INZ新西兰体检表.pdf
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INZ新西兰体检表.pdf
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OFFICEUSEONLYClientno.:
Datereceived:
/Applicationno.:
ChestX-rayCertificateINZ1096Forfurtherinformationonimmigrationvisitwww.immigration.govt.nzJuly2013Whoshouldusethisform?
ApplicantsforentrytoNewZealandarerequiredtohaveanacceptablestandardofhealth(HealthRequirements(INZ1121)hasmoredetails).ThischestX-raycertificaterecordsinformationaboutyourhealththatImmigrationNewZealandrequirestoassesswhetheryoumeetthisstandard.DecidingwhetheryouareeligibleforavisaImmigrationNewZealandcollectstheinformationaboutyouonthisformtodecidewhetheryouareeligibleforavisa.CollectingtheinformationisauthorisedbytheImmigrationAct2009andtheImmigrationRegulationsmadeunderthatAct.Youdonothavetoprovidetheinformation,butifyoudonotwearelikelytodeclineyourapplication.ImmigrationNewZealandmayalsosharetheinformationyouhaveprovidedwithothergovernmentagenciesthatareentitledtoitbylaw,orwithotheragencies(asyouhaveagreedinthedeclaration).Youareabletoaskfortheinformationweholdaboutyouandrequesttohaveanyofitcorrectedifyouthinkitisnecessary.TheaddressofImmigrationNewZealandisPOBox3705,Wellington,NewZealand.Thisisnotwhereyourapplicationshouldbesent.ApplicantsnotesTheinformationinthissectionwillhelpyoucompletethischestX-raycertificate.Pleasereadtheinformationinthissectionbeforeyoustarttocompletethiscertificate.WhendoIusethischestX-raycertificate?
YoumustusethischestX-raycertificateif:
youareapplyingforresidence,oryouareapplyingforatemporaryentryclassvisaandyouintendtostaylongerthan12months,unlessyouareapplyingforamilitaryvisa,diplomatic,consularorofficialvisa,oravisarelatedtotheAntarcticTreaty,oryouareapplyingforatemporaryentryclassvisaandyouintendtostaybetweensixto12monthsandyouarefrom,orhavevisited,aplacethatisnotonImmigrationNewZealandslistofcountries,areasandterritorieswithalowincidenceoftuberculosis(TB).TheguideHealthRequirements(INZ1121)hasmoredetailsandincludesthefulllist.Childrenunder11yearsofageandwomenwhoarepregnantarenotrequiredtoundergoachestX-rayexaminationunlessrequestedbyINZ.WhatifIsubmittedachestX-raycertificatewithmylastapplication?
YoumaynotneedanewchestX-raycertificateifyouhavesubmittedachestX-raycertificatecompletedanddatedbyaradiologistoraradiographerwithinthelast36monthswithapreviousapplication,andthatinformationhasbeenretainedbyImmigrationNewZealand*.YourimmigrationofficerwillletyouknowifanewchestX-raycertificateisrequired.Ifanewcertificateisrequiredyouareresponsibleforanyfees.Note:
YouwillneedtoprovideanewchestX-raycertificateifyouhavespentsixconsecutivemonthsinaplacethatisnotonImmigrationNewZealandslistofcountries,areasandterritorieswithalowincidenceofTBsinceanypreviouschestX-raycertificatewascompletedanddatedbyaradiologistorradiographer.TheguideHealthRequirements(INZ1121)hasmoredetailsandincludesthefulllist.*ImmigrationNewZealanddoesnotnecessarilyretainmedicalinformationaboutapplicants.2ChestX-rayCertificate-July2013Whenfillinginthisform,pleasewriteclearlyusingCAPITALLETTERS.Thisformhasbeenapprovedundersection381oftheImmigrationAct2009WheredoIgetmyimmigrationchestX-ray?
ThischestX-raycertificatemustbecompletedbyaradiologist.ThiscertificateisnottobecompletedbyaradiologistorradiographerwhoisrelatedtothepersonhavingthechestX-rayexamination.PleasenoteyoumayrequireareferralfromaregisteredmedicalpractitionerforachestX-ray.InmostcountriesImmigrationNewZealandhasapprovedlistsofpanelphysicianswhomustbeusedfortheexamination.Ifyourequireinformationonthepanelphysicianslist,pleasevisittheINZwebsiteatwww.immigration.govt.nz/healthinfo.Ifyouliveinacountrywhichdoesnothaveanypanelphysicians,aregisteredradiologistcancompletethiscertificate.YourresponsibilitiesYoumustpaythefeesforthechestX-ray,anytestsrequiredandallpostageandcourierfees.Youmusttellthetruth.Falsestatementsonamedicalcertificatemayresultinyourapplicationbeingdeclined,anyvisagrantedbeingcancelled,andifyouareinNewZealand,youmayberequiredtoleavethecountry.CompletingthecertificateThiscertificatemustbecompletedinEnglish.IfanyaccompanyingspecialistreportcannotbeprovidedinEnglish,acertifiedtranslationmustbeprovidedalongwiththeoriginalspecialistreport.RadiographerTheradiographermust:
certifytheidentityofthepersonbeingexamined,bysigninganddatingthefrontofthephotographatA1(withoutobliteratingtheimage).Thesedetailsmustextendbeyondthephotographsedgecheckpassportdetailsandrecordt
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