You must use this certifi cate if you are applying for a temporary visa or permit for New Zealand and you intend to stay longer than 12 months or if you are applying for residence. There are no panel doctors in New Zealand. If you are in New Zealand and you do not have a doctor please refer to the telephone book for a list of General Practitioners near you. + Your valid passport, for identifi cation. + Three recent passport photos. + Any spectacles or contact lenses you wear. + Any existing medical specialist reports, particularly if you have a known    medical condition. + Details of any prescription medicines you are currently taking    (including drug name and dosage). All applicants including children and newborn babies are required to submit a completed medical certifi cate, or have one submitted on their behalf. + Children under 16 must be accompanied during the medical examination by a parent or guardian. + Chest X-rays are not required of children under the age of 11. + Children under 15 are not usually required to undergo the standard blood tests,     unless risk or clinical factors make them necessary. + Children under 5 are not usually required to give a urine sample. In this section you confi rm your personal details and the type of work or study you will be doing in New Zealand. Please complete this section before you see the doctor. It is important that you answer every question because the information you provide will ensure your medical certifi cate is matched with your immigration application. This section summarises your medical history, to help the Medical Examiner and Immigration New Zealand understand your current state of health. Please complete this section in full with the Medical Examiner or their representative (e.g. the practice nurse). If you are not sure about an aspect of your medical history, please declare it. If you have written reports from other doctors with details of existing medical conditions it will help your case to bring these to the examination with you. All applicants 15 years of age and over must undergo the standard blood tests. Other blood tests may be requested by the doctor where indicated by your medical history or examination e.g. if you have diabetes. You will be required to give a blood sample and a urine sample for testing. The front part of this form is for the Medical Examiner to indicate which tests are required. You must complete the reverse of this form with your details and sign the declaration in front of the person who takes your blood. This page can be detached from the medical certifi cate and you must take it with you when you have your blood sample taken. Children under 15 may in some instances be required to undergo some blood tests if they have clinical indicators or risk factors for certain conditions. All applicants 11 years and over are required to undergo a chest X-ray to screen for tuberculosis and evidence of other systemic medical conditions. This X-ray is required even where you have recently submitted a temporary entry X-ray report. (The temporary entry chest X-ray report is concerned with tuberculosis only.) This page can be detached from the main form and is for you to take with you when you get your chest X-ray. Please answer questions J1 to J6 before your X-ray but do not sign the declaration until you are with the radiographer who takes the X-ray. If there are no abnormalities noted on the radiologist’s report you do not need to submit the film to Immigration New Zealand. Pregnant women and children under 11 are not required to undergo the chest X-ray examination.