Chapter 24 Annex 5

Template for letter from Post to IOM authorising gratis TB screening

To applicant
Please give this letter to the IOM office when you register for your TB test. Note that if you present any forged documents as part of your visa application, we may refuse your visa.

Dear IOM,

RE: Gratis Health Screening

Applicant (*and dependant) details:

British immigration law provides for an Immigration Officer to refer any person seeking entry to the UK under the Immigration Rules to a Medical Inspector at the port of entry for medical examination and to refuse entry if the person is not cleared. The only exception is for returning residents, who may be referred for examination but cannot be refused entry on such grounds.

However, in practice it is usually only those persons intending to remain in the UK for 6 months or more who are required to have medical clearance.

In British Embassies or High Commissions overseas an Entry Clearance Officer (ECO) takes the role of Immigration Officer and, when necessary, will refer an applicant for medical clearance before deciding whether to issue a visa.

The medical examination of an entry clearance applicant will be undertaken by a Medical Officer who will then pass the results to the Medical Referee. The function of a Medical Referee is to make a recommendation to the ECO concerning the suitability of the applicant for entry to the UK on medical grounds. In some countries, the posts of Medical Officer and Medical Referee are combined.

Procedures for the Referee
Examining Medical Officers should send to the Medical Referee a record of the medical examination on Form PQ.

A Medical Referee may wish to examine the applicant when:

• there appears to be some irregularity on the PQ Form; or
• after considering Form PQ, the Referee is not sure whether to recommend refusal of UK entry on medical grounds; or
• the Referee wishes to make an occasional check on the adequacy of the medical examinations.

There is provision at the end of Form PQ for the Medical Referee to either make a recommendation or defer a decision.

The Medical Referee may defer making a recommendation in certain circumstances, e.g. to await the result of a course of treatment for acute infectious diseases, contagious skin diseases etc.

The Referee may decide that the prospective applicant should have a further examination at a later date, in which case the Referee will have to state whether or not this should preclude entry to the UK.

In addition to making the recommendation on form PQ, the Medical Referee should complete Form XY and pass it with Form PQ to the ECO. If the application for entry clearance is successful, the applicant will be given the XY Form to show to the Immigration Officer or Medical Inspector on arrival in the UK. If the applicant is unsuccessful, the XY form will be retained by the ECO.

When completing Form XY the Referee indicates in code the medical findings from the PQ Form. The appropriate code letter(s) taken from the list (Annex 24.4) should be entered in the box above the space for the Referee’s signature. This should be written as distinctly as possible to avoid erasure or alteration; typewriter (if available) or ballpoint pen should be used.

Objectives and criteria for the medical recommendation
In giving a recommendation, the Referee should bear in mind that the object of the medical examination is to prevent the entry of, or bring to notice, persons who if admitted to the UK might:

1. endanger the health of other persons in the UK; or
2. be unable for medical reasons to support themselves and/or dependants in the UK; or
3. require major medical treatment (for which an entry clearance application has not been made).

The Referee should normally recommend refusal if the form PQ shows that applicants suffer from pulmonary tuberculosis, leprosy, trachoma, a mental disorder, senility, conduct disorder (e.g. alcoholism, drug addiction, serious sexual aberration, etc) or any disease, physical defect, bodily deformity or fits of any kind which would prevent them from supporting themselves or their dependants.

Particular care should be taken over cases of pulmonary tuberculosis. Of the three major stages of "active", "quiescent" and "healed", there will be no doubt about the requirement to recommend refusal for a person whose condition is "active". It is, however, not often possible initially to distinguish between activity and quiescence; and it is even more difficult to distinguish between "quiescent" and "healed" tuberculosis. Therefore an applicant should only be classified as "quiescent" if there is evidence, on the basis of 4 examinations at intervals of 6 months for 2 years following cessation of treatment, that there has been no alteration in his/her clinical, bacteriological and radiological condition.

What recommendations may be made
When a returning resident category is referred for medical clearance, the Referee is confined to bringing to the attention of the ECO any condition which might require treatment when the applicant is admitted to the UK. A returning resident cannot be refused entry to the UK on medical grounds. However, an ECO can require that such a person report to a Medical Officer for Environmental Health at the place of destination.

In all other categories of traveller and where there is evidence that (a), (b) or (c) above apply, the Referee may either recommend refusal or defer making a recommendation or draw the attention of the ECO to the circumstances of the case.

Back to Chapter 24