IME 19475750
Health case details
Client personal details Client identity details
Family name: TENORIO BENT Identity document presented: Original Passport
Given names: KEYLON EMILCE Identity document number: C02875251
Gender: MALE Issuing country: NICARAGUA
Date of birth: 14 Nov 1991 Date of issue: 20 Oct 2021
Country of birth: NICARAGUA Date of expiry: 20 Oct 2031
Source: Clinic
Client visa details
IME: Non EDE
Upfront medical type:
IME# 19475750
UCI# 1124401877
Preferred language
English
Contact channels
Contact type Contact details Primary Comments
Address (Business) Barrio north end detras del col. Bautista Yes -
Ebenezer, CORN ISLAND, NICARAGUA
E-mail (Personal) [email protected] No -
Client Declaration
The client stated that they read and understood the department's use of the information they have provided.
Examinations required for this visa application
Exam Status Clinic
501 Medical Examination Completed Clinica Dr Diaz
502 Chest X-ray Examination Completed Centro de Images CIM
707 HIV test Completed Clinica Dr Diaz
712 Syphilis Test (VDRL or RPR) Completed Clinica Dr Diaz
704 Serum Creatinine Completed Clinica Dr Diaz
951 Vaccinations Completed Clinica Dr Diaz
Health Case attachment
Document Type Attached
Signed eMedical client declaration Yes
Identity document presented Yes
Signed eMedical client declaration Yes
Other Yes
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Health case details
Microscopy report Yes
Chest specialist's report Yes
501 Medical Examination
Exam description Full physical medical examination report required
Exam status Finalised
Reason requested Required under policy
Clinic Clinica Dr Diaz
Exam date 16-May-2023
Confirm Identity
Issuing country NICARAGUA
Identity document presented Original Passport
Identity document number C02875251
Date of issue 20 Oct 2021
Date of expiry 20 Oct 2031
Do you have identity concerns? No
Medical History
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
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
Dr Rafael Antonio DIAZ SALAZAR has discussed the client's medical history with the client.
Attachments
Document Type Attached
- -
Basic questions
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Health case details
Chaperone Interpreter
Chaperone present?: Yes Interpreter used?: No - not required
Relationship to the client: Staff Member
Height & Weight Head circumference
Height : 178 Head circumference: -
Height percentile : - Head circumference percentile: -
-
Weight : 90
Weight percentile: -
-
Body Mass Index (BMI) : 28
Blood pressure
Initial blood pressure
Systolic: 120
Diastolic: 80
Eyes
Visual acuity with or without correction: At least one eye is 6/6, 6/9, 6/12 or 6/18
Best distance visual acuity (with or without correction):
Left eye: -
Right eye: -
Urinalysis
Initial exam
Exam date: 16 May 2023
Type of test: Microscopy
Result: Normal
Detailed questions
All systems
Cardiovascular system Normal
Respiratory system Normal
Nervous system: Sequelae of stroke or cerebral palsy, other neurological disabilities Normal
Gastrointestinal system Normal
Musculoskeletal system (including mobility for all persons 60 or more years of age) Normal
Endocrine system Normal
Brain and cognition
Mental and cognitive status Normal
Intellectual ability Normal
Ears, nose, throat and mouth
Eyes (including fundoscopy) Normal
Ear/nose/throat/mouth Normal
Hearing Normal
Miscellaneous
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Health case details
Skin and lymph nodes Normal
Breast examination where clinically indicated N/A
Are there any physical or mental conditions which may prevent this person from attending a No
mainstream school, gaining full employment or living independently now or in the future?
Evidence of drug taking (for example venous puncture marks) Absent
Examiner Declaration
I declare that this health examination report is a true and correct record of my findings: Dr Rafael Antonio DIAZ
SALAZAR
Date of Declaration: 16 May 2023
Provide Grading
Grading: A Grading
502 Chest X-ray Examination
Exam description Full chest x-ray examination report and x-ray is required.
Exam status Finalised
Reason requested Required under policy
Clinic Centro de Images CIM
Exam date 16-May-2023
Confirm Identity
Issuing country NICARAGUA
Identity document presented Original Passport
Identity document number C02875251
Date of issue 20 Oct 2021
Date of expiry 20 Oct 2031
Do you have identity concerns? No
Attachments
Document Type Attached
Chest x-ray image Yes
X-ray Images
Date of x-ray 16 May 2023
Detailed question
Skeleton and soft tissue: Normal
Cardiac shadow: Normal
Hilar and lymphatic glands: Normal
Hemidiaphragms and costophrenic angles: Normal
Lung fields: Normal
Evidence of Tuberculosis (TB): Absent
Are there strong suspicions of active Tuberculosis (TB)?: No
Special findings
Minor findings
Single fibrous streak/band/scar (1.1) No
Bony islets (1.2) No
Apical pleural capping with a smooth inferior border (<1cm, thick at all points) (2.1) No
Unilateral or bilateral costophrenic angle blunting (below the horizontal) (2.2) No
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Health case details
Calcified nodule(s) in the hilum/mediastinum with no pulmonary granulomas (2.3) No
Minor findings (sometimes associated with TB infection)
Solitary Granuloma (<1cm and of any lobe) with an unremarkable hilum (3.1) No
Solitary Granuloma (<1cm and of any lobe) with calcified/enlarged hilar lymph nodes (3.2) No
Single/Multiple calcified pulmonary nodules/micro-nodules with distinct borders (3.3) No
Calcified pleural lesions (3.4) No
Costophrenic angle blunting (either side above the horizontal) (3.5) No
Findings sometimes seen in active TB or other conditions
Notable apical pleural capping (rough or ragged inferior border and/or greater than or equals to 1cm No
thick at any point) (4.0)
Apical fibro-nodular/fibrocalcific lesions or apical micro-calcifications (4.1) No
Multiple/single pulmonary nodules/micro-nodules (non-calcified or poorly defined) (4.2) No
Isolated hilar or mediastinal mass/lymphadenopathy (non-calcified) (4.3) No
Single/multiple pulmonary nodules/masses >= 1cm (4.4) No
Non-calcified pleural fibrosis and/or effusion (4.5) No
Interstitial fibrosis/parenchymal lung disease/acute pulmonary disease (4.6) No
Any cavitating lesion or Fluffy or Soft lesions felt likely to represent active TB (4.7) No
Examiner Declaration
I declare that this health examination report is a true and correct record of my findings: Dr Maria Soledad
MANTILLA
Date of Declaration: 16 May 2023
Provide Grading
Grading: A Grading
712 Syphilis Test (VDRL or RPR)
Exam description Syphilis testing and results are required
Exam status Finalised
Reason requested Required under policy
Clinic Clinica Dr Diaz
Exam date 16-May-2023
Confirm identity
Confirm identity Yes
-
Record results
Syphilis test result Non-reactive
Repeat Syphilis test result
707 HIV test
Exam description HIV testing and laboratory results are required.
Exam status Finalised
Reason requested Required under policy
Clinic Clinica Dr Diaz
Exam date 16-May-2023
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Health case details
Confirm identity
Was the client's identity confirmed? Yes
Record results
Repeat HIV test result -
HIV test result Non-reactive
Post test counselling provided -
Attachments
Document Type Attached
HIV test report Yes
704 Serum Creatinine
Exam description Please provide serum creatinine results.
Exam status Finalised
Reason requested Required under policy
Clinic Clinica Dr Diaz
Exam date 16-May-2023
Confirm identity
Was the client's identity confirmed? Yes
Record results
Exam date 16-May-2023
Exam description -
Exam results Normal
Attachments
Document Type Attached
Serum Creatinine Yes
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