This is an HTML version of an attachment to the Official Information request 'Request for Medical Assessor Guidelines'.
October 2022
INZ 1378
Immigration New Zealand 
Guidelines for Medical Assessors
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  
• provide an overview of the medical assessment
[email address]
process
under the Official Information Act 1982.
Released 
immigration.govt.nz

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Information about these guidelines  .......................................................................................................................................1
Immigration New Zealand (INZ) health instructions ............................................................................................................... 3
How INZ collects health information .........................................................................................................................................................3
Glossary ................................................................................................................................................................................. 3
The Medical Assessor’s role ................................................................................................................................................... 3
Support for Medical Assessors ...............................................................................................................................................4
INZ support .................................................................................................................................................................................................4
Respiratory Physicians ...............................................................................................................................................................................4

1982.
Panel Physicians .........................................................................................................................................................................................4
Visa applicants who must undergo a medical examination ....................................................................................................4

Act 
Meeting the criteria for an acceptable standard of health  .....................................................................................................................4
Medical certificates ....................................................................................................................................................................................5
The medical assessment process ...........................................................................................................................................6
Outcomes from medical assessments ......................................................................................................................................................6
Guidelines for documenting opinions .................................................................................................................................... 7
General advice about opinions .................................................................................................................................................................. 7
Writing ASH opinions ................................................................................................................................................................................. 7

Information 
Writing AWC opinions ................................................................................................................................................................................ 7
Recording a deferral  .................................................................................................................................................................................. 7
Writing NOT ASH opinions ......................................................................................................................................................................... 7
Requesting further information ................................................................................................................................................................8
If an applicant disputes a Medical Assessor’s opinion .............................................................................................................................8

Official 
Guidelines for specific medical conditions .............................................................................................................................8
Requesting the guidelines .........................................................................................................................................................................9
the 
Online references ................................................................................................................................................................. 10
INZ guides and forms ............................................................................................................................................................................... 10
INZ website ............................................................................................................................................................................................... 10
Other health and education references .................................................................................................................................................. 10

under 
Online medical tools and calculators ...................................................................................................................................................... 10
Released 
2 – Immigration New Zealand Guidelines for Medical Assessors – October 2022

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 
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 
1982.
(IOs) and Medical Assessors to review medical information, 
purpose of the visa they apply for.
and record outcomes and opinions.
Act 
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.
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. 
Information 
•  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. 
subsequent tests.
They are published in the INZ Operational Manual.
High cost conditions – Those conditions that exceed the 
Immigration Medical Examination (IME) – The medical 
Official 
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:
of the condition if it is chronic. The A4.10.1 list of high 
the 
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
under 
services within New Zealand, the demand for which is 
Ongoing Resourcing Scheme (ORS) – see page 8
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
Released 
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 
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 – 

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 
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 
1982.
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 
Act 
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 
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.
Information 
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 
outcome for the applicant.
Official 
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 
under 
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 
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 
Released 
•  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 
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 
•  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
1982.
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 
Act 
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 
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.
Information 
•  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
Operational Manual – A4.10
Duration and validity of medical certificates
Official 
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 
relevant visa application. 
to provide a LMC. This screens only for the conditions which 
the 
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.
under 
date of the medical assessment.
Information on medical certificates
•  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.
Released 
•  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 
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 – 

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 
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 
1982.
•  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:
Act 
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 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 
Information 
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 
requirements or not. They enter their decision into IHS.
Outcomes from medical assessments
Official 
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 
under 
health
•  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 
Released 
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 
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 
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 
1982.
•  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 
Act 
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.  
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 
Information 
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 
additional diagnostic procedures.
documents are current and valid.
General advice about opinions
In preparing to make an assessment, Medical Assessors 
Official 
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 
have applied for. They cannot say they are likely to meet ASH 
resident visa – this determines the criteria they apply for 
the 
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 
under 
•  with access to the system, or
qualify for ORS funding – if they might, then the HAT 
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 
Released 
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
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 – 

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. 
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 
1982.
three months only.
visas) – A4.65
In the case of a deferral for three months, treatment could 
Requesting further information
include:
Act 
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 
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 
Information 
•  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.
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 
Official 
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 
often the most detailed as they can become the subject of a 
their ongoing extreme or severe difficulty with learning, 
the 
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 
under 
•  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.
•  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 
Released 
INZ RP to complete their assessment. 
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 
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
1982.
confirm their original opinion, the application is referred for 
a second opinion to a different Medical Assessor who has 
Act 
Guidelines for specific medical conditions
The INZ Operational Manual provides a list of medical 
conditions that are likely to impose significant costs or 
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
Information 
Guidelines have been developed for Medical Assessors to use 
when assessing some of these health conditions including:
•  Cardiovascular diseases
•  Cochlear implants
•  Diabetes
•  Haemophilia
Official 
•  Hepatitis B
•  Hepatitis C
•  HIV
the 
•  Non Tuberculous Mycobacterium
•  Renal failure and dialysis treatment
•  Syphilis, and
•  TB.
under 
There are also guidelines to help with assessing:
•  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
Released 
Medical Assessors can request the guidelines in PDF format 
by emailing: [email address]
Immigration New Zealand Guidelines for Medical Assessors – October 2022 – 

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)
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) 
1982.
•  General Medical Certificate (INZ 1007) 
•  Limited Medical Certificate (INZ 1201) 
•  RSE Scheme Supplementary Medical Certificate  
Act 
(INZ 1143) 
INZ website
Operational Manual – A4 Health requirements
Panel physician network
 – includes testing requirements, 
tools and instructions
Health – information for visa applicants
Other health and education references
Information 
Ongoing Resourcing Scheme (ORS) – Ministry of Education
Pharmaceutical Schedule – PHARMAC - contains some 
information on pharmaceutical costs
The economic cost of serious mental illness and 
comorbidities in Australia and New Zealand – The Royal 
Australian & New Zealand College of Psychiatrists
Official 
Guidelines for Tuberculosis Control in New Zealand, 2019  
– Ministry of Health
the 
Online medical tools and calculators
HbA1c Conversion Chart – New Zealand Society for the 

Study of Diabetes
Cholesterol Unit Conversion – Endmemo
under 
eGFR calculator – Kidney Health Australia
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 
Released 
Other endorsed generic online cardiovascular disease risk 
assessment calculators may be referenced.
10 – Immigration New Zealand Guidelines for Medical Assessors – October 2022

1982.
Act 
Information 
Official 
the 
under 
Released 
Immigration New Zealand Guidelines for Medical Assessors – October 2022 – 11 

1982.
Act 
Information 
Official 
the 
under 
Released 
12 – Immigration New Zealand Guidelines for Medical Assessors – October 2022

Document Outline