October 2022
INZ 1378
Immigration New Zealand
Guidelines for Medical Assessors
Act
Information about these guidelines
This document is for intending and new Medical Assessors
•  offer information about documenting opinions
to help them understand their role and responsibilities,
•  list specific medical conditions and situations where
and how their work fits into the immigration health
guidance is available, and
assessment process.
•  include a list of useful resources to support the work
These guidelines:
of Medical Assessors.
If you have any questions or concerns about the
•  describe the role of a Medical Assessor
information in these guidelines, contact
Information
•  provide an overview of the medical assessment
[email address].
process
Official
the
under
Released
immigration.govt.nz

Immigration New Zealand (INZ) health instructions
The New Zealand government requires that applicants for
Medical Assessors use these objectives as the basis for an
temporary entry to, and residence in New Zealand must have
opinion about whether or not an applicant is likely to meet
an Acceptable Standard of Health (ASH) before they can be
ASH requirements.
granted a visa. In some exceptional cases this requirement
can be waived.
How INZ collects health information
Doctors who undertake Immigration Medical Examinations Act
The objective of the immigration health instructions is to:
(IMEs) on behalf of INZ, known as Panel Physicians, submit
•  protect public health in New Zealand
information using eMedical, an online platform managed by
•  ensure that people entering New Zealand do not impose
the Australian Department of Home Affairs on INZ’s behalf.
excessive costs or demands on New Zealand’s health and
special education services, and
Information from eMedical is transferred to the Immigration
Health System (IHS). It is then used by Immigration Officers
•  where applicable, ensure that applicants can fulfil the
(IOs) and Medical Assessors to review medical information,
purpose of the visa they apply for.
and record outcomes and opinions.
Glossary
Applicant – A person who applies to enter or remain in New
whole of New Zealand is considered, not just the availability
Zealand as a permanent resident (including refugees, who
within a particular locality.
Information
may also be referred to as candidates) or as a temporary
entrant (including tourists, students or temporary workers).
Immigration instructions – These consist of:
•  immigration policy objectives
Candidate – A person mandated as a refugee by the UNHCR
•  any rules or criteria for determining the eligibility of a
(the United Nations refugee agency) who has been selected as
person for the grant of a visa, and
a candidate for New Zealand’s Refugee Quota Programme.
•  any other relevant information that should be considered
Conditions – Physical, mental, emotional or intellectual
in assessing a person’s eligibility for a visa.
disorders of the applicant that are identified by the applicant
Immigration instructions are certified by the Minister of
or by the Panel Physician from the history, examination and
Immigration under section 22 of the Immigration Act 2009.
Official
subsequent tests.
They are published in the INZ Operational Manual.
High cost conditions – Those conditions that exceed the
Immigration Medical Examination (IME) – The medical
high cost threshold of $81,000 over a five-year period in
examination undertaken by a Panel Physician for New Zealand
the case of an acute condition, or over the likely course
immigration purposes that includes:
the
of the condition if it is chronic. The A4.10.1 list of high
cost conditions in the INZ Operational Manual lists those
•  the functional inquiry for present, past and family history
conditions that are known to cost more than the high cost
•  the findings on physical and mental examination, and
threshold, so have been deemed to be high cost medical
•  the results of all relevant radiology, laboratory and
conditions already.
diagnostic tests including further specialist reports.
High demand conditions – Those conditions that require
Medical waiver – see page 8
services within New Zealand, the demand for which is
Ongoing Resourcing Scheme (ORS) – see page 8
under
currently unmet. The availability of health services across the
Panel Physician – see page 4
The Medical Assessor’s role
Based on the information provided by an applicant, a Medical
•  request additional tests and investigations to further
Assessor provides an opinion to INZ as to whether an
understand an applicant’s state of health
applicant is likely to meet the ASH requirements.
•  investigate the cost to, and demands on, New Zealand’s
health and education systems of an applicant’s health
Medical Assessors do not provide advice concerning the
condition.
decline or approval of visa applications.
The Medical Assessor may also provide advice on an
Released
applicant’s health, such as a prognosis or the economic
A Medical Assessor applies appropriate medical, ethical and
impact. This information is used by IOs if an applicant is
professional standards during their considerations. Before
eligible to be considered for the grant of a medical waiver –
they arrive at an opinion, they may:
that is, in some cases an applicant may be given a visa even
though they do not meet ASH requirements.
Immigration New Zealand Guidelines for Medical Assessors – October 2022 – 3

Support for Medical Assessors
INZ staff and external specialists support the successful
Respiratory Physicians
management of the IHS and the work of those who play a role
INZ contracts New Zealand-based respiratory physicians (INZ
in delivering it.
RPs) to provide specialist opinions where abnormalities in
INZ support
chest x-rays require specialist advice. This includes providing
an opinion where a Medical Assessor has referred the chest
Within INZ there are several teams responsible for the medical
Act
x-ray to an RP because they suspect, or cannot exclude, active
information submitted by visa applicants. They support
Tuberculosis (TB).
Medical Assessors in various ways.
If a Medical Assessor has proof of or suspects Multidrug-
The Immigration Health Team (IHT) is responsible for the
Resistant TB (MDR-TB) or Extensively Drug-Resistant TB (XDR-
overall medical assessment process – including management
TB) they must get the opinion of an INZ RP.
of Medical Assessors and the Panel Physician network. They
also provide health insights to other business units within
Panel Physicians
INZ, and have a working relationship with their equivalent
INZ accredits physicians and clinics in New Zealand and other
departments in Australia, Canada, the USA and UK through a
countries to carry out IMEs for visa applicants. If a Medical
group called the M5.
Assessor requests further information about an applicant’s
The Chief Medical Officer (CMO) for INZ, sits alongside the IHT
health this is, in most cases, provided by a Panel Physician.
in the Enablement Branch. The CMO is supported by a Medical
INZ regularly:
Officer (MO) who works in the IHT, and their roles include:
•  audits the clinics to ensure they are following the correct
•  assisting with the supervision, education and training of
Information
processes
Panel Physicians and Medical Assessors
•  provides education sessions for physicians, nursing and
•  providing advice about complex cases
administration staff.
•  supporting and advising the Health Assessment Team
Immigration Officers (HAT IOs).
Panel Physicians and clinics follow instructions provided by
INZ.
The HAT IOs are a team of officers who triage any IMEs that
raise a concern. If they need expert help to resolve that
New Zealand Immigration Panel Member Instructions (INZ
concern they refer the IME to a Medical Assessor and then use
1216)
the Medical Assessor’s opinion to help them decide the health  Official
outcome for the applicant.
Visa applicants who must undergo a medical examination
the
Visa applicants who apply for a temporary entry or resident
•  likely to impose significant costs and demands on New
visa must undergo a medical examination and provide one
Zealand’s publicly funded health services during their stay
or more medical certificates depending on the visa they are
•  applying for a student visa, are under 21 years of age and
applying for and how long they plan to stay in New Zealand.
likely to qualify for Ongoing Resourcing Scheme (ORS)
Exceptions to this can include applicants who have a visa to
funding through the Ministry of Education.
come to New Zealand for specific medical treatment, and
most people visiting New Zealand for less than six months.
“Significant costs and demands” have not been precisely
defined but usually imply an amount in excess of the average
under
Temporary entry visas include visitor, work and student visas.
amount per person of the annual vote health budget. For
Many temporary entry visa holders can apply to stay in New
example, if the vote health budget for 2022 is $24 billion and
Zealand for up to three years.
the New Zealand population is 5.1 million, then the average
vote health amount per person is $4705.
Resident visas include skilled migrant, family, refugee and
business visas. Holders of resident visas can:
Consideration of whether a temporary entry applicant meets
•  stay in New Zealand indefinitely
ASH requirements, or not, largely depends on their intended
•  study and work here
length of stay and purpose of their entry. The probability of an
applicant’s need for any of the following is taken into account:
•  travel in and out of the country, and
•  use New Zealand’s subsidised health services.
•  hospitalisation
•  residential care
Meeting the criteria for an acceptable standard of
•  high cost pharmaceuticals, or
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health
•  high cost services, including disability services or
Temporary entry visas
specialist services such as surgery or high-cost medical
For temporary entry visas, an applicant will fail to meet ASH
interventions.
requirements if they are:
•  likely to be a danger to New Zealand’s public health
•  unable to fulfil the purpose or conditions of the visa they
are applying for, such as work or study
4 – Immigration New Zealand Guidelines for Medical Assessors – October 2022

Resident visas
Medical certificates
For resident visas, an applicant will fail to meet ASH
Within Immigration Instructions, IMEs are referred to as
requirements if they:
medical certificates. The paper-based versions are occasionally
•  are likely to be a danger to New Zealand’s public health
used in countries where there are no Panel Physicians with
•  are unable to undertake the work that is the basis for
access to eMedical. They have an IME equivalent in eMedical
their visa application or a requirement of the visa they are
which is where INZ receives nearly all medical information. The
applying for
most common ones are noted in the table below. The IMEs tend
Act
•  are likely to impose significant costs or demands on New
to be referred to colloquially by the abbreviation of their initials
Zealand’s health services because there is a relatively high
– for example, GMC for General Medical Certificate.
probability that their:
Paper-based medical certificates
eMedical IMEs

– acute medical condition will require health services
costing in excess of NZ$81,000 within a period of
General Medical Certificate
501 Medical examination
five years after the assessment against the health
(INZ 1007) – GMC
requirements is made, or
Chest X-ray Certificate
502 Chest X-ray examination

– recurring chronic medical condition over the course
(INZ 1096) – CXR
of the condition will require health services costing in
excess of NZ$81,000, or
Limited Medical Certificate
512 Medical examination
(INZ 1201) – LMC

– medical condition will require publicly funded health
services for which the current demand in New Zealand is
The type of visa an applicant applies for determines which
not being met
certificates or IMEs they must submit.
•  are likely to impose significant costs or demands on New
Information
Zealand’s special education services – in this case the
Applicants do not need to provide a CXR if they are under the
Ministry of Education will have advised that the applicant’s
age of 11 or pregnant. Because there is a small risk to the foetus
physical, intellectual, sensory or behavioural condition,
from radiation exposure, INZ’s recommendation is that pregnant
or group of conditions would entitle them to Ongoing
women should not have a chest X-ray. If they decide to have a
Resourcing Scheme (ORS) funding
chest X-ray they must submit a written consent with the CXR.
•  have one or more conditions listed in A4.10.1 of INZ’s
The INZ website carries up-to-date information about which
Operational Manual which are considered to impose
certificates applicants must provide.
significant costs and demands on New Zealand’s health or
education services.
Who needs a chest x-ray or medical examination
Official
Operational Manual – A4.10
Duration and validity of medical certificates
A CXR, GMC and LMC are usually valid for 3 years. During
Criteria for a Limited Medical Certificate (LMC)
this time they can be used for a medical assessment for any
Some temporary entry and resident visa applicants only need
the  relevant visa application.
to provide a LMC. This screens only for the conditions which
INZ is unable to grant a medical waiver for. To meet ASH
For certificates to remain valid:
requirements for a LMC none of the following five conditions
•  INZ must receive a visa application within 3 months of the
can apply to the applicant.
certificates having first been submitted, and
•  They require dialysis treatment or, in the opinion of a
•  previously submitted certificates must not have resulted in
Medical Assessor, will require it within five years of the
an outcome of NOT ASH.
date of the medical assessment.
Information on medical certificates
under
•  They have severe haemophilia.
A GMC contains the following information:
•  They have a physical, intellectual, cognitive or sensory
incapacity that requires full-time care, including care in the
•  a full medical history
community.
•  a full medical examination
•  They currently have any form of TB or have not completed
•  urinalysis, and
full treatment for TB as outlined in the Guidelines for TB
•  blood tests, including a full blood count and tests for
control in New Zealand.
Creatinine, HBA1c, HIV, Hepatitis B and C, and syphilis.
•  They have a history, that is, diagnostic findings or
An LMC contains the following information:
treatment for MDR-TB or XDR-TB – unless they have been
•  medical history focusing on the conditions for which a
cleared by a New Zealand-registered RP, an infectious
medical waiver cannot be granted
diseases specialist or as specified in the Guidelines for TB
Control in New Zealand.
•  medical examination focusing on the conditions for which a
Released
medical waiver cannot be granted
Guidelines for Tuberculosis Control in New Zealand, 2019
•  blood tests, including a full blood count and a test for
– Ministry of Health
Creatinine.
Full information about the tests that Panel Physicians
must complete before they submit medical certificates is
documented in the Panel Member Instructions.
Panel Member Instructions (INZ1216)
Immigration New Zealand Guidelines for Medical Assessors – October 2022 – 5

The medical assessment process
This high-level view of the process for making an assessment
Outcomes for residence visa applications
may vary depending on the visa an applicant applies for and
For resident visa applications, the Medical Assessor may:
the information they provide.
•  record a FIR – the Medical Assessor needs further
1.  A Panel Physician uses eMedical to submit an IME to INZ on
information before they can form an opinion
behalf of a visa applicant.
•  record a 3 month deferral – the applicant has a medical  Act
2.  A HAT IO reviews the IME in IHS. They refer the IME to the
condition that is treatable within 3 months, and the
Medical Assessor if:
Medical Assessor needs to see results of further tests or
•  the Panel Physician notes significant or abnormal
reports before they can form an opinion
findings in the IME
•  record a 6 month deferral - the applicant has TB and is
•  the HAT IO requires advice concerning findings in the
undergoing treatment for TB, and the Medical Assessor
IME, or
needs to see further reports before they can form an
•  an applicant disputes the outcome of a previous
opinion.
assessment and provides information from a medical
If the Medical Assessor has all the information they need, they
professional to support their case.
can provide an opinion that the applicant is:
3.  The Medical Assessor considers all the information
provided.
•  likely ASH – the applicant has an acceptable standard of
health, or
4.  If the Medical Assessor doesn’t have sufficient information
to provide an opinion, they ask the HAT IO to request more
•  likely NOT ASH – the applicant fails to meet the standards
information from the applicant. This is called a Further
for an acceptable standard of health. In their opinion,
Information
Information Request (FIR).
the medical assessor must specify which Immigration
Instructions apply to the applicant – for example, the
5.  Applicants usually have 2 weeks to provide this
applicant has a condition included on the A4.10.1 list of
information. They contact a Panel Physician who submits
high cost conditions. There may be more than one reason
the information to INZ using eMedical.
applicable, and if so, each reason should be recorded
6.  If the Medical Assessor is satisfied they now have all the
separately. A visa is unlikely to be granted to the applicant
information they need, they enter their opinion in IHS.
unless the IO assessing their visa application decides they
7.  The HAT IO, informed by the Medical Assessor’s opinion,
qualify for a medical waiver.
makes a decision as to whether the applicant meets ASH
Official
requirements or not. They enter their decision into IHS.
Outcomes from medical assessments
When a Medical Assessor completes their assessment they
categorise their opinion as follows.
the
Outcomes for temporary visa applications
For temporary visa applications, if the Medical Assessor has all
the information they need, they can provide an opinion that
the applicant is:
•  likely ASH – the applicant has an acceptable standard of
health
under
•  likely AWC (ASH with conditions) – an applicant has
an acceptable standard of health for their current visa
application, but they must submit further information
when they apply for their next visa
•  likely NOT ASH – the applicant fails to meet the standards
for an acceptable standard of health. The medical assessor
must specify which Immigration Instructions apply to the
applicant – for example, the applicant is likely to impose
significant costs or demands on health services. There may
be more than one reason applicable, and if so, each reason
should be recorded separately. A visa is unlikely to be
granted to the applicant unless the IO assessing their visa
Released
application decides they qualify for a medical waiver, or
that an exception to immigration instructions is justified.
If the Medical Assessor needs further information before they
can form an opinion, they record a FIR.
6 – Immigration New Zealand Guidelines for Medical Assessors – October 2022

Outcomes for LMCs (residence or temporary visas)
A4.10.1 list of high cost conditions. There may be more than
The Medical Assessor may:
one reason applicable, and if so, each reason should be
recorded separately, and
•  record a FIR – the Medical Assessor needs further
information before they can form an opinion
•  a further opinion on which of the conditions screened for
on the LMC apply to the applicant – that is:
•  record a deferral for up to 6 months – the applicant
currently has any form of TB, or a history of MDR-TB or

– They require dialysis treatment or, in the opinion of a
XDR-TB, and requires treatment and clearance from an INZ
Medical Assessor, will require it within five years of the
Act
RP.
date of the medical assessment.

– They have severe haemophilia.
If the Medical Assessor has all the information they need, they

– They have a physical, intellectual, cognitive or sensory
can provide an opinion that the applicant is:
incapacity that requires full-time care, including care in
•  likely ASH – the applicant has an acceptable standard of
the community.
health, or

– They currently have any form of TB or have not
•  likely NOT ASH – the applicant fails to meet the standards
completed full treatment for TB as outlined in the
for an acceptable standard of health.
Guidelines for TB control in New Zealand.
If an applicant is likely NOT ASH, a Medical Assessor must

– They have a history, that is, diagnostic findings or
provide an opinion on the applicant’s medical condition and
treatment for MDR-TB or XDR-TB – unless they have
specify:
been cleared by a New Zealand-registered RP, an
•  which Immigration Instructions apply to the applicant –
infectious diseases specialist or as specified in the
for example, the applicant has a condition included on the
Guidelines for TB Control in New Zealand.
Information
Guidelines for documenting opinions
A Medical Assessor’s opinion is based on an appraisal of
Preparing for an assessment
the medical information submitted by the visa applicant.
Before doing an assessment the Medical Assessor opens
This includes medical certificates – CXR, GMC or LMC – and
every document relating to the assessment and assures
other supporting information provided by the applicant or
themselves that they have all the necessary documentation,
requested by the Medical Assessor, such as reports, tests,
including relevant test reports, and translations of documents
investigations, opinions from specialists and results from
provided in other languages. They also check that the
Official
additional diagnostic procedures.
documents are current and valid.
General advice about opinions
In preparing to make an assessment, Medical Assessors
Medical Assessors can only provide an opinion about the
consider the following information:
health of the applicant for the duration of the visa they
•  whether the applicant is applying for a temporary entry or
the
have applied for. They cannot say they are likely to meet ASH
resident visa – this determines the criteria they apply for
requirements if the length of the visa was shorter, and they
the assessment
cannot comment on the applicant’s eligibility for a visa.
•  if the applicant is intending to work or study so that they
can assess the medical information according to the visa’s
Opinions entered in the IHS are discoverable. This means
purpose or conditions
that they can be seen by anyone:
•  their age, in case it has a bearing on whether they might
•  with access to the system, or
qualify for ORS funding – if they might, then the HAT
under
IO must refer the medical certificate to the Ministry of
•  who makes an official request for all the information
Education for assessment
relating to a case, for example the applicant or their
lawyer or their Licenced Immigration Advisor.
•  how long they will be in New Zealand as this may affect
their need to access New Zealand’s health services.
Opinions are clearer to readers if they do not use medical
Writing ASH opinions
abbreviations. They may also include the details of other
If an applicant is likely to meet ASH requirements, there is
Medical Assessors or INZ staff, such as the Chief Medical
normally no need for any other information, although the
Officer, if they were consulted.
Medical Assessor may provide commentary to support their
opinion.
Conflict of interest
If the Medical Assessor believes they may have a conflict
Writing AWC opinions
Released
of interest, for example they know or are related to the
AWC comments are passed back to the applicant so need to
applicant, they do not undertake the assessment.
be clear and easy to understand. The Medical Assessor notes
that the applicant is likely to meet ASH requirements for
the duration of this visa, and include details of the tests or
reports the applicant needs to submit when they apply for
their next visa.
Immigration New Zealand Guidelines for Medical Assessors – October 2022 – 7

Recording a deferral
Medical waivers
Applicants for residence visas can be offered a deferral in the
After a Medical Assessor has given an opinion of likely NOT
following circumstances.
ASH, the IO assessing the applicant’s visa application can, in
1.  They have active pulmonary or non-pulmonary
some cases, approve the visa application by giving a medical
tuberculosis. In this case the deferral is for six months.
waiver. They consider whether the applicant’s benefits to New
2.  They have a history of, diagnostic findings of, or had
Zealand outweigh the risks of their potential medical costs
treatment for Multidrug-Resistant-TB or Extensively Drug-
and demands on New Zealand’s health services.
Act
Resistant-TB. In this case the deferral is up to six months.
The INZ Operational Manual has full details of when a medical
3.  They have a health condition which, if not successfully
waiver can or cannot be granted.
treated, would mean the applicant is likely NOT ASH. If
Medical waivers (applicants for residence class visas)
the Medical Assessor believes that a short-term course of
– A4.60
treatment for three months, may enable the applicant to
meet ASH requirements they can suggest a deferral for
Medical waivers (applicants for temporary entry class
three months only.
visas) – A4.65
In the case of a deferral for three months, treatment could
Requesting further information
include:
If a Medical Assessor cannot form an opinion from the
•  definitive treatment, such as surgery, intervention or
information submitted by an applicant, they can request
medication
further information including tests and specialist reports. This
•  time to recover – for example, recovery from major surgery
is called a Further Information Request (FIR).
•  surveillance and monitoring to check on the success of
Information
treatment, recovery, a cure or relapse
They may also make a FIR if the medical information is not
complete or they believe the medical certificate shows
Operational Manual – A4.55
evidence of tampering or unauthorised alterations.
In giving their opinion, the Medical Assessor notes:
The request should contain clear details of:
•  why the application is being deferred
•  all the information, including tests the Medical Assessor
•  the length of the deferral, and
needs, and
•  specific details of tests and reports the applicant needs to
•  the kind of doctors or specialists who can provide each
submit at the end of that time.
piece of information.
Official
Writing NOT ASH opinions
Referrals to the Ministry of Education
After considering all the submitted information, the Medical
Applicants for student visas or resident visas under the
Assessor provides reasons why there is a high probability the
age of 21 may, in a few cases, impose significant costs
applicant has not met ASH requirements. These opinions are
on New Zealand’s special education services because of
the
often the most detailed as they can become the subject of a
their ongoing extreme or severe difficulty with learning,
review. They include:
hearing, vision, physical movement, or language use and
•  the health criteria for a temporary entry or resident visa
social communication. For such an applicant, the Medical
that the applicant has not met
Assessor must refer the applicant’s case to the Ministry of
•  all medical conditions or disabilities that support the
Education for an Ongoing Resourcing Scheme (ORS) funding
Medical Assessor’s opinion and why they are a concern
assessment. ORS funding supports students with high needs
•  the probable health or special education services the
and if the applicant is assessed as being eligible for ORS
applicant may need, and the average cost if it is relevant
funding they will not meet ASH requirements.
under
•  the probable frequency of treatments
Requesting a respiratory physician’s opinion
•  whether the opinion is affected by the length of the
Requests to INZ RPs include:
applicant’s intended stay.
•  information about the applicant
They cannot take into account the financial status of the
•  their medical history
applicant, their ability to pay for treatment, or any health
•  relevant test results, and
insurances they have.
•  specific information the Medical Assessor needs from the
INZ RP to complete their assessment.
Released
8 – Immigration New Zealand Guidelines for Medical Assessors – October 2022

If an applicant disputes a Medical Assessor’s opinion
had no previous contact with the application. They act as a
If an applicant disagrees with the opinion of a Medical
medical referee and their opinion is considered final.
Assessor they can submit information from a medical
The Medical Assessor provides information to the applicant
practitioner, or suitably qualified health or education
about the reasons for the opinion.
professional to support their case.
Second opinion assessments by INZ medical assessors
The process used by the Medical Assessor to review the
(residence applications) – A4.45
information differs depending on the type of visa an applicant
Act
is applying for.
If the dispute over a residence visa application relates to a
Ministry of Education assessment, the new information is
For temporary visas, the Medical Assessor considers the new
referred to another Ministry of Education assessor for a new
information and provides a final opinion.
opinion. Their opinion is final.
For residence visas, the Medical Assessor confirms or changes
Second opinion assessments by Ministry of Education
their original opinion based on the new information. If they
(residence class visa applications) – A4.50
confirm their original opinion, the application is referred for
a second opinion to a different Medical Assessor who has
Guidelines for specific medical conditions
The INZ Operational Manual provides a list of medical
conditions that are likely to impose significant costs or
Information
demands on New Zealand’s health or education systems. All
applicants for residence who have any of these conditions are
considered NOT ASH.
Operational Manual – A4.10
Guidelines have been developed for Medical Assessors to use
when assessing some of these health conditions including:
•  Cardiovascular diseases
•  Cochlear implants
Official
•  Diabetes
•  Haemophilia
•  Hepatitis B
•  Hepatitis C
the
•  HIV
•  Non Tuberculous Mycobacterium
•  Renal failure and dialysis treatment
•  Syphilis, and
•  TB.
There are also guidelines to help with assessing:
under
•  an applicant who may have special education needs
•  an applicant who may need full-time care
•  urinalysis results
•  blood test results, and
•  chest X-rays.
Requesting the guidelines
Medical Assessors can request the guidelines in PDF format
by emailing: [email address]
Released
Immigration New Zealand Guidelines for Medical Assessors – October 2022 – 9

Online references
This list comprises INZ and other resources which can support
the work of Medical Assessors.
INZ guides and forms
Health Requirements for entry to New Zealand (INZ 1121)
Act
New Zealand Immigration Panel Member Instructions
(INZ 1216)
These downloadable certificates are only used in countries
that do not have Panel Physicians:
•  Chest X-ray Certificate (INZ 1096)
•  General Medical Certificate (INZ 1007)
•  Limited Medical Certificate (INZ 1201)
•  RSE Scheme Supplementary Medical Certificate
(INZ 1143)
INZ website
Operational Manual – A4 Health requirements
Panel physician network – includes testing requirements,
Information
tools and instructions
Health – information for visa applicants
Other health and education references
Ongoing Resourcing Scheme (ORS) – Ministry of Education
Pharmaceutical Schedule – PHARMAC - contains some
information on pharmaceutical costs
Official
The economic cost of serious mental illness and
comorbidities in Australia and New Zealand – The Royal
Australian & New Zealand College of Psychiatrists
Guidelines for Tuberculosis Control in New Zealand, 2019
the
– Ministry of Health
Online medical tools and calculators
HbA1c Conversion Chart – New Zealand Society for the
Study of Diabetes
Cholesterol Unit Conversion – Endmemo
eGFR calculator – Kidney Health Australia
under
CVD risk assessment calculator for people with Type 2
diabetes in New Zealand – New Zealand Society for the
Study of Diabetes
Radiology Assistant – Radiology Society of the
Netherlands – online learning tool for interpreting chest
X-rays
Other endorsed generic online cardiovascular disease risk
assessment calculators may be referenced.
Released
10 – Immigration New Zealand Guidelines for Medical Assessors – October 2022

Act
Information
Official
the
under
Released
Immigration New Zealand Guidelines for Medical Assessors – October 2022 – 11

Act
Information
Official
the
under
Released
12 – Immigration New Zealand Guidelines for Medical Assessors – October 2022

Version 12.0.
June 26, 2023
Single Failure Points:
This guide is to assist Immigration Officers in determining cases in which there is ONLY ONE FAILURE on the medical.

The conditions highlighted in dark blue and yel ow are used in conjunction with Multiple Failure Points. Please refer to the
Multiple Failure Points guideline for details.

This guideline can be used for initial or subsequent health assessments. When the relevant AWC tests have been received and
fal  within SFP/MFP, the decision can be reapplied. If the previous AWC test results in relation to the SFP conditions are al
normal, the case can be made ASH as no significant abnormality remains.
Act

GMC
Condition
Range
Recommended Outcome  Comments

Renal/Kidney stones - Please
No symptoms, stable
ASH with Conditions
provide an updated report from a
Renal/Kidney stones
and no haematuria

treating doctor regarding
(=Renal Calculi/Calculus)
renal/kidney stones
ASH for Residence

Information
BMI
BMI≤14
Discuss with onsite MO1

Normal range: 18≤BMI≤35
15≤BMI≤17
ASH
If nil concern with client’s photo
36≤BMI≤50
ASH

Acceptable Vision is ‘6/6, 6/9,

6/12, 6/18 or 6/24’ regardless
One blind eye but

corrected or uncorrected.
Eye
acceptable vision on the  ASH

other eye
*if the intented work activity is
Official  truck driving or operating heavy
machinery – Discuss with onsite
MO

the
BP≤160/90 whether or

Hypertension/Raised BP - Please
not on hypertension

provide the fol owing updates:
Hypertension
medication2 (Two or
ASH with Conditions
repeat BP, medication list,
(Normal Blood Pressure range  less)

creatinine, lipids, protein:
is ≤ 140/90)

Creatinine ratio, smoking history.

*Choose the lowest

Please include a reported ECG if
value for Systolic and
the client is above the age of 40
under
Diastolic from Initial BP
and Repeat BP
ASH for Residence

Hyperlipidemia
Whether or not on
ASH with Conditions
Hyperlipidemia - Please provide
Dyslipidemia
hyperlipidemia
lipids and medication update.
Hypercholesterolemia
medication3 (Two or

(=High cholesterol)
less)
ASH for Residence

If Lipids provided
Discuss with onsite MO

Released

1 Note: you may refer the health case to the MA bucket if onsite MO is not available.
2 Note: proceed with SFP/MFP even when there is any family history. Family history is more relevant to MA assessments.
3 Note: If unsure whether the medication is for the SFP conditions, discuss with onsite MO.

Version 12.0.
June 26, 2023

Critical Value
Requiring immediate onsite MA notification
Condition
Range
Recommended Outcome  Comments
Failed Business
High Risk Physician
Refer to onsite MO
Report to onsite MO before referral
rules
eGFR
<15
Refer to MA
Report to onsite MO before referral
FBC – HGB
<60 for both male and
Refer to MA
Report to onsite MO before referral
female
Act
FBC – WBC
>50
Refer to MA
Report to onsite MO before referral
FBC – PLT
<15
Refer to MA
Report to onsite MO before referral

eGFR
15≤eGFR<60
Refer to MA
Normal range:
eGFR<30
Please refer to FIR 10.0 to request Nephrologist report before
eGFR ≥60
referring the health case to MA

eGFR<15
Refer to MA and Report onsite MO before referral

Information

Hba1c
Range
Diabetes YES/NO
Recommended Outcome
Comments

YES

Diabetes - this requires the fol owing tests: repeat
Official

ASH with Conditions
HbA1c, medication list, Smoking status and BP.
Please include a reported ECG if the client is above
41 - 60
*whether or not

the age of 40
mmol/mol
on Diabetes
FIR for residence application
Please refer to FIR 10.0.
(5.9 - 7.6%)
medication(s)
the

Elevated Hba1c - this requires the fol owing tests:
Normal range:

repeat Hba1c, medication list, smoking status and
Hba1c ≤40

BP.  Please include a reported ECG if the client is

ASH with conditions
above the age of 40

NO

Note: For ≤45 years old, Hba1c ≤45 can be ASH
under
ASH for Residence

YES

Diabetes - this requires the fol owing tests: repeat

ASH with Conditions
HbA1c, medication list, Smoking status and BP.
≤40
*whether or not

Please include a reported ECG if the client is above
on Diabetes

the age of 40
medication(s)
ASH for Residence

>60
Don’t Check
Refer to MA
>80
Please refer to FIR 10.0 to request Endocrinologist report and then refer the health case to MA

Released

Version 12.0.
June 26, 2023

FBC
Check HGB, WBC and PLT only (see Note for more details)
Gender
Range
Recommended Outcome
Male
60≤HGB<110
Refer to MA
Normal range: 130-175
HGB≥110
ASH
60≤ HGB <90
Refer to MA

Act
HGB
Female
Normal range: 115-155
90≤HGB<115
≤50 years old
ASH
>50 years old
Refer to MA
HGB>156 and any age
ASH
Pregnant
90≤HGB<100 and ≤50 years old
ASH
Normal range: 100-145
HGB>146
ASH
WBC
Non-pregnant/Males: ≤15 or ≥3
ASH
Normal range: 4-11 / If pregnant: 5-14.5
Pregnant: ≤16.5 or ≥3
ASH
PLT Normal range: 150-400
Between 100 - 500
ASH

If Ferritin is provided, FBC within SFP range with a low Ferritin can be ASH (Women ONLY).
If Ferritin level is high, refer to MA (Both men and women).

Note
Please combine al  three (HGB /WBC/ PLT) and treat this as one failure instead of 3.
As long as the results for the FBC are within the SFP range, then ignore comments relating to 1) PCV, MCV, MCH, RBW,
Information
2) Thalassaemia (unless major), Microcytosis 3) Women with iron deficiency/ Anaemia with or without iron
supplements, 4) WBC differential (neutrophils, basophils, eosinophils, monocytes, eosinophils, and lymphocytes)

Official
CXR

SFP Condition
Range
Recommended Outcome  Comments

≥11 years of age, no physical  ASH
the
Scoliosis
limitations mentioned and
not severe scoliosis

History of Contact with TB -

Please provide repeat CXR.

History of Contact with TB in under

ASH with Conditions
*Repeat CXR is required after 6
work or family (within last 5  Normal chest x-ray

months for the applicant’s next
years )
visa application. If the repeat
CXR is normal - ASH
ASH for Residence

Vascular shadow/density
A grading
ASH

noted in either hilum of the
lungs
Imaging plate artefact
A grading
ASH

Released  A grading and radiologist  ASH
Nipple shadows
clearly stated they are nipple
shadows

Version 6.1
June 2, 2021
Multiple Failure Points:
This guide is to assist Immigration Officers in determining cases in which there are TWO or MORE failures on the medical. The conditions
highlighted in dark blue and yel ow on SFP and FIR guidelines are used in conjunction with Multiple Failure Points. This guideline can be used
for initial or subsequent health assessments. Please apply the Recommended Outcome and Comments [Age limits and Future conditions] from
the SFP and FIR guidelines when applying MFP.
Codes
Combinations
M2 combines 2 failure points where any ONE of the 8 conditions from the SFP or FIR
guidelines get combined with any ONE of the other SFP conditions; even the ones not
listed here. For over 40, please refer to CVD Risk before proceeding.
MA05-M2
1. BMI
2. FBC
(example: MA05-M2 = FBC +
3. Eye
Hba1c)
4. Kidney Stones
5. Hep C
6. Murmur
7. CXR
8. Syphilis
MA05-M3
M3 has a specific list of 3 conditions that can be combined together.  For over 40,
please refer to CVD Risk before proceeding.
(example MA05- M3 = BMI
+ FBC + Hba1c)
1. BMI + FBC + Hba1c
2. BMI + FBC + HTN
3. FBC + BMI + Eye
4. MA05-M2 + CXR
A CVD risk assessment is required for applicants who are over 40 years old and have a
combination of 2 or more of these conditions: BMI/HTN/Hba1c.
Calculate CVD Risk
Request a Cardiologists report:
(Age: Over 40)
The applicant has [high BMI/HTN/elevated HbA1c (delete as appropriate)]. This
requires the following information from the applicant’s treating physician: A reported
Combining two or more of:  ECG, smoking history, lipids, family history of heart disease, Protein:creatinine ratio
 BMI
and their cardiovascular risk assessment using the qRISK tool:
 HTN
https://qrisk.org/three/. If the CVD risk is over 10%, then the applicant would need to
 Hba1c (≥50
be reviewed by a cardiologist.
mmol/mol)
HAT: Once you have the CVD risk, 10% and over can be referred to an MA.
Request: “Cardiologists
Cases with less than 10% CVD risk can either be discussed with onsite MA or finalised:
under the Official Information Act
Report” from the Dropdown
•
TEMP – AWC for the CVD risk [turn the above requirement to conditional info and
include repeats of the tests you normal y make AWC]
•
RESI – ASH
If GP has provided everything in the further requirement but not the CVD risk then please
calculate it yourself.
MA05-FIR
(MA05-FIR = HTN + Hba1c)
Request a Specialist report:
Age: Over 40
The applicant has Hypertension and elevated HbA1c. This requires the following tests:
microalbumin:creatinine ratio, smoking history, lipids, repeat blood pressure
Request: “Specialist Report”  measurements, medication list and reported ECG.
Released
from the Dropdown
HbA1C range must be between 40-49mmol/mol to request a FIR
Please refer the case once you have this information.
Applicants under 40 can be referred to the MA without this FIR.
Note: Please only record the CVD risk and MA05-FIR health cases under the “MFP Record 2021” spreadsheet in the HAT folder
and include the codes for these in your initial assessment notes.

Document Outline