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    Record Medical History

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    29. Stella Nery
    This referral letter provides details for a client named Sumitro Giant regarding required health examinations for a student visa application. The client must schedule appointments with an approved panel physician to complete a medical examination and chest x-ray. The letter lists the client's required examinations, provides instructions and contact information, and includes the client's health history declaration indicating no relevant medical conditions.

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    © All Rights Reserved
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    Record Medical History

    Uploaded by

    29. Stella Nery
    78 views2 pages
    This referral letter provides details for a client named Sumitro Giant regarding required health examinations for a student visa application. The client must schedule appointments with an approved panel physician to complete a medical examination and chest x-ray. The letter lists the client's required examinations, provides instructions and contact information, and includes the client's health history declaration indicating no relevant medical conditions.

    Original Title

    Record Medical History (1)

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    This referral letter provides details for a client named Sumitro Giant regarding required health examinations for a student visa application. The client must schedule appointments with an approved panel physician to complete a medical examination and chest x-ray. The letter lists the client's required examinations, provides instructions and contact information, and includes the client's health history declaration indicating no relevant medical conditions.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    78 views2 pages

    Record Medical History

    Uploaded by

    29. Stella Nery
    This referral letter provides details for a client named Sumitro Giant regarding required health examinations for a student visa application. The client must schedule appointments with an approved panel physician to complete a medical examination and chest x-ray. The letter lists the client's required examinations, provides instructions and contact information, and includes the client's health history declaration indicating no relevant medical conditions.

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    © All Rights Reserved
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    You are on page 1of 2

    HAP 31602781

    Referral letter
    Client personal details Client identity details
    Family name: SUMITRO Identity document presented: Original Passport
    Given names: GIANT Identity document number: C7759750
    Gender: MALE Issuing country: INDONESIA
    Date of birth: 20 Dec 1997 Date of issue: 08 Jul 2021
    Country of birth: INDONESIA Date of expiry: 08 Jul 2026
    Source: Australia

    Client visa details


    Visa: TU 500 Student
    TRN: EGOWXBDTNO
    Visa Request ID: 2015664994

    Instructions to the client


    Please proceed to make an appointment to undergo the required immigration health examinations listed in this letter
    with an approved panel physician if you are outside AUSTRALIA or the Department of Home Affairs (Home Affairs)’s
    migration medical service provider if you are in Australia. You may also subsequently be referred to a specialist for
    additional health examinations. Specific requirements for arranging your health examination are explained on Home
    Affairs’ website at https://immi.homeaffairs.gov.au/help-support/meeting-our-requirements/health/arrange-your-health-
    examinations.

    If an examination is listed as Completed this means that there is an existing examination that can be re-used for this visa
    application. You will not be asked to complete this examination again unless a repeat examination is required because
    your medical circumstances have changed or the examination has since expired. More information about when re-use
    is allowed is available at https://immi.homeaffairs.gov.au/help-support/meeting-our-requirements/health/arrange-your-
    health-examinations. If you believe that you have additional examinations for re-use contact your case officer before you
    attend your appointment.

    When making your appointment, please provide the clinic with your health identifying number (HAP ID) indicated at the
    top of this letter. Please also make sure that you bring with you to your appointment:

    • this referral letter

    • your prescription spectacles or contact lenses, if applicable

    • existing specialist and/or other relevant medical reports for known medical conditions

    • any previous chest x-rays

    • a valid passport OR an agreed form of alternative documentation to confirm your identity.

    Note: a copy of any health information that you have already provided to Home Affairs online is
    included below for your information. This information will also assist staff at the panel clinic that you
    select to visit.

    Examinations required for this visa application

    Generated: 21 Mar 2023 01:57 PM HAP: 31602781 Page 1 of 2


    Referral letter

    Exam Status Clinic


    501 Medical Examination Required
    502 Chest X-ray Examination Required

    Consent provided
    On 21 MAR 2023 you consented online to using eMedical to process your health examinations where available.

    Tuberculosis (TB), treatment for tuberculosis? No


    Close household contact with Tuberculosis (TB)? No
    Prolonged medical treatment and/or repeated hospital admissions for any reason, including a No
    major operation or psychiatric illness
    Psychological/Psychiatric Disorder (including major depression, bipolar disorder or No
    schizophrenia)
    An abnormal or reactive HIV blood test No
    An abnormal or reactive Hepatitis B or Hepatitis C blood test? No
    Hepatitis B -
    Hepatitis C -
    Cancer or Malignancy in the last 5 years No
    Diabetes No
    Heart condition including coronary disease, hypertension, valve or congenital disease No
    Blood condition (including thalassemia) No
    Kidney or Bladder Disease No
    An ongoing physical or intellectual disability affecting your current or future ability to function No
    independently or be able to work full-time (including autism or developmental delay)
    An addiction to drugs or alcohol No
    Are you taking any prescribed pills or medication (excluding oral contraceptives, over-the No
    counter medication and natural supplements)? Please list

    Client declaration

    The client has provided true and correct medical history information.
    Doctor declaration
    -

    Generated: 21 Mar 2023 01:57 PM HAP: 31602781 Page 2 of 2

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