Express Entry Medical Exam and Police Clearance Certificate Guide (2026)

The medical exam and police clearance certificates are the two most time-sensitive documents in an Express Entry application. Both are issued by external bodies — not IRCC — and both have expiry dates that can force you to repeat the process if you misjudge the timing. Here is exactly what is required and how to manage each.

The Immigration Medical Examination (IME)

Every Express Entry applicant and all accompanying dependents must complete an IME conducted by an IRCC-designated panel physician. You cannot use your regular doctor, a clinic of your choice, or a hospital. The physician must be on IRCC's official list of designated panel physicians.

Find the list at canada.ca under "IRCC Panel Physician" — it is searchable by country and city.

What the IME Covers

The examination is not a general health checkup. It screens for conditions specified under Canada's Immigration and Refugee Protection Act. Physicians assess:

• Physical examination and vital signs
• Vision and hearing
• Chest X-ray (for applicants 11 and older)
• Blood work (HIV, syphilis in some cases)
• Urinalysis
• Review of medical history

Excessive Demand Threshold

Canada's admissibility assessment includes a test for "excessive demand" on the healthcare and social services system. For 2026, IRCC set the excessive demand cost threshold at $28,878 CAD per year, or $144,390 over five years. Applicants whose health conditions are projected to require costs exceeding this threshold over five years may be found medically inadmissible.

This affects applicants with certain chronic conditions. However, procedural fairness protocols allow you to submit a mitigation plan addressing the projected health or social-service costs before a final inadmissibility determination is made. If you have a pre-existing condition, discuss it with the panel physician before your appointment.

Upfront Medical Exam: Do It Before Your ITA

For FSWP applicants, completing the medical exam before receiving an ITA is strongly advisable. This is called an "upfront" or "early" medical exam.

The reason: after receiving your ITA, you have 60 days to submit a complete application. In high-demand regions, panel physician appointments can have multi-week waitlists. If you wait for the ITA, you lose much of your 60-day window to scheduling.

Use the expiry date shown by IRCC or the panel physician when planning. Do not assume a universal validity period or that a repeat exam is required solely because a fixed number of months has passed.

The panel physician sends results electronically to IRCC. Upload any information sheet or proof of medical examination that your personalized checklist requests; your online application account will show when the medical results have been received and whether there are any issues.

What to Bring to Your Appointment

• Valid passport (the physician records your passport details)
• Your existing vaccination records if available
• A list of any current medications and dosages
• Glasses or contact lens prescription if applicable
• Any relevant medical records for ongoing conditions

After the Exam

IRCC's system updates when your medical results are received. You will see a status change in your IRCC portal. Do not contact IRCC to ask about medical results — the system updates automatically.

Police Clearance Certificates (PCCs)

You need a Police Clearance Certificate from every country where you lived for six consecutive months or longer since the age of 18. This includes your country of birth if you lived there for six months, your current country of residence, and any other country where you spent six or more consecutive months.

The 60-day post-ITA window makes timing critical. PCC validity and issuance rules vary by country. Check the issuing authority's instructions and start early enough to obtain the certificate before the deadline.

Country-Specific PCC Requirements

India Apply through the Passport Seva Kendra (PSK) or Regional Passport Office (RPO). The online process through the PSK website generates a Police Clearance Certificate through the Ministry of External Affairs. Processing timing varies. Start the request early after receiving your ITA. A standard Police Clearance Certificate from PSK is generally accepted by IRCC.

Nigeria This is the most scrutinized PCC route. A standard Police Character Certificate obtained through the Police Specialized Services Automation Project (POSSAP) is routinely flagged as insufficient on its own. IRCC requires Nigerian police certificates to be authenticated by the Nigerian Ministry of Foreign Affairs, including the requisite governmental stamps and seals. Start early and verify current authentication requirements at the time of application.

Philippines Obtain the NBI Multi-Purpose Clearance Certificate from the National Bureau of Investigation. IRCC's specific requirements for the Filipino NBI certificate: it must include a clear thumbprint and the official dry seal of the NBI. A certificate without the required elements is invalid for immigration purposes. If the certificate contains a remark (such as "no pending case" or "HIT"), IRCC may require a written explanation and court clearance documents from the NBI.

China The Non-Record Certificate (Wú Fàn Zuì Jì Lù Zhèng Míng) is issued by the local public security bureau (police station) at your registered household address. Processing times and procedures vary by city. Some cities accept online applications; others require in-person attendance.

Pakistan The Police Character Certificate or Police Clearance Certificate is obtained through the relevant district or provincial police authority. Procedures vary by province and residence, so follow IRCC's Pakistan-specific instructions.

Other Countries IRCC maintains a country-by-country guide to obtaining police certificates on their website. For countries where you lived briefly (e.g., a country you worked in for one to two years), check the requirements early — some countries have closed embassies and restricted certificate-issuing procedures.

IRCC Panel Physician vs. Police Certificates: Timing Strategy

These two document types have opposite timing challenges:

• Medical exam: Best done early (as upfront), before ITA, because appointments can have multi-week waitlists. Use the expiry date shown by IRCC or the panel physician when planning.
• Police certificates: Best ordered during the first week of your 60-day post-ITA window (or shortly before your expected ITA if you can estimate it), following the issuing country's validity and timing rules.

If you order PCCs too early, they may no longer be current while your application is being processed (overseas FSWP processing is approximately 6-8 months after a complete application). IRCC may request an updated certificate if the original is no longer current.

Security Screening and Delays

Complex security screening is one of the primary causes of Express Entry processing times exceeding the six-month service standard. IRCC conducts background checks on all applicants, and when files are referred to the Canadian Security Intelligence Service (CSIS) for non-routine review, timelines can extend significantly. This is outside applicant control — submitting clean, complete documentation upfront and accurate travel history minimizes the chance of flagging.

The Canada Express Entry (Federal Skilled Worker) Guide includes country-specific timelines for both panel physician availability and PCC processing, plus the exact document specifications IRCC expects for the most commonly scrutinized nationalities. Getting these two document categories right — and timed correctly — removes the biggest completion risks from your 60-day sprint.

See more Canada guides →