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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.

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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  
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  
• Centre for Adoption Medicine: www.adoptmed.org/  
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  
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,  
and seek advice from RHLT at RHLT@mbie.govt.nz.  
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)  
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  
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  
(INZ 1253) available at www.immigration.govt.nz/  
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  
(INZ 1262) form is available at www.immigration.govt.nz/  
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.  
• Centre for Adoption Medicine: www.adoptmed.org/  
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  
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  
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