Guide Understanding Disease: A Health Practitioners Handbook

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CQUni Handbook. Unit Synopsis This unit will develop student understanding of public health nutrition, which encompasses the biological, social and environmental dimensions of health in promoting and maintaining the nutritional health of populations. Term 1 - Profile. Assessment Overview. Assessment Tasks Assessment Task Weighting 1. Grades and Results Policy. Review of Grade Procedure. Previous Feedback. No previous feedback available Feedback, Recommendations and Responses Every unit is reviewed for enhancement each year.

Source: Student formal evaluation. Students appreciated the self-learning aspects of this unit but more lectures may be appreciated by students requiring additional support. Additional lectures or tutorials will be provided in future terms of delivery. Additional lectures were developed and formative learning activities were also provided to align with assessment tasks. Source: Formal student feedback. The group activity promoted collaboration and teamwork. Group work activity will be maintained in the unit to promote development of skills and understanding of teamwork in public health nutrition.

Broader consideration of a range of public health nutrition issues could enhance skill development in relation to public health nutrition. It helps practitioners to understand how to identify the imbalances through appropriate case history taking and laboratory testing, and how to design and implement effective nutritional interventions. Developed by leading academics and practitioners in the fields of nutritional therapy and functional medicine, this evidence-informed approach can be used with all patients who present in clinic, regardless of whether or not they have a 'named medical condition'.

In the final chapter, a case example illustrates how to use the theoretical information in the practice of treating patients with chronically compromised health. Biochemical Imbalances in Disease is an essential text for nutritional therapy practitioners, as well as for students, and will be welcomed by complementary and conventional healthcare practitioners alike. Gastro-Intestinal Imbalances. Compromised Detoxification. Part 1. Lorraine Nicolle and Ada Hallam. Part 2. Compromised Thyroid and Adrenal Function.

Sex Hormone Imbalances. If a previous report is not adequate or sufficiently current, the case will be furthered at the discretion of IRCC for additional follow-up with a TB specialist. If a person infected with pulmonary tuberculosis is identified during the course of the IME, it is imperative to conduct contact tracing. Any client that meets the definition of close contact Appendix A and requires an IME should be considered part of the high risk groups and must undergo screening as outlined in the instructions. All results and specialist reports must be attached to the file.

General comments should be entered as per the algorithm. When indicated, Tuberculosis screening with sputum testing should be requested. The Regional Medical Office will provide further instructions. For results and reporting for contact tracing, go directly to the contact tracing algorithm below. HIV and TB are often comorbid conditions and their screenings should be done hand in hand. GeneXpert should be done on the first specimen when all AFB smears are negative OR on any specimen with a positive smear. Yes: Attach results. Order HIV test, if not already done.

Refer to TB specialist. Initiate contact tracing. Grade B and submit IME. No: Attach results. Yes: Attach results and reports. No: Attach results and reports. A TB close contact is an individual who has shared the same air space for a prolonged period of time with a person with infectious TB.

Book Review: Handbook of oral diseases for medical practice

The exact duration of exposure is traditionally at least 8 hours of cumulative exposure. Procedures to be performed in designated collection area by trained technician using protective equipment Adequate respiratory protection with N mask and gloves. Initial TB investigation consists of three sputum specimens to undergo microscopy for Acid-fast bacilli AFB as well as culture for mycobacteria at the M.

Please note that this test is not accepted as a substitute for tuberculosis cultures, which are required in all cases where sputum is collected. The three sputum specimens can be collected on the same day, at least 1 hour apart. Preferably spontaneously produced deep cough sputum should be obtained. When not possible to obtain spontaneous sputum, it is recommended that sputum inductions be performed. Concentrated sputum smear microscopy using auramine stain with fluorescence microscopy is preferable but Zielh-Neelsen or Kinyoun staining is acceptable. The log sheet and tracking numbers are used to trace lost or misplaced records.

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The following list provides definitions for acronyms and technical terms found in this Handbook:. EDE Excessive demand exempt is a category of client who is exempt from assessment of excessive demand. Furthered cases Cases that require supplemental medical reports to complete the medical assessment. GAF Global assessment of functioning Guardian A legal guardian is a person who has custody or who is empowered to act on behalf of another person and has been recognized as such by the competent authorities in the jurisdiction where the status was either recognized or granted.

Handbook This Handbook is the standard reference for the orientation and training of panel members. All panel members must ensure that they remain familiar with it and with departmental instructions, including interim changes and updates provided by CIC. HIV Human immunodeficiency virus IFHP Interim Federal Health Program: a program funded by CIC that provides limited, temporary coverage of costs related to health care for specific categories of people, including protected persons, refugee claimants, rejected refugee claimants, certain persons detained under the Immigration and Refugee Protection Act IRPA and other specified groups.

IMA Immigration medical assessment, i. IME Immigration medical examination: the examination is conducted by a panel member. IMM Supplemental medical and resettlement needs assessment form providing information on the special needs a client may have while settling in Canada. LFT Liver function test Locum tenens Medical practitioners who replace panel physicians for a short period while they are on vacation, taking training or unable to provide service for other reasons. Panel clinic A clinic where designated physicians and radiologists conduct IMEs.

Panel member A general term that refers to a panel physician, panel radiologist or panel laboratories or specialists authorized by CIC to perform IME-related activities. Designated medical practitioner DMP was the previously used term. P number A unique identifier for each panel member issued by the Health Branch. Refugee overseas Convention refugee overseas RMO Regional medical office is the location of operations for medical officers who are CIC officials with responsibility for the Canadian immigration health program in a given region.

VO Visa office, where immigration and other applications are processed. Chapter 2: Legislation related to the Immigration Medical Examination. Chapter 3: The Work of Panel Members. A panel member cannot be designated until all the requirements of the designation process have been met: Completion of all required forms: application form; consent to share information; consent to use eMedical where available; acknowledgment of having read the Handbook; and acceptance of designation.

Panel members are not authorized to perform IMEs for CIC during the orientation phase; and Completion of training, including eMedical training where and when relevant, which may be done individually or through group activities involving several panel members in locations where they operate in geographic proximity. CIC does not guarantee that you will receive a specific number of cases per year. Equal Rights for Applicants Race, national or ethnic origin, colour, religion; Gender or sexual orientation; Age, mental or physical disability. Good standing with local medical authority If the following issues or events arise, panel members must notify the responsible RMO immediately: The panel member is suspended, or comes under investigation by his or her respective medical or regulatory authorities or is charged or convicted of a criminal offence or offences by medical or regulatory authorities; and The panel member discovers inappropriate activity relative to the provision of IMEs by clinic, office, laboratory or radiology centre staff.

Requests for Accommodation Panel members must be aware that some clients may request special accommodation during the IME due to personal or cultural sensitivities. The list should include fees for required radiological and laboratory investigations, for postage or courier charges, and for other services. Any special fees for groups or large families should also be listed. Copies should be available for clients on request and all clients should receive a receipt for services; ensure that all panel clinic staff members under their supervision are aware of the requirements and standards for the IME and its procedures; ensure that panel clinic staff understand the role and obligations that pertain to panel members; ensure that individual and clinic contact information is up-to-date.

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Panel physicians must: obtain client consent and declaration see details in Section 4. This includes, but is not limited to, protecting collected information against loss and unauthorized access, use, modification, disclosure and other misuse; and ensure that all panel clinic staff under their supervision are aware of and abide by the requirements and standards for completing IMEs in the eMedical system. Panel members are expected to exhibit professional behaviour and perform their IME-related activities in a manner that is in keeping with the principles of proper medical practice and with CIC policy.

Panel physicians are to provide appropriate and timely advice to the client when they discover a serious disease not known to the client.

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Approved identification documents include the following: Original passport or a copy of passport certified by a Canadian Visa Office National ID card an original Birth Certificate is an acceptable national ID document for minors under the age of consent only. All anticipated absences from IME activities over 7 calendar days must be brought to the attention of the RMO and, where possible, an estimated date of return to work should be provided to ensure that appropriate information is provided for the clients.

Section 3. Panel members cannot submit IMEs if their leave information indicates that they are on leave. After notification of the absence to the RMO:. For personal and program integrity, they must enter leave dates directly in their personal record. Paper-based Panel Clinics The RMO will update the information in their record in order to track the leave in their system. If the RMO approves the request, a written response by letter or email will be sent to the panel member.

The panel member will then notify the locum that he or she has been authorized to provide services. Panel members must ensure that the locum has adequate training in IME requirements, reporting procedures and any updates. CIC will provide the locum with a unique identifier refer to Section 3. The termination of a panel member will automatically cancel prior approvals of a locum for this panel member.

The system will be updated with appropriate information for locums. English and French are the official languages of Canada and panel members must be able to communicate with Canadian officials in at least one official language. Panel members should inform CIC of the official language they prefer to use in correspondence. Panel members should inform CIC of the official language and any other language they speak. The IME must be completed in the Canadian official language requested by the client.

Panel members should also indicate in the drop-down list in eMedical other languages they speak. When performing IMEs, panel physicians may examine clients who speak neither of the two official languages, nor any other language that the panel physician speaks. In these cases, an interpreter will be required. If an interpreter is used, panel members must select and ensure that the interpreter is unbiased and has no connection to the client. Family members or friends cannot act as an interpreter for a client. For panel members or their locum tenens performing a paper-based IME, the unique identifier, along with their name, must be clearly readable on each Medical Report forms IMM and IMM and on each chest x-ray.

Each photo attached to the Medical Report IMM must be stamped to confirm the identity of the client. Make sure that each IME is stamped and signed properly. Panel radiologists may embed this information on the chest x-ray along with other required information about the client. Panel physicians are encouraged to save a full copy or a summary of the IME for their own records e.

The panel physician can access the IME for days after submitting the case. Paper-based Panel Clinics. Original documents and information related to an IME must be forwarded to the responsible RMO by regular mail or commercial courier and must never be given to the client for delivery to the RMO. Panel physicians are required to keep copies and records of files for at least 2 years and in compliance with their local regulatory and licensing requirements.

Panel members should refer all requests for comment or information to the RMO. Specific questions about the IME process could include the following: total amount of time that CIC requires to complete the medical assessment process; amount of time between completion of the IME and subsequent steps of the immigration process or the issuing of a visa; administrative or policy aspects of the program; and other immigration-related issues. For contact information related to eMedical, refer to Appendix I.

These fees include the following: panel physician services; radiological and laboratory services; consultations with specialists; investigations and treatment e.

Panel members may also charge a reasonable fee for the following: Follow-up visits in the case of furtherances; providing copies of the IME to the client upon request; and missed appointments in accordance with local standards of practice. Incidents occurring during the IME process If, during an IME, a panel member has a disagreement with a client, or confusion arises or an event occurs that might compromise client service, panel members should report these incidents to the RMO. Complaints Complaints are common in any client service procedure.

Quality assurance concerns Health Branch officers will occasionally visit panel members to ensure the quality of their work. The following are examples of situations where panel members or their clinic staff would be seen to be failing to meet performance standards: Unacceptable behaviour or demonstrated misconduct: unprofessional or unethical conduct or activities; illegal activities; and loss or suspension of medical licence. Continued failure to maintain an acceptable level of performance as set out in this Handbook or in accordance with written instructions from the RMO.

This includes continued or repeated deficiencies after notification, in the following: timely and correct completion of IMEs including errors or omissions in the medical history and physical examination of clients ; appropriately providing requisite laboratory and clinical investigations and activities; gathering and management of medical information; timely transfer of information and communication with the CIC Health Branch; and following the instructions in this Handbook.

Termination CIC retains complete authority over the management of the panel member network. Retirement and resignation Panel members may retire or request removal from the panel network at any time. Request for reconsideration Panel members may request a reconsideration of a termination letter. The eMedical system will include the photograph on all requisitions and referrals laboratory, radiology, specialists and others. Paper-based Panel Clinics The client must provide four photographs to the panel clinic. If the photographs do not meet the specifications, ask the client to provide new photographs before their IME can be completed.

Approved identification documents include the following: Original passport or a copy of passport certified by a Canadian Visa Office National ID Card an original Birth Certificate is an acceptable national ID document for minors under the age of consent only. The form should be printed from eMedical and provided to the client. Clinic staff or a panel member should review the Consent and Declaration form with the client and answer any questions. The form must be scanned and uploaded to eMedical.

Paper-based Panel Clinics Clinic staff must print and provide the form to the client. Clinic staff must attach the form and submit it along with the IME.

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Non-EDE clients are assessed for: Danger to public health; Danger to public safety; Excessive demand on the Canadian health care system. Refugee overseas clients are also EDE. A live photo of the client is taken and uploaded to eMedical to verify identity throughout the life cycle of the IME. The IME and all of its components are then completed in the eMedical system. Panel physicians should not refuse to examine these clients. Enter the Identity Document Details. Clinic staff will check identity with the approved identification document. Note: a live photo of the client must be taken and uploaded to eMedical at a later step during the IME.

Note: For refugee claimants in Canada, select the category family EDE, and scan and attach the document provided by the client. Complete Identity Confirmation. Clinic staff will check identity with a valid government-issued ID. Clinic staff must attach a client photo provided by the client to the form. Clinic staff must select the immigration category by checking the appropriate box student, worker, visitor, family EDE or refugee claimant in Canada only.

An IME grade will be provided automatically by the system based on the reported findings. Grade A indicates that there are no abnormal findings present and no significant abnormal history. If the system has provided a B-grade, it cannot be changed to an A-grade. No comments are permitted for A-grade IMEs. Comments are mandatory for B-grade IMEs. Panel members must provide an IME grade based on the reported findings. Comments should not be included for A-grade IMEs. CIC requires the following information: date of diagnosis; date of treatment or surgery; relevant medications; and current status of the condition and, if applicable, the prognosis.

The physical examination must be completed by the panel physician. CIC requires the following information: history; diagnosis; treatment details including dates and medications ; lab results; specialist reports as required ; current status; and prognosis. Inspect neck, axilla and groin for lymphadenopathy Evidence of substance abuse e.

Client photograph must be attached to ensure IME integrity for laboratory testing. Indicate with a checkmark R the tests required. Laboratory staff must fill out the declaration to confirm the following: The requested laboratory tests have been performed; and The sample for testing was collected from the client identified on the requisition. A urinalysis is mandatory for all clients five years of age or older. Testing is also necessary for all clients below the age of 15 who have any of the following risk factors : signs and symptoms compatible with syphilis diagnosis; history of unprotected anal or vaginal sex or pregnancy; history of another sexually transmitted infection such as HIV, herpes, chlamydia, gonorrhoea or bacterial vaginosis; or history of being born to a syphilitic mother.

For positive syphilis serology results, panel physicians will: treat according to the Canadian Guidelines on Sexually Transmitted Infections and provide proof of treatment; or accept previous treatment carried out according to the Canadian Guidelines on Sexually Transmitted Infections and provide proof of treatment.

CIC requires the following treatment information: dates; medications; and dosages. Panel physicians must also request HIV screening for clients below the age of 15 who have any of the following risk factors : signs and symptoms compatible with HIV diagnosis; history of unprotected anal or vaginal sex or pregnancy; history of another sexually transmitted infection such as syphilis, herpes, chlamydia, gonorrhoea or bacterial vaginosis; history of sharing needles, syringes and other equipment and drug solutions for injecting drugs; history of receiving unsafe injections, blood product transfusions or medical procedures that involve unsterile cutting or piercing; accidental needle stick injuries, including among health workers; suspected active TB or hepatitis B or C; tattooing, piercing or having received acupuncture; history of being born to an HIV positive mother; or any child showing failure to thrive.

If the client chooses to defer her chest x-ray because of pregnancy:. The radiology clinic must notify the panel physician that the chest x-ray has been deferred; The panel physician may complete the IME, except for the chest x-ray; and The IME is only submitted once the post partum chest x-ray is returned to the panel physician. Panel physicians must arrange for immediate referral for TB investigation. Panel physicians can now submit the health case in eMedical. For all confirmed active pulmonary TB cases, panel physicians must conduct screening for hepatitis B and C, as well as HIV if not already done , and proceed with contact screening for all family members or close contacts who are also CIC clients.

Treatment for latent TB should be recommended for contacts as per instructions. If health case has been submitted this screening will be requested as a furtherance process by the RMO. For all confirmed active pulmonary TB cases, panel physicians must conduct screening for hepatitis B and C, as well as HIV if not already done , and proceed with contact- screening for all family members or close contacts who are also CIC clients. Prior to submitting the chest x-ray, the radiologist must provide a grade for the radiography. Grade A indicates that there is no evidence of TB or abnormalities suggestive of other significant diseases identified.

Grade B indicates that there is evidence of TB or abnormalities suggestive of other significant diseases identified. If the system has provided an A-grade and the radiologist believes that there is evidence of TB or abnormalities suggestive of other significant diseases, they may change the grade to B. No comments are permitted for A-grade chest x-rays.

Comments are mandatory for B-grade chest x-rays. Paper-based Panel Clinics Radiologists must provide a radiology grade based on the reported findings. Comments should not be included for A-grade chest x-rays. The radiologist or authorized radiology support staff enter the general and special findings in the eMedical system. The panel physician clinic is notified of the completion of the chest x-ray examination. The panel physician reviews the radiologist report and grading.

Paper-based Panel Clinics The radiologist provides the general and special findings and grades the digital chest x-rays or film using the proper form. The radiologist or authorized radiology staff forward the chest x-rays and the report to the panel physician. The RMO issues a client letter with instructions to return to a panel physician for further investigations. The furtherance request is transferred to eMedical. The panel physician completes the additional examination s or generates a referral letter containing the information that will be sent to a specialist for the required investigation s.

The panel physician enters the information in eMedical and submits the information to CIC. The RMO issues a client letter with instructions to return to the panel physician and also provides the client with a sealed letter for the panel physician along with detailed instructions for further investigations. The panel physician completes the additional examination s or refers the client to a specialist for the required investigation s.

Once all the required investigations have been completed, the panel physician returns the reports to CIC. The IFHP fee policy is to reimburse according to usual and customary fee rates in place on the date of service or as per fee rates established by the IFHP. A Provider must not collect from the client the difference between the total amount billed for the services and the amount to be reimbursed by Medavie Blue Cross, if any. Fees for services rendered must not be dependent on method of payment nor influenced by whether the service is a covered benefit for the client.

Eligibility groups for pre-departure medical services Individuals identified for resettlement before they come to Canada i. Government-assisted refugees, privately sponsored refugees and blended visa office referred refugees are eligible for PDMS. Eligibility may also be extended to groups or individuals who have been specially designated by the Minister of IRCC. They are not required to submit the claims for reimbursements to Medavie Blue Cross. For registration procedures, please consult the PDMS provider handbook.

This reference document is also available on the Medavie Blue Cross website. Outbreak response ; The IFHP will reimburse the services and products related to diagnostic testing rapid and serologic , post-exposure prophylaxis, vaccines and drug therapy , pre-departure health screening and personnel cost including the cost of physician and nursing visits required to manage communicable disease outbreaks in refugee camps.

Ongoing action capacity Provide brief description of the current response and capacity, including investigation done and control measures taken human, medical, etc. Proposed response: What should be done to control this outbreak? Describe proposed control activities and supplies needed medicines, materials and expected cost per client, including: Treatment of cases and carriers. Isolation of cases Surveillance of suspects Immunisations.

Identify required vaccine s and number of doses. Confirm vaccine cost per doses including the administration costs. Appendix I: Contact Information. Appendix III: Forms. IMM Medical Report. Q1: Is the client 75 years old or older? No: No need for an ADL assessment Yes: ADL assessment is mandatory Q5: Is there an ongoing physical or mental health condition that might prevent the client from attending a regular school program, obtaining full-time employment, or living independently? Algorithm Text version: TI for cognitive functioning assessment TI for cognitive functioning assessment IME should be graded B if any abnormalities in the cognitive functioning assessment are found.

No: No need for a cognitive functioning assessment Yes: cognitive functioning assessment is mandatory Q2: Is there abnormal findings on physical examination of the nervous system? No: No need for a cognitive functioning assessment Yes: cognitive functioning assessment is mandatory Q3: Is there abnormal findings on physical examination of the musculoskeletal system? No: No need for a cognitive functioning assessment Yes: cognitive functioning assessment is mandatory Q4: Is there abnormal findings on physical examination suggestive of cognitive impairment or intellectual disability?

No: No need for a cognitive functioning assessment Yes: cognitive functioning assessment is mandatory Q5: An ongoing physical or mental health condition that might prevent the client from attending a regular school program, obtaining full-time employment, or living independently No: No need for a cognitive functioning assessment Yes: cognitive functioning assessment is mandatory Breast examination Subject Instructions regarding breast examination of clients as part of the Immigration Medical Examination IME. Instructions A screening breast exam is not indicated for an IME.

If performed by the Panel Physician, the following are mandatory: Breast exams must always be conducted in the presence of a chaperone Provide the client with an explanation of why and how the examination is being conducted Rationale for a clinical breast examination and the risk factors, must be provided in the comments section of the IME Developmental milestones: Chart of early childhood development Subject Instructions for evaluating early childhood development and completing the Chart of Early Childhood Development CECD section in the context of the Canadian immigration medical examination IME.

Grading and submission of files All IMEs for clients with abnormal developmental milestones must be graded B. Q1: Is the client 5 years old or less? Yes: Complete an assessment of developmental milestones — Chart of Early Childhood Development No: No need to proceed with an assessment of developmental milestones. No: Continue the medical examination.

These 5 sections of the resettlement needs section are: Functional Assessment physical and psychological , Special Travel Requirements, Post-arrival Service Requirements, Housing and Daily Activities or Assistance requirements, and Other Resettlement needs. Section 1: Functional assessment The functional assessment on the resettlement needs section is clear in identifying major problems that can impact on resettlement of the refugee in Canada see figure below : Text version: Section 1: Functional assessment Functional assessment: Indicate Yes or No for every listed impairments: Hearing impairment Partial or Complete ; Vision impairment Partial or Complete ; Speech impairment Partial or Complete ; Cognitive impairment Mild or Moderate or Severe ; Mobility impairment indicate the current mobility aid and the mobility aid required ; Other impairment provide details.

Activity of daily living Independent or Partial care or Total care; provide details. Provide details if necessary. Please specify the specialized services required. Section 5: Other comments related to resettlement needs This section must only be used when relevant details are needed and cannot be written in any of the above sections.

Select Yes and provide details. Q2: Functional assessment Q2. Indicate in how many weeks the consultation is required. Select Yes or No. Medications: regimen, recent changes Drug or alcohol abuse Additional investigation An assessment of cognitive functioning and activities of daily living ADL is mandatory for all clients aged 75 years and older. Reporting All additional assessment information, including assessments of ADL and cognitive functioning, must be attached to the IME report.

Any behaviour suggesting the client may present a danger to self or others must be reported. Yes: An ADL and a screening test for cognitive functioning are mandatory. Screening and testing During the IME, the PPs must be vigilant in assessing clients with diabetes, hypertension or chronic renal or cardiac diseases for the presence of possible end-organ damage and long term complications, especially renal function impairment. Signs associated with end-organ damage include: retinopathy neuropathy: check for symptoms or findings such as peripheral neuropathy or pain, autonomic neuropathy for example, erectile dysfunction, gastrointestinal disturbance, orthostatic hypotension , PPs should include screening via monofilament during foot exam Cardiopathy: chest auscultation and radiography is necessary to assess cardiomegaly and cardiopathy Nephropathy: special attention should be brought during the IME to blood pressure measure as well as to urinalysis and creatinine results refer to TIs on urinalysis and serum creatinine The identification of clients with end-organ damage and renal function impairment is based on the completion of an appropriate medical history, careful review of risk factors and commonly associated co-morbid conditions, physical examination, and screening investigations.

Grading and submission of files All IMEs for clients with renal function impairment must be graded B. Q3: Is serum creatinine level normal? Genital, gynecological and rectal examination Subject Instructions regarding examination of genitals, gynecological and rectal examinations of clients as part of the Canadian Immigration Medical Examination IME.

Instructions Genital, gynecological and rectal examinations are never indicated in the context of the IME. Developmental delay in children Subject Instructions for screening children with a possible developmental delay in the context of the Canadian immigration medical examination IME. The following questions can be used to identify older children and adolescents for whom a hearing screen may be necessary: Do you have a problem hearing over the telephone?

Do you have trouble following the conversation when two or more people are talking at the same time? Do others complain that you turn the television volume too high? Do you have to strain to understand conversation? Do you have trouble hearing in a noisy background? Do you find yourself asking other people to repeat themselves? Do many people you talk to seem to mumble or not speak clearly? Do you misunderstand what others are saying and respond inappropriately?

Section I - Requirements

Do you have trouble understanding the speech of women and children? Do people get annoyed because you misunderstand what they say? Grading and submission of files All IMEs with significant abnormal findings on the hearing examination must be graded B. No: Continue with the medical examination.

References New born hearing screening Ten ways to recognize hearing loss. Results and reporting An indeterminate or reactive that is, positive test result should be repeated automatically by the laboratory using a different assay on the same blood specimen prior to reporting the initial result.

Post-Test Counselling for Positive Results Post-test counselling for a positive result should occur after the lab has reported a confirmed positive HIV result. Q3: Is the initial HIV results are confirmed positive? Anxiety disorders, personality troubles or mild mood disorders requiring no or minimal follow up and that have no impact on public safety are quite common. No additional investigation is required Depression is the most common psychiatric disorder in the general population.

Again, the PP should assess the depressive disorder in terms of risk to public safety and the level of services required by the client.