A refugee health assessment, or newcomer health intake, is the first primary care assessment after arrival in Canada: interpreter, migration journey, coverage, vaccines, screening by region of origin, mental health, family needs, and the plan, usually over two or three visits. Copy the free template, see a woman from Eritrea resettled in Ontario and a family of four from Syria in British Columbia, and check the Canadian guidelines and IFHP rules behind each line.
For clinicians in Canada.
Blank refugee and newcomer health intake template
FreeREFUGEE AND NEWCOMER HEALTH INTAKE Patient: [Name, preferred name, date of birth, and whether the birth date is approximate] Visit: [Date, visit 1, 2, or 3, in person or virtual] Clinician: [Name, credentials] Language: [Preferred language and dialect, and whether they read it] Interpreter: [Professional interpreter's name or ID, language, in person, phone, or video; family members and children not used] Others present: [Settlement worker, sponsor, family member, or none, with the patient's agreement] Consent: [Confidentiality explained, the right to skip any question, and the patient's questions] MIGRATION AND STATUS Country of origin: [Country and region] Journey: [Countries lived in or passed through, with dates, and camp or city settings] Arrival and status: [Date and city of arrival; government-assisted refugee, privately sponsored refugee, refugee claimant, protected person, or other newcomer] Family: [Who came together, who is still abroad, and plans to reunite] Immigration medical exam: [Date and place, chest x-ray, HIV and syphilis results if done, and any medical surveillance referral] COVERAGE AND ACCESS Coverage: [IFHP with UCI, provincial health card and its start date, or both] IFHP benefits: [Basic, supplemental, and prescription coverage, and the co-payments explained] Pharmacy: [Name and phone, registered with IFHP] Settlement support: [Settlement agency or sponsor group, contact name and phone] HEALTH HISTORY Concerns today: [In the patient's words, through the interpreter] Past illnesses: [Malaria, TB or TB contact, hepatitis, and treatment received abroad] Injuries, surgery, and hospital stays: [Year, country, and reason, as much as the patient wants to share] Medications: [Current medicines, including those bought abroad and traditional remedies, and any that ran out] Allergies: [Substance and reaction, or none known] Family history: [Diabetes, high blood pressure, TB, hepatitis B, blood disorders, and others] IMMUNIZATIONS Records: [Written record with dates, camp or travel card, or none; no written record means unimmunized] Given today: [Vaccine, dose number, and site] Catch-up plan: [Each vaccine still due with its date, per the Canadian Immunization Guide and your provincial schedule] SCREENING BY REGION AND RISK Tuberculosis: [TB incidence in the country of birth, risk factors, test and date, on the same day as any measles vaccine or 4 weeks after] Hepatitis B: [HBsAg, anti-HBc, and anti-HBs, or results already on file] Hepatitis C: [Antibody if from a region with higher prevalence or other risk] HIV and syphilis: [Immigration medical exam result, or test offered with consent] Strongyloides and schistosoma: [Serology by region of origin, and any eosinophilia] Iron: [Hemoglobin and ferritin for women of reproductive age and children aged 1 to 4] Blood pressure and diabetes: [Blood pressure today, and A1c or fasting glucose by age and risk] Vision and hearing: [Visual acuity in each eye, and hearing screen or concerns] Dental: [Pain, visible decay, gum disease, and the dental referral] MENTAL HEALTH AND SAFETY Approach: [Why we ask explained, the patient chose what to share, no pressure to describe trauma] Symptoms: [Sleep, mood, nightmares, startle, worry, and body symptoms, with any scores] Risk: [Thoughts of suicide or self-harm, and safety at home] Strengths: [Faith, family, community, and what has helped them cope] WOMEN'S HEALTH Pregnancy and contraception: [Last period, pregnancies and births, pregnancy test if needed, and contraception wishes] Cervical screening: [Last test and result, or never screened, and the plan under your provincial program] Genital cutting: [Asked when relevant and when she is ready, with any symptoms, or not yet discussed] CHILDREN Growth: [Height, weight, BMI, and head circumference under 2, on WHO growth charts] Development: [Milestones in the first language, and any concerns] School or child care: [School, grade, language support, or child care] CHRONIC CONDITIONS [Each condition: when and where diagnosed, treatment abroad, control today, and the plan] SOCIAL NEEDS Housing: [Temporary or permanent, who lives there, and safety] Food and income: [Food security and source of income support] Language, school, and work: [English or French classes, past work, and goals] Getting to care: [Transportation to visits, and the best way to reach them] ASSESSMENT AND PLAN Problems found: [Numbered list] Tests ordered: [Each test and the reason] Treatment started: [Medicine, dose, and length] Referrals: [TB clinic, dentist, eye care, mental health, settlement agency, or specialists] Follow-up: [Next visit date, interpreter booked, and what will be reviewed] RESULTS REVIEW [Each result with its date, what it means, and the decision made] Signed: [Clinician name, credentials, date and time]
Use it for
Each one follows the template. Use them to judge how much detail every part needs.
Community health centre in Ontario, visit 1 and results visit, Tigrinya interpreter by phone
Tigrinya; reads and writes Tigrinya, speaks some Arabic, a few words of English. Professional Tigrinya interpreter by phone, ID 4471, a woman, at her request. Her cousin offered to interpret; she chose the professional interpreter, and her cousin waited outside. Settlement worker present for the first 10 minutes, with her agreement. Explained that the visit is confidential, that she can skip any question, and that she doesn’t need to talk about her past to get care. She asked whether the visit costs anything; explained that doctor visits have no co-payment under the IFHP.
Born in Eritrea. Left in 2015, at 23, and crossed into Sudan; lived in a refugee camp in eastern Sudan until September 2026. Government-assisted refugee; arrived in Toronto on September 24, 2026. Single, no children; mother and a sister in Eritrea, a cousin in the same city. Immigration medical exam in Sudan, March 2026: chest x-ray normal, HIV and syphilis negative, no referral for medical surveillance. IFHP, UCI from her confirmation of permanent residence, eligibility checked with Medavie Blue Cross. Ontario health card applied for with her settlement worker; IFHP basic coverage until it starts, and prescriptions and supplemental care through IFHP while she receives Resettlement Assistance Program income support. Explained the $4 for each prescription and the 30% she pays for dental, vision, and counselling services. Pharmacy registered with IFHP.
“My stomach hurts on and off, and I cannot sleep.” Crampy upper abdominal pain a few times a week for about 2 years; no blood in her stool, no weight loss. Itchy skin on and off. Malaria twice in the camp, treated. No known TB, TB contact, or hepatitis. A healed left wrist injury from 2015 that she chose not to discuss; full movement, no pain. No surgery or hospital stays. Medicines: paracetamol from the camp clinic as needed. No known allergies. Mother has high blood pressure; her father died when she was a child, cause unknown.
No written record; her camp card was lost. BCG scar on the left upper arm. Treated as unimmunized, per the Canadian Immunization Guide. Last period 12 days ago; urine pregnancy test negative. Given today: Tdap-IPV, dose 1 of 3, left deltoid; MMR, 1 dose, right upper arm. Varicella IgG drawn, as she grew up in a tropical country. Plan: Td and IPV dose 2 in December 2026 and dose 3 6 to 12 months later; varicella and hepatitis B vaccines if serology shows she isn’t immune.
TB: Eritrea’s incidence is well above 50 per 100,000 and she is under 65, so IGRA drawn today, the same day as MMR. Hepatitis B: HBsAg, anti-HBc, anti-HBs. Hepatitis C antibody. HIV: negative in March; a repeat test offered because it has been 7 months, and she agreed. Strongyloides and schistosoma serology, as a refugee from Africa. CBC with differential, ferritin, and ALT. BP 118/74. Weight 52 kg, height 161 cm, BMI 20.1. Visual acuity 6/9 in each eye. No hearing concerns. Teeth: two broken lower left molars, painful when she chews.
Explained why we ask about sleep and mood, and that she chooses what to share. She said, “Bad things happened on the road. I don’t want to talk about it now,” and we didn’t ask more. Nightmares 4 or 5 nights a week, wakes with her heart racing, startles at loud sounds, avoids crowded buses, and feels on guard most of the day; present for years, worse since she arrived. Low mood and poor appetite. PHQ-9 14, through the interpreter. No thoughts of suicide or self-harm. Feels safe where she lives. Strengths: her church, her cousin, and sewing.
Never pregnant. Not sexually active; doesn’t want contraception now. Periods regular, not heavy. Never had cervical screening. Women’s health visit booked with a female clinician at visit 3, where screening and any questions about genital cutting can be discussed when she is ready.
In temporary housing with other newcomers; moving to an apartment in December. Food and rent from Resettlement Assistance Program income support. English classes start this month. Worked as a seamstress in the camp and wants to work. Bus pass from the agency. Mobile phone; prefers voice calls with an interpreter.
1. Resettled refugee from Eritrea via Sudan, intake started. 2. Symptoms consistent with PTSD, with moderate depressive symptoms; no current risk. 3. Abdominal pain and itch; strongyloides possible. 4. Dental pain from broken molars. 5. Vaccines from the start. Tests as above. Referrals: a dentist registered with IFHP, for urgent care; the centre’s counsellor, with a Tigrinya interpreter, first session booked. Dental co-payment discussed with her settlement worker. Results visit in 3 weeks, phone interpreter booked.
November 4, 2026. IGRA positive. No cough, fever, night sweats, or weight loss; chest x-ray this week normal. Latent TB infection: referred to the TB clinic, where 4 months of daily rifampin is the likely plan. Strongyloides serology positive, eosinophils 0.9 × 10⁹/L: ivermectin 12 mg once a day for 2 days, started today; she has never lived in central or west Africa, where Loa loa is found. Schistosoma serology negative. HBsAg negative, anti-HBc and anti-HBs positive: past infection, immune, no vaccine needed. Hepatitis C antibody and HIV negative. Varicella IgG positive. Hb 109 g/L, ferritin 7 µg/L: iron deficiency anemia; ferrous fumarate 300 mg once a day, recheck in 3 months. ALT normal. First counselling session done; PHQ-9 13. Next: women’s health visit and vaccine dose 2 in December.
Family practice in Surrey, British Columbia, four back-to-back visits, Arabic interpreter in person
Arabic, Levantine dialect. Both parents read Arabic; the father also speaks Turkish. The 9-year-old speaks Arabic, Turkish, and some English; he was not asked to interpret. Professional Arabic interpreter in person for all four visits. A member of the sponsor group drove the family and joined the start of the visit, with the parents’ agreement. Each person seen in their own appointment, with their own chart; this is the family summary.
From Aleppo. Left Syria in 2015 and lived in Gaziantep, Türkiye, for 11 years; both children were born there. Privately sponsored refugees, sponsored by a faith group; arrived in Vancouver on October 15, 2026. Father 42, mother 37, son 9, daughter 4. Grandparents in Syria. Immigration medical exam in Türkiye, May 2026: parents’ chest x-rays normal, HIV and syphilis negative; no referral for medical surveillance. IFHP for all four, UCIs on file. BC MSP applied for; IFHP basic coverage until it starts, and prescriptions and supplemental care through IFHP while they receive private sponsorship support. Explained the $4 for each prescription and the 30% for dental and vision care; the sponsor group will pay the co-payments this year.
Father: high blood pressure since 2022, on amlodipine 5 mg bought in Türkiye; ran out 3 weeks ago. Smokes 15 cigarettes a day, for 25 years. No chest pain or breathlessness. Mother: well; two vaginal births. Son: healthy; toothache on the lower right for 2 weeks. Daughter: picky eater, drinks about 3 cups of cow’s milk a day; no illnesses. No known TB contact or hepatitis in the family. No allergies. Father’s father had a stroke at 60.
Turkish health records for both children: doses to 18 months match the Canadian schedule; the son missed his school-entry doses. Parents have no records and are treated as unimmunized. Today: each child, the school-entry doses, Tdap-IPV and MMRV; each parent, Tdap-IPV dose 1 of 3 and MMR. A catch-up plan written for each person against the BC schedule, with the remaining doses, including meningococcal and hepatitis B where needed, from December.
TB: Syria and Türkiye are both below 50 per 100,000, and no one has a TB contact or a risk factor for reactivation, so no TB testing. Hepatitis B serology for all four. Hepatitis C antibody for both parents. Strongyloides and schistosoma serology not indicated by region; CBC with differential for all four. Hemoglobin and ferritin for the mother and the daughter. Father: BP 158/98, repeat 154/96; creatinine, electrolytes, A1c, lipids, urinalysis, and ECG. Vision: son 6/18 right, 6/12 left; the others normal for age. Hearing: no concerns; daughter to have a hearing test before kindergarten. Teeth: son has 4 cavities, one deep in a lower right molar; daughter has early decay on her front teeth.
Asked each parent about sleep, mood, and worry in general terms; neither was asked to describe what happened in Syria. Father: sleeps poorly, worries about money and his parents; PHQ-9 5. Mother: misses her mother, tearful at times, sleeping 6 hours; PHQ-9 8. No thoughts of suicide in either parent; no safety concerns at home. Son: settling into school, some trouble falling asleep. Daughter: plays well, clings to her mother in new places. Strengths: a close family, their mosque, and an active sponsor group.
Mother: last period 1 week ago. Two pregnancies, two births in Gaziantep. Uses condoms; would like a copper IUD, booked for December. Never had cervical screening; an HPV self-collection kit through BC’s cervix screening program, explained with the interpreter.
Son, 9: height 128 cm and weight 26 kg, both between the 15th and 50th percentiles; BMI 15.9, near the 50th, on the WHO growth charts for Canada. Grade 4 at the local elementary school, with English language learner support. Daughter, 4: weight 13.4 kg, below the 10th percentile, down from the 25th at her last check in Türkiye; height 99 cm, about the 20th. Speaks Arabic in full sentences, hops on one foot, draws a person with a head and body; no developmental concerns. Starts kindergarten next September; goes to a drop-in early learning program with her mother.
Three-bedroom apartment rented with the sponsors’ help. Food and rent from sponsorship support for the first year. The father was a tailor and wants work once his English improves; English classes for both parents start this month. The sponsor group drives them to visits. The father keeps the family’s phone and prefers texts in Arabic.
Father: 1. Hypertension, above target off treatment: amlodipine 5 mg daily restarted; home BP log with a cuff from the sponsors; tests as above. 2. Smoking: wants to cut down; nicotine replacement discussed. Mother: 3. Low mood with homesickness, PHQ-9 8: follow-up at each visit, and an Arabic-language women’s group at the settlement agency. Son: 4. Dental decay with pain: urgent referral to a dentist registered with IFHP. 5. Reduced vision in the right eye: optometry referral. Daughter: 6. Falling weight and a high milk intake: iron studies, and milk kept to 500 mL a day. All four: catch-up vaccines as above. Results visit in 4 weeks, interpreter booked for all four.
December 1, 2026. Hepatitis B: all four HBsAg negative; father anti-HBc and anti-HBs positive, immune from past infection; mother not immune, hepatitis B vaccine dose 1 given today; both children immune from their vaccines. Hepatitis C antibody negative in both parents. CBCs normal, no eosinophilia. Mother: Hb 126 g/L, ferritin 34 µg/L. Daughter: Hb 102 g/L, ferritin 6 µg/L: iron deficiency anemia; iron drops, 3 mg/kg of elemental iron a day, about 40 mg; recheck Hb in 4 weeks. Father: home BP average 136/88 on amlodipine 5 mg, so increased to 10 mg; creatinine, potassium, A1c, and ECG normal; cardiovascular risk calculated and recorded. Son: fillings done, including the deep molar; glasses from the optometrist. Next visit in January for vaccines and the father’s blood pressure.
Preventive care for newcomers follows the Canadian Collaboration for Immigrant and Refugee Health (CCIRH) guidelines, set by region of origin and migration history. Newer national standards update parts of them: the Canadian Tuberculosis Standards for TB testing and the Canadian Immunization Guide for vaccines. Immigration, Refugees and Citizenship Canada sets IFHP coverage.
How you and the patient understood each other. Everything else on the page depends on it.
Avoid: A relative or a child as interpreter. Family members may soften or leave out what is said, and a child shouldn’t carry a parent’s health history. Book a trained interpreter, by phone if no one can come in person.
Where the patient has lived, which decides the screening, and how their care is paid for, which decides what they can use.
Avoid: Writing only the country of birth. Years in a camp or a third country can change TB, parasite, and hepatitis risk, so screening follows the whole journey.
Past illness, medicines, and vaccines, built from the patient’s memory and whatever papers survived the journey.
Avoid: Accepting “I had all my vaccines” as a record. The Canadian Immunization Guide treats newcomers without adequate written records as unimmunized, and repeat doses of measles-containing vaccine are safe.
The tests this patient needs because of where they were born and lived, not the same panel for everyone.
Avoid: Giving MMR and then doing an IGRA or skin test a week later. Measles vaccine can blunt the TB test, so test the same day or wait 4 weeks.
Symptoms and safety, asked in a trauma-informed way: the patient decides what to tell you, and when.
Avoid: Asking for the story of what happened. Guidelines advise against routine screening for trauma exposure, because pressing for details can do harm. Watch for symptoms and offer care.
Pregnancy, contraception, and cervical screening for women; growth, development, and school for children.
Avoid: Doing every child’s assessment in one rushed family visit. Give each child their own appointment and chart, even when the family comes together.
The 9-year-old who speaks the most English is the easiest choice and the wrong one. A child shouldn’t hear a parent’s trauma or carry their diagnoses, and family interpreters may change what is said. Book a professional interpreter, and write their name or ID in the note.
Pressing for details at a first visit can retraumatize, and the Canadian guidelines advise against routine screening for trauma exposure. Ask about sleep, mood, and symptoms, let the patient decide what to share, and offer care.
A panel ordered for every newcomer misses some infections and over-tests others. Screening follows region of origin and journey: strongyloides serology for someone from Eritrea, but not for someone from Syria; TB testing for incidence of 50 per 100,000 or more.
Since May 1, 2026, IFHP patients pay $4 for each prescription and 30% of supplemental services such as dental and vision care. A patient who doesn’t know may leave a prescription unfilled. Explain it, and ask whether a sponsor or settlement worker can help.
Vero Scribe drafts the intake in your template from the visit, with the patient’s consent, or from your dictation. You review and edit every section, then copy it into your EMR or export it to Word or PDF. Vero works in 60+ languages.
It is the first primary care assessment for a refugee or other newcomer after arrival in Canada. It covers language and an interpreter, the migration journey, coverage, vaccines, screening chosen by region of origin, mental health, women’s and children’s health, chronic conditions, and social needs. It usually takes two or three visits: one to take the history, give vaccines, and order tests, and one or two to review results and start treatment.
It depends on where they were born and lived. Common ones are a TB infection test for refugees 65 or younger from countries with TB incidence of 50 per 100,000 or more; hepatitis B serology where 2% or more carry the virus; hepatitis C antibody for higher-prevalence regions; strongyloides serology for refugees from Africa and Southeast Asia, and schistosoma serology for refugees from Africa; and hemoglobin for women of reproductive age and young children. Add vision, hearing, and dental checks, and check what the immigration medical exam already tested.
The immigration medical exam is part of the immigration process: done before arrival for resettled refugees, and in Canada for refugee claimants. It looks for conditions such as active TB, and the CCIRH guidelines note it isn’t designed for preventive care. The intake is ongoing primary care: catch-up vaccines, screening by region, mental health, and the patient’s own concerns. Use the exam’s results, such as the chest x-ray and HIV test, so you don’t repeat them without reason.
The Interim Federal Health Program gives limited, temporary coverage to resettled refugees, refugee claimants, and some other groups until they qualify for provincial or territorial insurance. Basic care, such as doctor visits, hospital care, and lab tests, has no co-payment. Since May 1, 2026, patients pay $4 for each prescription and 30% of supplemental services such as urgent dental care, vision care, and counselling. Services must come from providers registered with the IFHP.
Yes. Copy it, or download it as a Word or text file. No account needed.
The preventive visit: interval history, screening and vaccines due, full exam, and counseling.
The Medicare AWV, G0438 and G0439: health risk assessment, cognition, screening schedule, risk factors, and the prevention plan.
The one-time IPPE, G0402: history, depression and safety review, exam with visual acuity, end-of-life planning, and the written plan.
The standing summary at the front of the chart: problems, history, medications, allergies, immunizations, risks, and reminders, kept current.
Screening, vaccines, and counselling due at an adult periodic health review, by age and sex, with a next due date on every line.
Intake and visit notes for teams that serve newcomers, drafted for review.
First visits, follow-ups, and results, documented in one place.
Notes, documents, and follow-up in one workspace.
The codes used most often in family medicine and primary care.
Vero writes your notes and letters in the templates you choose, so you review instead of type.
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