COMMUNICABLE DISEASES?
Ask about risk factors and history of communicable
diseases including (but not limited to):
C22. DO YOU HAVE ANY DIFFICULTY DOING ANYTHING
BECAUSE OF YOUR VISION?
• Tuberculosis
• Hepatitis B
• Hepatitis C
• Syphilis
• HIV
If the answer is yes, ask for examples of impact on
function e.g. unable to read without glasses.
C23. DO YOU HAVE AN ONGOING PHYSICAL OR
INTELLECTUAL DISABILITY AFFECTING YOUR CURRENT
OR FUTURE ABILITY TO FUNCTION INDEPENDENTLY OR
BE ABLE TO WORK FULL-TIME (INCLUDING AUTISM OR
DEVELOPMENTAL DELAY)?
• Malaria
• Dengue.
INZ wishes to establish if further resources are required
to assist with refugees who have a diagnosed long
term issue with cognitive capacity. Note any evidence
of physical, intellectual or developmental conditions,
such as:
C13. DO YOU HAVE HEARING OR VISION RELATED
CONDITIONS?
Provide details of any hearing or vision related condition
including:
• date of diagnosis
• progress
• current problems
• complications
• treatment.
• physical disability
• intellectual disability
• autistic spectrum disorders
• brain injury.
Also provide details of:
• significant periods of time off work
• date last worked
C14. DO YOU HAVE A HEARING LOSS OR HAVE YOU
NOTICED A DECREASE IN YOUR HEARING?
• restrictions on work ability
• prognosis.
C15. DO YOU HAVE PAIN IN YOUR EARS?
C16. DO YOU HAVE A BLOCKED FEELING OR A FEELING
OF PRESSURE IN YOUR EARS?
If there is a history of autism, Asperger’s syndrome
or special schooling, attach any existing report that
is available from a paediatrician, clinical psychologist
and/or other therapists.
C17. DO YOU HAVE TINNITUS?
Settlement Health Instructions – May 2022 – 11
When filling in this form, please write clearly using CAPITAL LETTERS.
C24. DO YOU HAVE ANY BIRTH OR DEVELOPMENTAL
ISSUES (ONLY FOR CLIENTS AGED 5 OR LESS)
• any history of detoxification or rehabilitation
programmes
• the duration of abstinence
• triggers for drug and alcohol use.
Ask parent/s or caregiver/s if they have any concerns
about the client’s development. Document all concerns.
C25. HAVE YOU EVER HAD AN ABNORMAL OR REACTIVE
HIV BLOOD TEST?
C30. SMOKING HISTORY
If the client is a current cigarette smoker or has ever
regularly smoked cigarettes for a period of six months or
longer, the number of cigarettes smoked, the frequency,
and the duration of smoking need to be documented.
Provide details of any abnormal or reactive HIV blood
test including:
• date of test
• subsequent test/s
• follow up including diagnosis and/or treatment.
If the client is an ex-smoker, the number of years they
have been ‘cigarette-free’ should also be documented.
The physician should calculate the pack year history.
Pack year history is a way to measure the amount a
person has smoked over a long period of time. It is
calculated by multiplying the number of packets of
cigarettes smoked per day by the number of years the
person has smoked:
C26. HAVE YOU EVER HAD AN ABNORMAL OR REACTIVE
HEPATITIS B OR HEPATITIS C BLOOD TEST?
Note relevant details including:
• date of diagnosis
• risk factors
• progress including recent liver function tests results
if available
• (Packs of twenty cigarettes per day) x (number of
years smoked)
• Example 1: 10 cigarettes per day for 10 years = ½ x 10
= 5 pack year history
• Example 2: 40 cigarettes per day for 30 years = 2 x 30
= 60 pack year history.
• management, if any, including management
of contacts.
C27. DO YOU HAVE OR HAVE YOU HAD CANCER OR
MALIGNANCY IN THE LAST 5 YEARS?
C31. DO YOU HAVE ANY SIGNIFICANT FAMILY HEALTH
HISTORY?
Provide details of malignancies of organs, skin and
haematopoietic tissues including:
Ask the client if they have a parent or sibling:
• with a condition such as diabetes
• with cardiovascular/kidney/liver/blood/neurological
disease
• with a genetic disorder
• with cancer
• dates
• sites
• staging
• histology reports
• treatments
• current status
• prognosis.
• who died due to illness before the age of 65.
Document the client’s relationship to that person
(e.g. father, sibling) and the nature of the condition.
C28. DO YOU HAVE DIABETES?
If the client is a child under 15 years of age and either
parent is HIV positive, document this.
Note any evidence of diabetes such as:
• sugar in the urine, polydipsia, polyuria
• positive diabetes tests
• history of gestational diabetes mellitus
• need for anti-hyperglycaemic medication
C32. ARE YOU TAKING ANY MEDICATION (INCLUDING
CONTRACEPTIVES, OVER-THE-COUNTER MEDICATION
AND NATURAL SUPPLEMENTS)?
Provide a complete list of all medications including
contraceptives, over the counter medications and
natural supplements, with their doses and frequency.
Complete the table with the medication (brand and
generic), dose and frequency.
• end organ damage such as nephropathy, retinopathy,
neuropathy, and peripheral vascular disease.
C29. DO YOU HAVE AN ADDICTION TO DRUGS OR
ALCOHOL?
Note any known substance addictions. If there is any
positive history of alcohol/drug abuse, note:
C33. DO YOU HAVE ANY KNOWN ALLERGIES
(E.G. SPECIFIC MEDICATIONS OR FOOD TYPES)
• any current use of alcohol or drugs
• any narcotic or intravenous drug use or addiction
• the history of any social or occupational
consequences from the abuse/addiction
• addiction to prescription medications
Note any allergies and provide details including:
• allergen/s
• details of reaction e.g. rash, swelling, wheeze,
diarrhoea
• treatment/s required
• date of last reaction.
12 – Settlement Health Instructions – May 2022
Delegating responsibility
SECTION D: PREGNANCY
The following measurements may be collected by
staff supervised by the physician on the basis that
the staff member concerned uses the equivalent skills
that the physician would use to achieve the equivalent
assessment result quality.
D1. ARE YOU PREGNANT?
D2. WHAT IS THE EXPECTED DATE OF DELIVERY?
If the client has a letter from their own doctor or
lead maternity carer (obstetrician) confirming their
pregnancy, scan and attach it to the health case.
• Weight
• Height
• BMI
D3. ANY COMPLICATIONS TO DATE
Enquire as to whether the pregnancy is progressing
normally. Provide details if there are any complications.
• Head circumference
• Visual acuity
• Blood pressure
• Urine testing.
Ask about obstetric history including:
• previous gestational diabetes mellitus
• pre-eclampsia
• difficult deliveries
• previous premature babies
• prolonged labours
If the physician delegates any part of the physical
examination as above, this may only be performed by
a registered nurse or registered medical practitioner for
whose work the physician takes professional and legal
responsibility.
• recurrent miscarriage.
Medical findings
D4. HAVE RUBELLA STATUS, BLOOD GROUP, RHESUS
FACTOR AND FERRITIN LEVEL MATERNITY BLOODS
BEEN DONE?
Where an abnormality is detected or declared, the
physician must provide sufficient details regarding
the nature, severity and possible/likely prognosis of
the medical condition and/or disability to enable INZ
to clearly understand and appreciate the examined
person’s state of health.
Attach details of tests, if available, including:
• dates
• results.
The physician is to provide detailed comment on
examination findings where:
D5. HAVE FOLIC ACID, IRON, IODINE SUPPLEMENTS
BEEN PRESCRIBED?
• ’Yes’ has been answered to a question in the ‘Medical
history’ section
• There are pre-existing medical conditions (the client
should provide any relevant reports they have)
If prescribed, record medication, dose and frequency in
the table in C32.
SECTION E: PHYSICAL EXAMINATION
• Abnormalities are present or are detected.
If medical reports have been provided by the client,
attach these to the eMedical Settlement Health
Assessment, or for paper-based medical certificates,
authenticate these by initialling each page and attaching
securely to the certificate.
Clients must be advised that the physical examination
includes an assessment of general appearance,
a head-to-toe examination, and a mental health
assessment. For the examination to provide the best
information, they will be asked to remove sufficient
clothing for a full and appropriate physical examination.
A chaperone should be offered and details recorded if
one was present.
Timely medical tests
All other medical tests required or indicated as a result
of the examination should be carried out on or about
the date of the medical examination.
Once the client is comfortable to be examined, proceed
with the examination.
Where an abnormality is detected or declared, the
physician must provide sufficient details regarding
the nature, severity and possible/likely prognosis of
the medical condition and/or disability to enable INZ
to clearly understand and appreciate the client’s state
of health.
E2. E3. HEIGHT AND WEIGHT
Record height in metres and weight in kilograms.
• A stadiometer fixed to the wall is recommended.
• When the client is unable to stand then record length
on the application form.
• Adults and children must stand barefoot and wear
lightweight clothing.
• Infants must be naked except for a diaper/nappy
and recorded to the nearest 0.1kg.
Settlement Health Instructions – May 2022 – 13
When filling in this form, please write clearly using CAPITAL LETTERS.
E4. BMI
E14. HEART RHYTHM
This will be automatically calculated in eMedical when
required. For paper forms: body mass index (BMI) must
be calculated for clients over 18 years of age.
Assess rhythm clinically e.g. regular, regularly irregular,
irregularly irregular. Add description of rhythm after
heart rate in E13. To confirm heart rhythm, do an ECG.
• The formula is the weight (in kg) divided by the
height (in m2).
E15. E16. E17. URINALYSIS
Check appropriate box for dipstick findings.
BMI calculators are available online, for example:
E18. CARDIOVASCULAR SYSTEM
Assessment includes:
E5. E6. HEIGHT PERCENTILE AND WEIGHT PERCENTILE
• cyanosis, pallor, peripheral temperature and oedema
• additional blood pressures readings as indicated
(e.g. standing and sitting, left arm and right arm)
Record the nearest percentile. (www.health.govt.nz/our-
• size and consistency of thyroid gland, including
any masses
• jugular venous pressure
Baby, infant and child height and weight must be
compared to standardised height and weight chart for
the appropriate population. Growth charts supplied can
be accessed through the following links:
• palpation for thrills and character of apex beat
• auscultation of heart sounds, extra sounds and
murmurs
• peripheral vascular system: carotid, radial, femoral,
posterior tibial and dorsalis pedis
• Centre for Adoption Medicine:
This includes links to country specific growth charts.
• carotid and femoral bruits.
E7. E8. HEAD CIRCUMFERENCE
All abnormalities must be noted.
Record the head circumference in all children up to
two years of age:
E19. RESPIRATORY SYSTEM
Assessment includes:
• respiratory rate
• any respiratory distress, cyanosis and accessory
muscle use
• Assess greatest occipitofrontal circumference.
Compare measurement with the standardised head
circumference chart for the appropriate population.
Growth charts supplied can be accessed through the
following links:
• position of trachea
topics/growth-charts.html. This includes links to
country specific growth charts.
• cervical lymphadenopathy
• chest shape and expansion
• percussion of the chest
• auscultation of breath sounds
• finger clubbing
E9. E10. BLOOD PRESSURE
Blood pressure must be measured for all clients over
15 years using an appropriate cuff size.
• peak expiratory flow rate (especially for clients with
a 20 pack year or more smoking history)
• good quality spirometry if possible.
If blood pressure is elevated, repeat after the patient
has rested for five minutes and, if necessary, again after
10 minutes.
All respiratory abnormalities must be noted.
E20. NERVOUS SYSTEM: SEQUELAE OF STROKE OR
CEREBRAL PALSY, OTHER NEUROLOGICAL DISABILITIES
If concerned about postural hypotension or left to right
shunts, record sitting and standing blood pressures
and side that blood pressure was taken on. Record
these additional blood pressure readings under E18:
Cardiovascular System.
Assessment includes:
• cranial nerves (visual assessment, face sensation
and movement, hearing, tongue)
E11. TEMPERATURE
• tone
• power
Take temperature. Record temperature if abnormal.
• reflexes
E12. RESPIRATORY RATE
• sensation to light touch, pin prick
• plantar responses
• coordination
• gait
E13. HEART RATE
Measure rate per minute and record in respective field.
• Romberg’s test.
14 – Settlement Health Instructions – May 2022
E21. GASTROINTESTINAL SYSTEM
Assess cognition if the client is over 70 years of age or
there is concern that the client may have a cognitive or
memory deficit.
Assessment includes:
• stoma sites
Complete the Rowland Universal Dementia Assessment
Scale (RUDAS) screening test www.immigration.govt.nz/
The test questions should be performed in the client’s
own language or with the assistance of a professional
interpreter. If a language barrier to assessment is
present, this should be recorded. For more information
on administering RUDAS, see the RUDAS Administration
• ascites, distension
• tenderness, masses, guarding
• liver, spleen, kidneys
• bowel sounds
• hernias
• femoral pulses and bruits
• any unexplained weight loss.
Abnormalities must be noted.
E26. INTELLECTUAL ABILITY
E22. MUSCULOSKELETAL SYSTEM
If intellectual ability is abnormal, document all concerns.
Assessment includes:
Assess:
• inspection of joints, muscle and the skeletal system
looking for erythema, swelling, tenderness, nodules,
lumps, range of motion, any deformities and ability
to stand from squatting
• behaviour
• need for long-term supported or special education
• level of independence and need for assistance or
institutional care
• mobility and locomotion, limping
• use of accessories such as braces, walking aids or
wheelchairs.
• employment capacity and occupation history.
E27. VISUAL ACUITY WITH OR WITHOUT CORRECTION
All abnormalities must be noted. If there concerns about
managing activities of daily living, complete an activities
of daily living (ADL) assessment (Appendix 2).
Test the client’s best vision. The visual acuity of each eye
must be tested separately with corrective lenses if worn.
If the client usually wears corrective lenses but has not
brought them in on the day, document this. Snellen’s,
E or similar charts must be used.
E23. ENDOCRINE SYSTEM
Examination of the endocrine system should include
thyroid examination and review of signs and symptoms
of diabetes. Clients known to have benign thyroid
disease do not need additional investigations such
as thyroid function tests.
If a refractive defect is suspected, pinhole testing must
be done.
Corrected visual acuity must be recorded. In children
too young to use a chart, a comment must be made on
whether vision appears normal.
E24. EYES (INCLUDING FUNDOSCOPY)
Examination should include physical inspection of the
eye for deposits in the iris, xanthelasma, lid issues and
eye motility.
E29. HEARING
Assessment includes:
• either grossly or with an audiogram where possible
• each ear must be tested separately
E25. MENTAL AND COGNITIVE STATUS
Mental health conditions can be at times particularly
difficult to identify. Assess for a recent history or
current clinical evidence of the following:
• in young children, a comment must be made on
whether hearing appears normal.
All abnormalities must be noted.
• schizophrenia
E30. EAR/NOSE/THROAT/MOUTH
• bipolar or depressive affective psychosis
• personality disorder
• paranoid disorder
Assessment includes:
• external ear, auditory canal, ear drums, general
hearing
• autism
• chronic alcohol abuse
• drug dependence or substance abuse
• eating disorders
• chronic neurosis (for example, chronic anxiety or
depression, obsessive compulsive disorder, phobias).
• nasal obstruction and discharge
• oral cavity, tongue (including under) and pharynx
• teeth (including under dentures if any) and gingiva
• any masses, leukoplakia and other abnormalities.
All abnormalities must be noted.
Settlement Health Instructions – May 2022 – 15
When filling in this form, please write clearly using CAPITAL LETTERS.
E31. DEVELOPMENTAL MILESTONES (CHILDREN UNDER
FIVE YEARS OF AGE)
Gynaecological examination (vaginal or pelvic
examination) is never indicated in the context of
a settlement health examination. If there has been
a history or clinical suspicion of gynaecological
malignancy that has been identified in the settlement
health assessment, discuss with RHLT about referral to
a gynaecologist.
Assessment includes the following critical
developmental milestones:
• cannot hold head up unsupported at eight or more
months (normal four months)
• cannot sit unsupported at nine months
(normal eight months)
E33. BCG
Mark as normal if absent. Mark as abnormal if present
and provide details about scar including size and
location.
• cannot walk at 18 months (normal 13 months)
• no words by 18 months (normal 15 months)
• no two–three-word phrases by 24 months and
40 months respectively (normal 21 and 36 months
respectively)
E34. BREAST EXAMINATION ON WOMEN OVER 45 YEARS
OF AGE
• Moro reflex persisting at six or more months.
Examinations should only be done if there is a clinical
indication and must be conducted with sensitivity and,
in the case of a male physician, with the presence of a
chaperone. If examination is necessary, always explain
clearly to the client the reason for the examination and
check their understanding. Document this conversation
in detail.
For further milestones, see Child Development Milestone
Guidelines (appendix 3). All abnormalities must be
noted.
E32. SKIN AND LYMPH NODES
Assessment includes:
Assessment includes:
• scars - note scars from surgical procedures and
significant injuries
• nipple symmetry, eversion and discharge
• tattoos – as INZ screen for various infectious
diseases, including Hepatitis C, it is not necessary
to comment on tattoos. Please only provide details
relating to tattoos if there are specific concerns.
• skin conditions and lesions
• lymph nodes: cervical, axillary, inguinal
• evidence of peau d’orange or skin changes around
the nipple
• breast lumps or cancers, and
• axillary lymph nodes. All abnormalities must
be noted. Record benign breast lesions such as
fibroadenoma or fibrocystic disease.
• cervical nodes in children: submental, submandibular,
anterior and posterior cervical, pre- and post-
auricular, suboccipital and supraclavicular lymph
nodes are not usually palpable in children who are
well. If they are palpable, consider tuberculosis.
E35. ANY PHYSICAL OR MENTAL CONDITIONS WHICH
MAY PREVENT THIS PERSON FROM ATTENDING A
MAINSTREAM SCHOOL, GAINING FULL EMPLOYMENT
OR LIVING INDEPENDENTLY NOW OR IN THE FUTURE?
Consider any condition or finding that has current
or likely future impact, on the client’s capacity for
independent living and/or employment, and provide
full details. Assessment includes:
Abnormalities must be noted. Referral to an appropriate
physician is necessary for:
• palpable cervical lymph nodes in children
• unexplained lymphadenopathy
• unstable, progressive, symptomatic or complicated
conditions
• any condition likely to significantly affect the client’s
ability to function at home, study or work or perform
activities of daily living.
• eating, drinking, dressing, washing, toileting, bladder
and bowel control, mobility and locomotion
• communication, comprehension, expression
• social cognition, social interaction
• memory
• need for devices, aides or assistance.
Note: In male and female clients, examination of
the external genitalia should only be done if clinical
evidence is presented to indicate a condition requiring
assessment. Rectal examination is rarely, if ever,
indicated. If either of these sensitive examinations is
necessary, always explain clearly to the client the reason
for the examination, check their understanding and
offer a chaperone and the presence of a family member.
Document this conversation in detail.
All abnormalities must be noted.
Activities of Daily Living (ADL) needs to be assessed for
any client where there is concern about their ability to
carry out the activities of daily living, including the frail
elderly. See ADLs assessment (Appendix 2).
Where there is concern about capacity for full
employment, provide details of any anticipated
employment restrictions.
Full details should be provided of any required
rehabilitation services currently being provided to
the client, or which will be needed in the future.
16 – Settlement Health Instructions – May 2022
E36. EVIDENCE OF DRUG-TAKING
Processes for safe immunisations
Assessment includes:
• puncture marks, phlebitis
• mental state
• smell of alcohol on the breath, signs of chronic liver
disease in the context of alcohol dependence
covers pre-vaccination screening in 2.1.3, with condition
or circumstance to screen for (e.g. is pregnant, has a
disease that lowers immunity), what actions to take
and the rationale for this. This chapter also covers
contraindications in 2.1.4 and post-vaccine advice
in 2.3.1.
• any other indicators of drug-taking or addiction.
All abnormalities must be noted.
F1 EXAM DATE
Record the date the exam was completed.
SECTION F: SETTLEMENT VACCINATIONS
F2 CONTRAINDICATIONS
Ensure copies of all documentation of previous vaccines
are attached in this section and labelled as vaccinations.
Provide details of any contraindications.
Record all contraindications.
F4 DISEASE / VACCINE:
If the client advises that they have been vaccinated
but has no documented evidence of this, this must
be recorded and they must be treated as if they were
not vaccinated. In this case, complete the Absent
Vaccination Documentation and attach this to the
Settlement Health assessment. The Absent Vaccination
Documentation form is available for download from the
INZ website : www.immigration.govt.nz/assist-migrants-
Provide the name of the vaccine given.
Administered by clinic: (must be completed).
Batch number: As displayed on vaccine vial
(must be completed).
Batch expiry: As displayed on vaccine vial
(must be completed).
Route: Mark which route used (must be completed).
Waiver reasons: Only mark if any applies (can be left
blank).
Offer vaccinations according to New Zealand’s
Immunisation Schedule. https://www.immune.org.nz/
F5 MEASLES, MUMPS, RUBELLA, HEPATITIS B, POLIO
& VARICELLA
If required, plan and complete a catch up schedule
of vaccinations. Follow guidance from Immunisation
Handbook: Planning Immunisation Catch-Ups in the New
Zealand Immunisation www.health.govt.nz/our-work/
Test for immunity positive
Record if test for immunity was previously done and
date of test. If more than one immunity test was done,
supply all records. There is no need to arrange immunity
tests if not previously done.
Record all vaccines given.
F6 VARICELLA
For further information about vaccinations, see the
New Zealand Immunisation Handbook 2020
Has the client had the disease? Document if the client
has a history of having Varicella. Indicate yes or no.
SECTION G: LABORATORY TESTS
Chapters of specific interest include:
Planning Immunisation Catch-Ups
Physicians should perform specimen collection onsite.
If the physician delegates this procedure to a nurse or
phlebotomist, the physician remains accountable for
the integrity of the procedure. For further information
about specimen integrity, please refer to New Zealand
Immigration Panel Member Instructions (INZ 1216).
Immunisation of special groups
The physician must select trusted laboratories to
perform the tests required by INZ.
immunisation-handbook-2020/4-immunisation-
special-groups including pregnancy and lactation,
immunocompromised individuals, chronic kidney
disease, chronic liver disease
The physician must discuss the nature of testing with
the client or, if the client is a person under 18 years of
age or an incapable person, with the client’s parent or
guardian. Where applicable the physician should explain:
• standard tests that are advised as a part of the
settlement health services
Settlement Health Instructions – May 2022 – 17
When filling in this form, please write clearly using CAPITAL LETTERS.
• the nature and reason for any discretionary tests
• that all test results will be provided to INZ.
• Referral for medical intervention as discussed with
RHLT. The physician is to detail any referral in the
Laboratory Test ‘Remarks’ field.
It is compulsory to record and attach results for all
laboratory tests. When reviewing the laboratory tests,
ensure that the person collecting the blood, and/
or receiving the laboratory specimens has confirmed
the client’s identity to confirm that the samples
were collected from the individual identified on the
settlement health form.
Standard laboratory tests
The following blood tests are advised for all clients:
• HBsAg
• Hep C Antibody
• HIV serology
• Syphilis test.
Each of these tests requires a number value or
‘nonreactive/reactive’ response by the physician.
The laboratory reference standard ranges for each test
must be included in the results. Where the test(s) is
serological for antibodies or antigens, the laboratory
test used must also be specified.
The following blood tests are advised for all clients
40 years of age and over or where clinically indicated:
• HbA1C.
Urinalysis is required for clients 5 years and older.
eMedical: 948 Medical Resettlement Needs –
Referral forms for laboratory tests can be generated
using standard eMedical functionality. Please refer
to the training guides within eMedical (module 9
– Examinations, section 9.6 Pathology and Other
examinations) for more information if required.
Following up abnormal laboratory test results
The following tests can be organised without discussing
with RHLT. If considering other follow up tests or local
alternatives, discuss with RHLT at RHLT@mbie.govt.nz
before undertaking.
Paper: Settlement Health Assessment (INZ 1260)
– The laboratory referral form (Section J) is included
and comprises two pages to be detached and given
to the client to take to the laboratory for completion.
The physician is to sign and date the form, including
adequate address details where the results and the
completed ‘Section K: Confirmation of identity and
declaration’ are to be returned.
Test
Follow up of abnormal results
HbA1C (in mmol/mol)
If >50mmol/mol, add serum creatinine,
eGFR, lipids, TSH and urinary
albumin:creatinine ratio.
Hepatitis B surface antigen
positive
Add:
›
›
›
›
Hepatitis B e-antigen
HBV DNA
LFTs
Please provide these pages of the form to the client
along with directions to the laboratory. A separate
laboratory referral form should be provided for each
set of laboratory tests.
AFP, if over 30 years of age
Hepatitis C serology positive
Syphilis screening
Add HCV-RNA.
Local screening test for syphilis should
be done. All positive tests must be
confirmed with a treponemal specific
test:
It is acceptable for physicians to use their own
laboratory forms/process, with the proviso that
‘Section K: Confirmation of identity and declaration’
is still completed at the time of specimen collection,
by both the client and the person collecting the
specimens.
›
›
›
treponema pallidum particle
agglutination test (TP-PA)
fluorescent treponemal antibody
absorption test (FTA-ABS), or
microhaemagglutination for
treponema pallidum (MHA-TP).
Laboratory reports must be initialled on each page and
securely attached to the health form.
If positive then please provide specific
details regarding any management
required or given (including drug
names, doses and dates).
Abnormal laboratory tests
If a client’s laboratory tests are abnormal, the physician
should arrange additional testing as indicated below,
Dipstick urinalysis positive
Add mid-stream urine sample. Send
for albumin, protein, red cells, to laboratory for examination of
glucose AND the female client red cell casts or dysmorphic cells on
The following points need to be covered in discussion
with the client where applicable, bearing in mind local
ethical standards and requirements:
does not have her period
(menstruation)
microscopy. If positive for glucose
check HBA1C if not already done, and
add albumin:creatinine ratio.
If positive for blood, request culture
and sensitivity.
• Information about the tests and results
• Implications and possible prognosis
• Ways of transmission of the organism/s
If protein positive, request creatinine
and eGFR if not already done.
• Ways of protecting others from infection with the
organisms, in particular, the vaccination of close
contacts of hepatitis B carriers
Haematuria Greater than
10 cells per high power
field AND the female client
does not have her period
(menstruation)
Repeat urine microscopy for
confirmation and trend.
• Ways of minimising future complications
18 – Settlement Health Instructions – May 2022
Discretionary laboratory tests
PART 3: COMPLETING A 956
SETTLEMENT ADDITIONAL
INFORMATION / SETTLEMENT
ADDITIONAL INFORMATION
(INZ 1364)
The physician should consider additional tests in any age
group, due to indications from the medical history or
physical examination findings, or known local conditions
and risks (e.g. the local risks of Trypanosoma cruzi
for Latin America and Spain). HIV testing for children
<15 years of age is strongly recommended if their
mother is HIV positive or if the child has history of blood
or blood product transfusion. Discuss discretionary
laboratory tests with RHLT at RHLT@mbie.govt.nz
before undertaking.
This part of the instructions provides advice about
completion of the settlement additional information
requests for UNHCR-mandated refugees:
• eMedical enabled clinics must use the 956
Settlement Additional Information form.
Below is guidance for follow up of abnormal results
for common discretionary laboratory tests. Tests
recommended as part of this guidance can be organised
without discussing with RHLT. Any other follow up tests
need to be discussed with RHLT at RHLT@mbie.govt.nz
before undertaking.
• non-eMedical clinics need to complete the paper
Settlement Health Additional Information (INZ 1364)
form available at annawww.immigration.govt.nz/
Test
Follow up of abnormal results
Estimated glomerular
filtration rate (eGFR) in mL/
min/1.73m2
›
›
Ensure the client is well hydrated
and repeat.
Where eGFR is not available,
creatinine clearance must be done
(involves 24-hour urine collection).
The sections and questions below are listed in the order
of the eMedical 956 Settlement Additional information /
Settlement Additional Information (INZ 1364).
SECTION: RECORD RESULTS
HIV positive
Add confirmatory tests such as
Western Blot test or line-blot test.
The questions in this section are for the purpose of
confirming the date the exam was completed and the
type of exam, as well as for documenting additional
information requested by the RHLT.
Full blood count
If abnormal result, repeat test after
a period for two weeks for trend. If
abnormality is low haemoglobin, add
ferritin test when doing repeat testing.
If significantly abnormal result, discuss
with RHLT.
The following tests are
required:
Hb – haemoglobin in g/L
WCC – total white cell count
cells x 109/L
Exam date: Record the date the exam was completed.
Enter values as whole numbers with
the exception of the White Blood
Cells which should be recorded to one
decimal place.
Exam Description: On the eMedical form, this will be
auto-populated with the description requested by RHLT.
For paper medicals, write the description requested
by RHLT.
PLATS – platelet count cells
x 109/L
Liver function tests.
Should include:
If abnormal, discuss further testing
with RHLT.
Provide details: Provide details about the information
requested by RHLT. If an interpreter or chaperone was
required, record their details.
›
›
›
total bilirubin
alkaline phosphatase
AST – aspartate
aminotransferase (SGOT)
›
›
ALT – alanine
aminotransferase (SGPT)
GGT – gamma
glutamyltransferase
Albumin
total protein
SECTION: ATTACHMENTS
This section enables the attachment of documents to
support the tasks/information requested in the 956
Settlement Additional information by the RHLT Team.
›
›
Please provide documents in English. If original
documents need to be translated to English by either
the physician or professional interpreter, provide
original as well as the translated document.
Lipids
Repeat testing not routinely required.
Discuss with RHLT if concerns.
These do not need to be
fasting lipids.
A full Lipid Profile should be
provided: Total cholesterol;
LDL; HDL; Triglycerides;
Chol:HDL ratio.
Naming of Attachments
Name the file using a description of the attachment
e.g. if you are attaching a discharge summary from a
hospital admission, name the file ‘Hospital discharge
summary related to [medical condition]’.
Settlement Health Instructions – May 2022 – 19
When filling in this form, please write clearly using CAPITAL LETTERS.
Processes for safe immunisations
PART 4: COMPLETING 953
SETTLEMENT VACCINATIONS /
SETTLEMENT VACCINATIONS
(INZ 1251)
which covers pre-vaccination screening in 2.1.3, with
conditions or circumstances to screen for (e.g. is
pregnant, has a disease that lowers immunity), what
actions to take and the rationale for this. This chapter
also covers contraindications in 2.1.4 and post-vaccine
advice in 2.3.1.
This part of the instructions provides advice about
completion of the Settlement Vaccination form.
It allows the recording of vaccinations given to UNHCR-
mandated refugees.
Exam date
Record the date the exam was completed.
Contraindications
• eMedical-enabled clinics must use the 953
Settlement Vaccination: Record Results form.
• Non-eMedical clinics need to complete Settlement
Vaccinations (INZ 1251) which is available at
Provide details of any contraindications.
Disease / vaccine
Provide the name of the vaccine given.
Administered by clinic: (must be completed).
The sections and questions below are listed in the order
of the eMedical 953 Settlement Vaccination: Record
Results.
Batch number: As displayed on vaccine vial (must be
completed).
Batch expiry: As displayed on vaccine vial (must be
completed).
SECTION: SETTLEMENT VACCINATIONS
Route: Mark which route used (must be completed).
The questions in this section are for providing an
accurate record for any vaccines that have been
provided by your clinic.
Waiver reasons: Only mark if any applies (can be left
blank).
Remarks: Document any additional information or
issues (can be left blank).
Offer vaccinations according to New Zealand’s
Immunisation Schedule
MEASLES, MUMPS, RUBELLA, HEPATITIS B, POLIO
& VARICELLA
Test for immunity positive
If required, continue catch up schedule of vaccinations.
Follow guidance from Immunisation Handbook:
Planning Immunisation Catch-Ups in the New Zealand
Immunisation https://www.health.govt.nz/our-work/
Record if test for immunity was previously done and
the date of the test. If more than one immunity test
was done, supply all records. There is no need to arrange
immunity tests if not previously done.
VARICELLA
Record all vaccinations.
Has the client had the disease? Document if the client
has a history of having Varicella. Indicate yes or no.
For further information about vaccinations, see the
New Zealand Immunisation Handbook 2020
Attachments
If a client has documentation of previous vaccines,
attach these and name the attachment ‘Previous
vaccination documentation’.
Chapters of specific interest include:
Planning Immunisation Catch-Ups
If the client advises that they have been vaccinated but
there is no documented evidence of this, document this
using the Absent Vaccination Documentation Record
assessments and arrange vaccinations as if they were
not vaccinated.
Immunisation of special groups
Topics include pregnancy and lactation,
immunocompromised individuals, chronic kidney
disease and chronic liver disease.
20 – Settlement Health Instructions – May 2022
• National Identity Card with photo (as long as the
identity card was issued by one of the following
countries and the examining clinic is located in the
issuing country)
PART 5: COMPLETING 949
DEPARTURE HEALTH CHECK /
DEPARTURE HEALTH CHECK
(INZ 1262)
This part of the instructions provides advice about
completion of a departure health check for UNHCR-
mandated refugees:
Albania
Belgium
Brazil
Bulgaria
Canada
China, People’s Republic of
Croatia
Czech Republic
• eMedical enabled clinics must use the 949 Medical
Resettlement Needs form.
• non-eMedical clinics need to use the Departure
Health Check (INZ 1262) form (paper format)
available at
Egypt
France
Germany
Hong Kong (Special Administrative Region of the
People’s Republic of China)
Hungary
Indonesia
Italy
Malaysia
Clients may require a professional interpreter or
a chaperone to be present (please see ‘privacy
considerations’ and ‘chaperones’ in Part 1). The details
of the interpreter and/or chaperone must be recorded
on the form.
Netherlands Antilles
Pakistan
Poland
Portugal
The sections and questions below are listed in the order
of the eMedical 949 Departure Health Check.
Russia – Note: Internal passports are considered
equivalent to a National Identity Card.
SECTION A: PERSONAL DETAILS
Singapore
South Korea
Spain
Sweden
Taiwan
The questions in this section are for the purpose of
confirming the identity of the client and their contact
details.
Client visa category
Departure Health Check should only be completed for
clients who have been approved for a New Zealand
resident visa under New Zealand’s Refugee Quota
Programme or the Refugee Quota Family Reunification
Category.
Thailand
Turkey.
SECTION B: CLIENT CONSENT
For eMedical-enabled clinics, the 949 Departure Health
Check form will be prescribed for approved clients. For
clinics without eMedical, the Departure Health Check
The client consent must be signed and dated by the
client in the presence of the physician. The physician
must ensure that the client has read and/or had it read
to them in their preferred language. This may require
a professional interpreter.
If there are any parts of the consent that the client
doesn’t understand, the physician will provide the
information in vocabulary and language the client does
understand so that informed consent can be gained.
The physician must ensure the client understands the
entire consent before witnessing the client signing
the consent. A parent or guardian must sign on behalf
of a client who is under 18 years of age or who is an
incapable person.
Client identity
The examining physicians and/or their clinic staff must
confirm the identity of all individuals who present for
a Departure Health Check. INZ accepts the following
documents to confirm an applicant’s identity:
• Original passport
• Certificate of identity
• Refugee travel document
EMedical: 949 Departure Health Check – the consent
must be printed, signed by the client and the physician,
then scanned and attached within eMedical.
Settlement Health Instructions – May 2022 – 21
When filling in this form, please write clearly using CAPITAL LETTERS.
Paper: Departure Health Check (INZ 1262) – the consent
is included within the form. The client must sign the
form in the presence of the physician. When signing the
consent, the physician must also stamp the document
with their name and address, or legibly print those
details.
Medical findings
Where an abnormality is detected or declared, the
physician must provide sufficient details regarding
the nature, severity and possible/likely prognosis of
the medical condition and/or disability to enable INZ
to clearly understand and appreciate the examined
person’s state of health.
If a client does not consent to the Departure Health
Check, the reason for this must be recorded.
The physician is to provide detailed comment on
examination findings where:
If the client does not consent to the Departure Health
Check, and does not travel to the responsible clinic,
guides/inz1254.pdf) needs to be completed by the
physician. This must then be submitted to the RHLT so it
is aware that the client has opted out of the Departure
Health Check at this time.
• ’Yes’ has been answered to a question in the
‘Mental Health Condition’ section
• There are pre-existing medical conditions (the client
should provide any relevant reports they have)
• Abnormalities are present or are detected.
If medical reports have been provided by the client,
attach these to the Departure Health Check, or for
paper-based medical certificates, authenticate these
by initialling each page and attaching securely to the
certificate.
SECTION C: GENERAL MEDICAL EXAMINATION
Clients must be advised that the physical examination
includes an assessment of general appearance,
a head-to-toe examination, and a mental health
assessment. For the examination to provide the best
information, they will be asked to remove sufficient
clothing for a full and appropriate physical examination.
A chaperone should be offered and details recorded
if one was present.
Timely medical tests
All other medical tests required or indicated as a result
of the examination should be carried out on or about the
date of the medical examination. The Departure Health
Check and all attachments need to be submitted within
72 hours of finalisation.
Once the client is comfortable to be examined, proceed
with the examination.
C1. EXAM DATE:
Record date exam was conducted.
Where an abnormality is detected or declared, the
physician must provide sufficient details regarding
the nature, severity and possible/likely prognosis of
the medical condition and/or disability to enable INZ
to clearly understand and appreciate the client’s state
of health.
C2. OVERALL PHYSICAL CONDITION
If you indicated ’Abnormal’, provide full details on
what is abnormal. Please also indicate whether this
is a temporary or a permanent abnormality.
C3 C4. HEIGHT AND WEIGHT
Delegating responsibility
Record height in metres and weight in kilograms.
• A stadiometer fixed to the wall is recommended.
• When the client is unable to stand then record length
on the application form.
• Adults and children must stand barefoot and wear
lightweight clothing.
The following measurements may be collected by
staff supervised by the physician on the basis that
the staff member concerned uses the equivalent skills
that the physician would use to achieve the equivalent
assessment result quality.
• Weight
• Height
• BMI
• Infants must be naked except for a diaper/nappy and
recorded to the nearest 0.1kg.
• Head circumference
• Visual acuity
• Blood pressure
• Urine testing.
C5. BMI
This will be automatically calculated in eMedical when
required. For paper forms: body mass index (BMI) must
be calculated for clients over 18 years of age.
• The formula is the weight (in kg) divided by the
height (in m2).
If the physician delegates any part of the physical
examination as above, this may only be performed by
a registered nurse or registered medical practitioner for
whose work the physician takes professional and legal
responsibility.
BMI calculators are available online, for example:
22 – Settlement Health Instructions – May 2022
C5. C6. HEIGHT PERCENTILE AND WEIGHT PERCENTILE
C16. SKIN
Record to the nearest percentile. (www.health.govt.nz/
Assessment includes:
• scars - note scars from surgical procedures and
significant injuries
Baby, infant and child height and weight must be
compared to standardised height and weight chart for
the appropriate population. Growth charts supplied can
be accessed through the following links:
• Tattoos – as INZ screens for various infectious
diseases including Hepatitis C, it is not necessary
to comment on tattoos. Please only provide details
relating to tattoos if there are specific concerns.
topics/growth-charts.html. This includes links to
country specific growth charts.
• skin conditions and lesions
• lymph nodes: cervical, axillary, inguinal
• Cervical nodes in children: submental, submandibular,
anterior and posterior cervical, pre- and post-
auricular, sub occipital and supraclavicular lymph
nodes are not usually palpable in children who are
well. If they are palpable, consider tuberculosis.
C8. HEAD CIRCUMFERENCE
Record the head circumference in all children up to
two years of age:
Abnormalities must be noted.
• Assess greatest occipitofrontal circumference.
C17. LEGS AND FEET (PRESENCE OF INFESTATIONS
OR INFECTIONS)
C9. C10. BLOOD PRESSURE
Blood pressure must be measured for all clients over
15 years using an appropriate cuff size.
Mark the appropriate box. If abnormal, provide details
of infection and any treatment.
If blood pressure is elevated, repeat after the patient
has rested for five minutes and, if necessary, again after
10 minutes.
Significant medical conditions
C18. HEARING
If concerned about postural hypotension or left to right
shunts, record sitting and standing blood pressures and
side that blood pressure was taken on. Record these
additional blood pressure readings under C2. Overall
physical condition.
Each ear must be tested separately. In young children,
indicate whether hearing appears normal.
All abnormalities must be noted.
C19. VISION
C11. HEART RATE
Test the client’s best vision. The visual acuity of each eye
must be tested separately with corrective lenses if worn.
If the client usually wears corrective lenses but has not
brought them on the day, document this. Snellen’s, E or
similar charts must be used.
Measure rate per minute and record in respective field.
C12. RESPIRATORY RATE
Measure rate per minute and record in respective field.
Corrected visual acuity must be recorded. In children
too young to use a chart, a comment must be made on
whether vision appears normal.
C13. MOUTH /THROAT
Assessment includes:
• nasal obstruction and discharge
C20. LEARNING/DEVELOPMENT
• oral cavity, tongue (including under) and pharynx
• teeth (including under dentures if any) and gingiva
• any masses, leukoplakia and other abnormalities.
Provide details on what special attention is required
for travel.
C21. COMMUNICATING
All abnormalities must be noted.
Provide details on any difficulties with communicating.
C14. TEMPERATURE
C22. MOBILITY
Take temperature. Record temperature if abnormal.
If anything other than ‘Normal’, provide full details on
what mobility aids are used in Q23 or what is required
in Q24.
C15. ABDOMINAL EXAMINATION FOR MASSES
Assessment includes:
C25. TRAUMA/INJURY
• ascites, distension
If anything other than ‘Normal’, provide full details on
what the trauma/injury is and how it may affect travel.
• tenderness, masses, guarding.
Abnormalities must be noted.
Settlement Health Instructions – May 2022 – 23
When filling in this form, please write clearly using CAPITAL LETTERS.
C26 COGNITION
C35 ARE YOU VERY CONCERNED WITH THEIR
BEHAVIOUR IN ANY OTHER WAY?
If anything other than ’Normal’, provide full details
on what the cognition issues are and how it may
affect travel.
C36. HAS YOUR CHILD WITNESSED OR BEEN DIRECTLY
EXPOSED TO VIOLENCE AND/OR SIGNIFICANT LOSS?
Mental health condition
C37 HAS THIS RESULTED IN ABNORMAL BEHAVIOURS?
Questions C27 to C32 are to be answered for clients aged
15 years and older.
Other medical conditions present
C38 ARE ANY OF THE FOLLOWING PRESENT
For clients under the age of 15, go to questions C33 to
C37 and answer these with the assistance of a parent/
legal guardian.
Indicate in the boxes provided all the conditions that
are present. If the condition is not listed, mark ’Not
categorised’ and provide details.
If anything other than ‘Normal’, provide full details.
Pregnancy
For 15 years and older
C39 IS THE CLIENT PREGNANT?
C27 ANY OF THE FOLLOWING ABNORMAL BEHAVIOURS
OBSERVED?
This is a mandatory question for all non-males over
6 years of age.
If you observe any of the following behaviours provide
full details in the section provided.
C40 ESTIMATED DATE OF DELIVERY
• Severely withdrawn
• Severely agitated
• Responding to non-observable external stimuli
(voices/visions)
If the client has a letter from their own doctor or
lead maternity carer (obstetrician) confirming their
pregnancy, scan and attach it to the health case.
Record date in section provided.
• Deliberate self-harm.
SECTION D: CHEST X-RAY AND TB SCREENING
For the questions C28-C32, ask the client the question
observing their response to the questions. If the client
answers ‘Yes’ to any of the questions, provide full
details.
If abnormalities consistent with TB found on Chest X-ray
and TB screening, email RHLT@mbie.govt.nz as soon
a possible to enable prescription of further tests and
assessments.
C28 HAVE YOU EVER BEEN HOSPITALISED OR TREATED
FOR A MENTAL HEALTH PROBLEM OR HAVE YOU EVER
BEEN SUICIDAL?
Questions D1 to D3 are to be answered for clients aged
11 years and older.
For clients under the age of 11, go to questions D4 to D10.
C29 DO YOU HAVE BAD MEMORIES ABOUT VIOLENCE
OR OTHER EVENTS WHICH WON’T LEAVE YOU AND IF SO,
HOW MUCH DO THEY GET IN THE WAY OF YOU BEING
ABLE TO UNDERTAKE YOUR DAILY RESPONSIBILITIES
OR ACTIVITIES?
D1 IS A REPEAT X-RAY REQUIRED
A chest x-ray is required if the last screening chest x-ray
was taken ≥ 6 months ago.
C30 HAVE YOU EVER BELIEVED THAT SOMEONE WAS
READING YOUR MIND, CONTROLLING YOUR MIND OR
COULD PUT THOUGHTS IN YOUR MIND?
D2 DATE OF X-RAY
D3 RESULT
If results abnormal, provide details in full.
C31 HAVE YOU EVER HEARD THINGS SUCH AS VOICES
COMING FROM OUTSIDE OF YOUR HEAD AND IF SO,
WHAT DO THEY SAY?
TB SCREENING FOR UNDER 11 YEARS OF AGE
D4 IS TB SCREENING REQUIRED
C32 DO YOU HAVE THOUGHTS OF DEATH OR WISHING
TO DIE WHICH DO NOT GO AWAY?
TB screening is required if the last test was done
≥ 6 months ago.
For clients under 15 years
D5 EXAM DATE
If the answer to any of the following questions is ‘Yes’,
provide full details.
This is the date that the blood is taken or the test
is applied.
C33 ANY SOCIAL WITHDRAWAL OR BEHAVIOURAL
DISTURBANCE OBSERVED?
D6 TYPE OF EXAM CONDUCTED
For children aged<2 years, do a Tuberculin Skin Test
(TST). For children aged 2-11 years, do a Interferon
Gamma Release Assay (IGRA). Indicate which type
C34 IS YOUR CHILD EXTREMELY WITHDRAWN OR
AGGRESSIVE A LOT OF THE TIME?
24 – Settlement Health Instructions – May 2022
of test was used. For Tuberculin Skin Test (TST),
answer questions D7 and D8. If Interferon Gamma
Release Assay (IGRA), proceed to questions D9 and D10.
Paper: Departure Health Check (INZ 1262) –
A laboratory referral form (Section M) is included and
comprises two pages to be detached and given to
the client to take to the laboratory for completion.
The physician is to sign and date the form including
adequate address details where the results and the
completed ‘Section N: Confirmation of identity and
declaration’ are to be returned.
D7 IF TUBERCULIN SKIN TEST (TST)
Record the date of the test reading.
D8 IF TUBERCULIN SKIN TEST (TST)
Must be recorded in millimetres.
Please provide these pages of the form to the client
along with directions to the laboratory. A separate
laboratory referral form should be provided for each
set of laboratory tests.
D9 IF INTERFERON GAMMA RELEASE ASSAY (IGRA)
IS SELECTED
Indicate which type of IGRA used.
It is acceptable for physicians to use their own
laboratory forms/process, with the proviso that ‘Section
N: Confirmation of identity and declaration’ is still
completed at the time of specimen collection, by both
the client and the person collecting the specimens.
D10 RESULT
If result was not ’Negative’, provide full details.
SECTION E: LABORATORY TESTS
Laboratory reports must be initialled on each page
and securely attached to the health form.
Physicians should perform specimen collection onsite.
If the physician delegates this procedure to a nurse or
phlebotomist, the physician remains accountable for
the integrity of the procedure. For further information
about specimen integrity, please refer to New Zealand
Immigration Panel Member Instructions (INZ 1216).
Abnormal laboratory test results
If a client’s laboratory test results are abnormal,
the physician should arrange additional testing as
indicated below and seek advice from the RHLT at
The physician must select trusted laboratories to
perform the tests required by INZ.
The following points need to be covered in discussion
with the client where applicable, bearing in mind local
ethical standards and requirements:
The physician must discuss the nature of testing with
the client, or if the client is a person under 18 years of
age or an incapable person, with the client’s parent or
guardian. Where applicable the physician should explain:
• Information about the tests and results
• Implications and possible prognosis
• Ways of transmission of the organism/s
• Ways of protecting others from infection with the
organisms, in particular, the vaccination of close
contacts of hepatitis B carriers
• standard tests that are advised as a part of the
Departure Health Check
• the nature and reason for any discretionary tests
• that all test results will be provided to INZ
• Ways of minimising future complications
It is compulsory to record and attach results for all
laboratory tests. When reviewing the laboratory tests,
ensure that the person collecting the blood, and/
or receiving the laboratory specimens has confirmed
the client’s identity to confirm that the samples
were collected from the individual identified on the
settlement health form.
• Referral for medical intervention as discussed with
RHLT. The physician is to detail any referral in the
Laboratory Test ‘Remarks’ field.
Standard laboratory tests
The standard laboratory tests are not usually required
as part of a departure health check.
Each of these tests requires a number value or
‘nonreactive/reactive’ response by the physician.
The laboratory reference standard ranges for each test
must be included in the results. Where the test(s) is
serological for antibodies or antigens, the laboratory
test used must also be specified.
However, additional laboratory tests are routinely
requested on a Settlement Additional Information
prescription when a Departure Health Check is
prescribed. These are tailored to the client but will
generally include:
• Full Blood Count
• Ferritin
• Sodium, Potassium, Creatinine and eGFR
• Calcium
• Liver Function Tests
• Vitamin D.
eMedical: 949 Departure Health Check– Referral forms
for laboratory tests can be generated using standard
eMedical functionality. Please refer to the training
guides within eMedical (module 9 – Examinations,
section 9.6 Pathology and Other examinations) for
more information if required.
Settlement Health Instructions – May 2022 – 25
When filling in this form, please write clearly using CAPITAL LETTERS.
Discretionary laboratory tests
SECTION F: TRAVEL REQUIREMENTS
The physician should consider additional tests in
any age group, due to indications from the medical
history or physical examination findings, or known
local conditions and risks (e.g. the local risks of
Trypanosoma cruzi for Latin America and Spain).
HIV testing for children <15 years of age is strongly
recommended if their mother is HIV positive or if the
child has history of blood or blood product transfusion.
Discuss discretionary laboratory tests with RHLT at
RHLT@mbie.govt.nz before undertaking.
F1 ESCORT REQUIRED?
Mark the appropriate box. If yes is selected answer all
questions from F2-F8.
If answered ‘No’, proceed to F9 (leaving question F2-F8
unanswered).
F2 ESCORT DESTINATION
Indicated from boxes how long escort required for.
Below is guidance for follow up of abnormal results
for common discretionary laboratory tests. Tests
recommended as part of this guidance can be organised
without discussing with RHLT. Any other follow up tests
need to be discussed with RHLT at RHLT@mbie.govt.nz
before undertaking.
F3 ESCORT TYPE
Indicate what type of escort is required. If a doctor
is needed, provide details of specialisation.
F4 MEDICAL CONDITION(S) REQUIRING ESCORT
Indicate in the boxes all the conditions that the escort
is required for. If the reason is not in the list provided,
mark ‘Not Categorised’ and provide details in F5.
Test
Follow up of abnormal results
Estimated glomerular
filtration rate (eGFR) in mL/
min/1.73m2
›
›
Ensure the client is well hydrated
and repeat.
Where eGFR is not available,
F5 EXACT MEDICAL CONDITION
Provide details of exact reason why escort required
if not listed in the examples in F4.
creatinine clearance must be done
(involves 24-hour urine collection).
F6 EXACT COST OF ESCORT
HIV positive
Add confirmatory tests such as
Western Blot test or line-blot test.
Provide details of cost of the escort with documentation
to support this if you have it.
Full blood count
If abnormal result, repeat test after
a period for two weeks for trend. If
abnormality is low haemoglobin, add
ferritin test when doing repeat testing.
If significantly abnormal result, discuss
with RHLT.
The following tests are
required:
F7 ESCORT NAME IF KNOWN
Hb – haemoglobin in g/L
Provide full name and position, if applicable.
WCC – total white cell count
cells x 109/L
F8 SUPPORT THE ESCORT WILL PROVIDE DURING
TRAVEL
Enter values as whole numbers with
the exception of the White Blood
Cells which should be recorded to one
decimal place.
PLATS – platelet count cells
x 109/L
Provide details of what the role of the escort is during
travel.
Liver function tests.
Should include:
If abnormal, discuss further testing
with RHLT.
F9 –F13
›
›
›
total bilirubin
alkaline phosphatase
AST – aspartate
aminotransferase (SGOT)
ALT – alanine
aminotransferase (SGPT)
GGT – gamma
glutamyltransferase
Questions F9-F13 relate to personal travel requirements.
Answer all questions.
F9 WHEELCHAIR
F10 SEATING
F11 IV RX
›
›
›
›
Albumin
total protein
F12 AIR-LIFT
F13 OXYGEN
F14-F17
Lipids
Repeat testing not routinely required.
Discuss with RHLT if concerns.
These do not need to be
fasting lipids.
A full Lipid Profile should be
provided: Total cholesterol;
LDL; HDL; Triglycerides;
Chol:HDL ratio.
Questions F14-F17 relate to oxygen requirements.
If oxygen is not required in F13, proceed to F18.
F14 FLOW
F15 DELIVERY
F16 TO
F17 WHILE
26 – Settlement Health Instructions – May 2022
F18 OTHER REQUIREMENTS
SECTION H: PERSONAL REQUIREMENTS
Record any other assistance client needs during travel.
This section helps facilitate any arrangements required
for the client when they come to NZ, to ensure the
appropriate support and services are available and
ready to manage health needs.
F19 DEPARTURE DATE
Provide date of flight if known.
F20 IS THERE ANY MEDICAL CONDITION THAT WILL
DELAY TRAVEL?
Answer all questions in this section indicating the
appropriate answer in each question. If you answer
yes to any question from H2 to H7, provide further
detail of assistance required in question H8. If the
person requires assistance and it is not covered in the
questions H2 to H7, use H9 to provide details of what
assistance is required including the reason for the
requirement and duration.
If ‘Yes’, answer questions F21 and F22. If ‘No’, proceed
to Section G of form.
F21 ANTICIPATED REVISED TRAVEL DATE
F22 REASON FOR DELAY
Provide reasons for the delay and what will be
happening, if anything, during this time.
H1 WILL THE CLIENT NEED ASSISTANCE WITH PERSONAL
CARE, HOUSING, SCHOOLING OR EMPLOYMENT?
H2 PERSONAL CARE
SECTION G: POST – ARRIVAL REQUIREMENTS
H3 AMOUNT OF ASSISTANCE REQUIRED
This section is to help the RHLT in planning of any future
health services or community assistance that may be
needed to aid resettlement and make plans for services
to be provided.
H4 MOBILITY PROBLEMS, ACCOMMODATION WITHOUT
STAIRS
H5 WHEELCHAIR ACCESS
H6 OXYGEN
G1 WILL THE CLIENT HAVE MEDICAL REQUIREMENTS
ON ARRIVAL
If the answer is ‘Yes’ to G1, continue with questions
G2-G4. G5 enables documentation of any other
requirements the client may have that isn’t covered
by G2-G4.
H7 SCHOOLING / EMPLOYMENT
H8 PROVIDE DETAILS
H9 OTHER NEEDS
If the answer is ’No’ to G1, proceed to G6.
G2 AMBULANCE AT THE AIRPORT?
G3 HOSPITALISATION
SECTION I: SETTLEMENT VACCINATIONS
The questions in this section are for providing an
accurate record for any vaccines that have been
provided by your clinic.
G4 SURGERY
G5 OTHER REQUIREMENTS
Offer vaccinations according to New Zealand’s
Immunisation Schedule www.immune.org.nz/new-
RECOMMENDED MEDICAL FOLLOW UP ON ARRIVAL
G6 IS MEDICAL FOLLOW UP REQUIRED
If required, continue catch up schedule of vaccinations.
Follow guidance from Immunisation Handbook:
Planning Immunisation Catch-Ups in the New Zealand
Immunisation www.health.govt.nz/our-work/
If the answer is ‘Yes’, continue with questions G7-G10.
G9 enables documentation of the details of what is
required.
If the answer is ‘No’ for G6, proceed to Section H.
G7 URGENCY
Record all vaccines given.
For further information about vaccinations, see the
New Zealand Immunisation Handbook 2020
G8 CASE PROVIDER
G9 DETAILS
G10 DURATION
Chapters of specific interest include:
Planning Immunisation Catch-Ups in the New Zealand
Immunisation
Settlement Health Instructions – May 2022 – 27
When filling in this form, please write clearly using CAPITAL LETTERS.
Immunisation of special groups
SECTION J: SETTLEMENT MEDICATIONS
This section should be completed by the examining
Physician. Answer all questions.
special-groups including pregnancy and lactation,
immunocompromised individuals, chronic kidney
disease, chronic liver disease.
J1 EXAM DATE
Record the date of exam
Parasite medication
Processes for safe immunisations
2020/2-processes-safe-immunisation which covers
pre-vaccination screening in 2.1.3, with condition or
circumstance to screen for (e.g. is pregnant, has a
disease that lowers immunity), what actions to take
and the rationale for this. This chapter also covers
contraindications in 2.1.4 and post-vaccine advice
in 2.3.1.
J2 PARASITE TREATMENT GIVEN
Provide clients with medications for presumptive
treatment of parasites as per CDC Guidelines
for Overseas Presumptive Treatment of
Strongyloides, Schistosomiasis and Soil-Transmitted
Helminth Infections available at www.cdc.gov/
parasites-overseas.html. Therapy does not need to be
directly observed. Advise clients to take the provided
medications 1-2 days prior to travel.
I1 EXAM DATE
Record the date the exam was completed.
I2 CONTRAINDICATIONS
Please complete table with the medication (brand and
generic), dose and date medication given.
Provide details of any contraindications.
If parasite medication not given, please answer
questions J3-J4.
I4 DISEASE / VACCINE:
Provide the name of the vaccine given.
Administered by clinic: (must be completed).
J3 PROVIDE REASON
Indicate reason why parasite treatment was not
provided.
Batch number: As displayed on vaccine vial (must be
completed).
J4 PROVIDE DETAILS
Batch expiry: As displayed on vaccine vial (must be
completed).
If the answer to J3 is anything other than ‘Not required’,
record details here.
Route: Mark which route used (must be completed).
Regular medication
Waiver reasons: Only mark if any applies (can be left
blank).
J5 HAS A FOUR-MONTH SUPPLY OF REGULAR
MEDICATIONS BEEN GIVEN
I5 MEASLES, MUMPS, RUBELLA, HEPATITIS B, POLIO
& VARICELLA
If no, and is on medications, please provide details
about why four-month’s supply of medications is
not provided.
Test for immunity positive
Record if test for immunity was previously done and
date of test. If more than one immunity test was done,
supply all records. There is no need to arrange immunity
tests if not previously done.
If yes, provide a complete list of all medications
including contraceptives, over the counter medications
and natural supplements, with their doses and
frequency. Complete the table with the medication
(brand and generic), dose, quantity supplied, frequency
and date given.
I6 VARICELLA
Has the client had the disease? Document if the client
has a history of having Varicella. Indicate yes or no.
28 – Settlement Health Instructions – May 2022
APPENDIX
APPENDIX 1: UNDRESSING FOR A SETTLEMENT HEALTH PHYSICAL EXAMINATION
From Australian Panel Members Instructions:
Settlement Health Instructions – May 2022 – 29
When filling in this form, please write clearly using CAPITAL LETTERS.
APPENDIX 2: ACTIVITIES OF DAILY LIVING INDEX (ADL)
30 – Settlement Health Instructions – May 2022
APPENDIX 3: CHILD DEVELOPMENT MILESTONES GUIDELINES
This is one of the most difficult parts of any examination, especially if you have never met the child before and the
child is anxious. Much can be achieved by observing the child: talking to the parents/guardians and having the child
perform some simple tasks. These are average dates for the milestones
(Development guidelines drawn from General Practice, 3rd edition, John Murtagh, Mcgraw-Hill, Sydney, 2003)
Settlement Health Instructions – May 2022 – 31
When filling in this form, please write clearly using CAPITAL LETTERS.
32 – Settlement Health Instructions – May 2022