PROTECTED WHEN COMPLETED - B

Page 1 of 1

INSTRUCTIONS FOR PREGNANT CLIENT - X-RAY DEFERRED

IMM 5733 (07-2018) E (DISPONIBLE EN FRANÇAIS - IMM 5733 F)

Date (YYYY-MM-DD):

UCI number:

IME number:

UMI number (if applicable) : Attach image

Family name:

Given name(s): Date of birth (YYYY-MM-DD):

Completion of your immigration medical examination (IME) has been delayed due to your pregnancy. In order to complete your IME, a chest x-ray will be required following your pregnancy or as soon as your physician feels it is clinically safe.

Please take this letter and the enclosed x-ray requisition form to the following x-ray clinic: (Insert name, address and contact info of the designated eMedical Radiology Clinic.)

If you require a list of radiologists in your area, please contact a Panel Physician at http://www.cic.gc.ca/pp-md/pp-list.aspx to request the names of radiologists in your area. When your chest x-ray is completed, the radiologist will report the results to your panel physician at which time it will be submitted to Citizenship and Immigration Canada for review and assessment. Please note the following: 1. It is your responsibility to ensure the x-ray is completed as soon as possible after pregnancy; and 2. You may wish to provide your visa office with a copy of this letter so they are aware that you will be delaying your x-ray due to pregnancy.

Thank you for your cooperation in this matter.