The medical is done, as we said earlier, by the panel physicians, which are designated by IRCC, but they're not IRCC positions. Once the medical is done, it is sent to one of the four regional medical offices that we have in Ottawa, New Delhi, Manila, and London. It's reviewed by the medical officers at that regional medical office, or RMO.
With most of the medicals, if they don't have a serious or significant problem, they are passed. Only the complicated cases are then sent to the specialized unit in Ottawa, which is called the centralized medical admissibility unit. We look at the file again and then make our recommendation to the visa officer. That is step one.
Then the applicant is given an opportunity to provide that mitigation plan through procedural fairness. Once that information is received by the visa officer, they send it back to us. We provide the second opinion, and the final decision is made by the visa officer.