datamile

Ok, This comes from Iscah Migration monthly newletter www.iscah.com , no idea what they are like as an agent but I've been receiving their newsletter for a couple of years, and it always has useful info in it.


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Generally the cost of the health condition should not exceed $25,000 over a 5 year period (higher for partner and child applications). The following policy explains how some more common medical conditions are assessed ..



8.1 Height and weight

The applicant's height and weight should be determined accurately and recorded (at page 4, number 1 on the form 26) in centimetres and kilograms, respectively. The body mass index (BMI) should be calculated by means of the formula - weight (kg)/height (m)2.

Ranges for BMI are:

• Overweight 25-29.9 kg/m2

• Obese 30-39.9 kg/m2

• Severely obese 40 kg/m2 and more.

If the applicant's BMI falls into any of these ranges, comment should be made on how the weight is affecting the applicant's general health or any medical condition present.

The cases of all applicants with BMIs of more than 30kg/m2 should be graded as "B".

It should be noted that a BMI of 40 kg/m2 or more is regarded as incompatible with good health.

Evidence of excessive weight loss or of underweight should be noted. In infants and children, the height and weight should be assessed against standardised height and weight charts for the appropriate population. A comment should always be included as to whether the child's height and weight is standard for age and compatible with normal development.



8.2 Urinalysis

The urine of every applicant 5 years or older must be tested for abnormalities. The specimen of urine must be passed at the time of the examination. Children under 5 should be tested if indicated, for example, when there is a history of kidney disease or recent tonsillitis.

The urine test should be repeated immediately on a new specimen if a trace or more of protein, blood or glucose is detected.

In applicants who are menstruating, the test should be repeated after menstruation has ceased.

If the test result is still positive, a serum creatinine level, a urine microscopy (for cell count and morphology) and culture test, a protein-creatinine ratio, a fasting blood glucose level, a glycosylated haemoglobin level and a glucose tolerance test, as appropriate, should be requested.

All reports should be attached and the results entered on form 26 (page 7, number 19) before it is returned to the office processing the application.



8.3 Venereal Diseases' Reference Laboratory (VDRL) test

A Venereal Diseases' Reference Laboratory (VDRL), Rapid Plasma Reagin (RPR) or equivalent test for syphilis should be arranged, the report (to include titres) attached and the results included on the form 26 (page 7, number 20) for:

• any applicant whom the examining doctor suspects may be infected with a sexually transmitted disease; and

• all refugee applicants 15 years or older who are living in, or who have recently lived in, camp-like conditions.



8.4 Hepatitis B

Applicants in the following categories must undergo a blood test for the presence of hepatitis B antigen:

• children who have been, or are to be, adopted by Australian residents;

• unaccompanied minor refugee children;

• pregnant women; and

• any person whom the examining doctor considers to be at a high risk of hepatitis B infection, for example, drug abusers, tattooed persons, persons with a history of hepatitis, jaundice or blood transfusions or showing clinical evidence of hepatitis-B infection. In this category, hepatitis-C testing should also be performed.

If an applicant is found to be hepatitis-Bs antigen or hepatitis-C antibody seropositive, liver-function tests should also be performed.

The report(s) should be attached to, and the results entered on, form 26 (page 6, number 16) before it is returned to the office processing the application.

All members of a hepatitis B carrier's family whose own hepatitis B antigen tests give negative results, should be advised of the desirability of hepatitis B vaccination.



8.5 Human Immunodeficieny Virus (HIV) testing

Doctors should undertake the venepuncture for this test themselves. If another person takes the blood for the HIV test, the doctor must know the identity of the venepuncturist and is accountable for the security of the process.

Applicants for a permanent visa

It is Australian government policy that all applicants for a permanent visa who are 15 years or older must undergo an HIV antibody test. The result should be entered on form 26 (page 6, number 17).

HIV testing of children

Children under 15 must be tested if there is a reason to suspect HIV infection, for example, on clinical grounds, a history of blood transfusions or haemophilia, or if the mother or father is HIV-seropositive.

Children who have been, or are to be, adopted by Australian residents will be identified by the office processing the application. Such children must also undergo an HIV antibody test. The result should be entered on form 26 (page 6, number 17).

Applicants for a temporary visa

Applicants for a temporary visa should be asked to undergo HIV testing only if possible signs of the acquired immunodeficiency syndrome are present, or where specific arrangements are in place to do so.





9.1 Cardiovascular disease

(Form 26, page 4, number 2)

Referral to a cardiologist or an appropriate alternative specialist for assessment and determination of the prognosis and the need for treatment is required when there is a history or clinical evidence of:

• coronary artery disease;

• valvular heart disease;

• cardiomyopathy;

• hypertension - blood pressure greater than 150/90 mmHg (140/90 mmHg, if 40 years or under; 160/90 mmHg, if 65 years or older) on 3 occasions, after rest;

• congenital heart disease; and

• peripheral (including cerebral) vascular disease.



9.2 Pulmonary tuberculosis

(Form 26, page 5, number 3)

Procedure

The medical examination places particular emphasis on excluding a history of tuberculosis (including haemoptysis) or contact with tuberculosis. If a history of tuberculosis is elicited [form 26, page 2, number 15(c)], treatment records should be obtained.

All applicants 11 years or older, and applicants less than 11 years old who are suspected of having tuberculosis or have a history of contact with a case of known tuberculosis, must undergo a chest x-ray examination.

The maintenance of a very high index of suspicion of tuberculosis is vital to its diagnosis. Usually further films with alternative views are necessary to determine the nature of an abnormality. Old chest films should be obtained if possible, as comparison with old films will help in this determination.

Bacteriological examination

Cultures of 3 sputum specimens obtained 24 hours apart and incubated for at least 6 weeks are necessary to detect the presence of Mycobacterium tuberculosis.

Such cultures are required in all cases with overt or suspected pulmonary tuberculosis, based on clinical and radiological findings.

The examination of stained smears only without follow-up cultures is not sufficient to exclude activity and therefore is not acceptable

The collection of samples must be supervised closely to avoid substitution and to ensure a good sample. If bacteriological tests are unavailable or unreliable, then activity is judged on the appearances of chest x-ray film alone. Serial chest x-ray films are a useful method of determining activity.

The collection of a true sputum specimen is of critical importance, if the organism is to be isolated.

Bronchoscopy is the ideal method of obtaining a specimen for culture but usually is not achievable in the context of a migration examination. The best alternatives are aspiration of fasting gastric contents or closely supervised sputum collections with a nebuliser.

Specimens must not be collected at home and then brought to the laboratory.

Early morning specimens are preferable.

A salivary specimen should not be cultured.

Treatment

The need for chemotherapy in any particular case will be indicated by the MOCs but the final decision will be left to a local infectious-diseases or thoracic physician.

In cases of active disease, evidence of the satisfactory completion of a current course of supervised treatment is required before a medical clearance can be given.

In inactive cases, documented evidence of full satisfactory treatment in the past usually is required before a medical clearance can be given. This is because of the likelihood of future reactivation, particularly in the elderly, refugees and in subjects with co-existing diabetes mellitus, pneumoconiosis, chronic obstructive airways disease and any disease that suppresses the body's immune system, including rheumatoid arthritis, lymphomas and HIV infection.

However, demonstrated radiological stability of lesions over a period of at least 6 months is an acceptable alternative in most persons without an adequate history of previous treatment, who have negative results of sputum cultures.

The standard treatment protocol recommended by the Australian National Health and Medical Research Council is either a daily regimen of:

• ethambutol; and

• isoniazid; and

• rifampicin; and

• pyrazinamide

or an intermittent, fully supervised regimen, until bacterial cultures give negative results and a course of at least 6 months of chemotherapy (pyrazinamide and ethambutol usually are ceased after the first 2 months) has been administered.

Alternative approved regimens may be used. Inadequate chemotherapy is the major cause of drug-resistant organisms.

A certificate from a reputable chest physician, chest clinic or hospital is required as proof of treatment. This certificate must provide details of the generic names of the drugs used, the dosage and frequency of administration, and the duration of treatment.

Inactive tuberculosis

There is a significant (10%) chance of relapse in persons with inactive tuberculosis who have not undergone treatment. Relapse also may occur in treated persons but at a much-lower rate.

Therefore, applicants in whom tuberculosis has been found to be inactive will be issued by a MOC with a Health Undertaking to attend a chest clinic in Australia for surveillance.



9.3 Mental disorders

Referral for psychiatric assessment and determination of the prognosis and the need for treatment is necessary when there is a history (form 26, page 2, numbers 15[e] and 15[f]) or clinical evidence (form 26, page 5, numbers 5, 6 or 12) of:

• schizophrenia;

• bipolar or depressive affective psychosis;

• personality disorder;

• paranoid disorder;

• infantile autism;

• chronic alcohol abuse;

• drug dependence or substance abuse; or

• chronic neurosis (for example, chronic anxiety or depression, obsessive compulsive disorder, phobias).

In all applicants of more than 70 years of age, and if dementia is suspected, a Folstein MiniMental state examination must be conducted with the protocol (as adapted by Murtagh) in Attachment 1. The protocol should be adapted as appropriate linguistically and culturally. The score must be entered on the form 26 (page 5, number 5) or the proforma.

Please note that the test questions should be performed in the applicant’s own language or with the assistance of a professional interpreter. If a language barrier to assessment is present, this should be recorded. The Folstein test is a screening tool. If it suggests a problem, a psychiatrist’s or geriatrician’s opinion should be sought.



9.4 Intellectual disability

Referral for psychological or psychiatric assessment, as appropriate, is required if there is clinical evidence of an intellectual disability whether this is borderline, mild, moderate or severe (form 26, page 5, number 6).

The purpose is to determine:

• behaviour;

• level of independence and need for assistance; and

• employability.

Developmental assessment always should be undertaken of children and young infants. Developmental milestones should be noted whenever available. With children for adoption, some delay in achieving milestones may be expected where children have been deprived of adequate stimuli.

The following represent critically delayed milestones:

• Can not hold head up unsupported at 8 or more months of age (normal, 4 months);

• Can not sit unsupported at 10 months (normal, 8 months);

• Can not walk at 24 months (normal, 13 months);

• No words by 24 months (normal, 15 months);

• No 2-3 word phrases by 36 months (normal, 21 months);

• Moro reflex persisting at 8 months or older.

Non-symmetrical findings on examination and significant hypotonia or hypertonia are abnormal at any age.



9.5 Neurological and musculoskeletal disorders

(Form 26, page 5, numbers 4 and 8)

It is particularly important to assess the effect of such disorders on the ability to carry out daily tasks and the capacity to work. A detailed assessment of functional ability must be provided and any work restrictions or loss of time from work must be documented. Specialist referral may be necessary to reach a formal diagnosis and prognosis.



9.6 Diabetes mellitus

(Form 26, page 5, number 11)

Applicants with glycosuria, as noted at form 26, page 7, number 19 or who are known to have diabetes mellitus require referral to a physician for:

• glucose tolerance test, if required to establish the diagnosis;

• glycosylated haemoglobin level;

• microalbumin estimation or protein-creatinine ratio;

• assessment of need for treatment and appropriateness of treatment;

• determination of end-organ damage (for example, additional ophthalmologist's report regarding retinopathy, 24 hour urine protein excretion and creatinine clearance, electrocardiogram); and

• prognosis.



9.7 Evidence of drug-taking

(Form 26, page 5, number 12)

Details should be recorded of any indications of possible drug abuse, such as puncture marks, phlebitis, pupil size, mental state, and so on.



9.8 Eyes and visual acuity

(Form 26, page 6, number 15)

The examination should include inspection of the conjunctiva, cornea and fundus.

The presence of cataracts or trachoma should be recorded.

In the case of trachoma, whether the lesion is old or acute and the degree of residual damage should be recorded.

Applicants with cataracts, a history of trauma, trachoma or other eye diseases or conditions should obtain a report from a specialist ophthalmologist (not an optician or an optometrist). Attach this report to the form 26 when it is returned to the office processing the application.

The distance visual acuity of each eye should be tested separately, with corrective lenses if worn, by means of Snellen's or a similar test and the results recorded in metric fractions.

If defective vision is found, record the cause - (if known) for example, myopia, hypermetropia or astigmatism.

If an applicant has forgotten to bring glasses, pinhole testing for the acuity should be used.

In children too young to read the test charts or to use an E-chart or a picture chart, a comment must be made on whether the vision appears normal.

Applicants whose corrected vision is worse than 6/12 in the better eye should be asked to obtain a specialist ophthalmologist's (not an optician's) report. Attach this report to the form 26 when it is returned to the office processing the application.



9.9 Neoplastic diseases

Reports are required of operations and of pathology, including staging of the cancer, unless the cancer has been in full remission for more than 5 years. Referral to an oncologist for a current assessment and prognosis, and details of past, present and possible future treatment always is required.



(Source: DIMA)
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