Abnormal chest x-ray, tuberculosis and the health undertaking: what happens after the visa medical finds something

MARN 1576536

Why the x-ray matters

The health requirement has two limbs: freedom from a disease or condition that is a threat to public health, and freedom from one that would cost the community significantly. Tuberculosis is the disease the first limb is about. It is airborne, it is treatable, and Australia has one of the lowest rates in the world, which it keeps by screening everyone who comes to live here for more than a short visit. The chest x-ray is required of most applicants aged eleven and over for permanent visas and for temporary visas of more than six months from higher-incidence countries, and the panel radiologist reports it to the Department against a protocol that flags anything that could be tuberculosis, old or new. The medical examination guide covers the rest of the examination.

What an abnormal result starts

An x-ray reported with a finding, scarring, a nodule, a shadow, calcification, pleural thickening, goes to a Medical Officer of the Commonwealth, who decides whether the finding needs further investigation and, if so, what. The applicant receives a request, through the panel clinic or through ImmiAccount, for the further tests, with a period in which to complete them. Nothing is decided at this point about the visa; the Department waits. The commonest finding in applicants from South Asia, South-East Asia, Africa and parts of Eastern Europe and Latin America is the scar of an infection acquired in childhood and healed without ever being diagnosed, and the further tests exist to confirm that it is healed.

Sputum, CT and the specialist

The usual request is for sputum: three early-morning samples on consecutive days, examined by microscopy for the bacterium and cultured for several weeks to see whether it grows. Microscopy is quick; the culture takes six to eight weeks to report as negative, because the organism grows slowly and the laboratory waits the full period before saying it has not. Where the finding is unclear, a CT scan of the chest is requested; where the picture needs interpretation, a report from a respiratory physician. The applicant pays for the tests at the panel clinic's rates, and the results go to the Medical Officer, who then advises the Department that the applicant meets the requirement, meets it with an undertaking, or does not meet it. An applicant who delays the tests delays the decision by exactly that period.

Active tuberculosis

Where the culture grows the organism, or the clinical picture is of active disease, the applicant does not meet the health requirement, because active tuberculosis is a threat to public health, and no visa that carries the requirement can be granted while it persists. The requirement is not waivable on this limb; it is met by treatment. The applicant is treated, in Australia under the public health system if they are here, or at home if they are not, with a standard course of six months or longer, and at the end the panel doctor re-examines, repeats the x-ray and the sputum, and confirms the disease is resolved and the applicant is not infectious. The Department then proceeds, usually with a health undertaking attached. An applicant in Australia on a bridging visa during treatment is not removed for the disease; an applicant outside Australia waits until cleared. The application is not refused for the disease unless the applicant declines treatment or the time allowed runs out.

Inactive and previous tuberculosis

Where the tests show no active disease but the x-ray shows the marks of an old infection, or the applicant declares previous treatment, or a blood test for latent infection is positive, the Medical Officer advises that the applicant meets the requirement subject to a health undertaking. Latent infection is not infectious and is not a threat, but it can become active disease years later, particularly if the person's health changes, and the undertaking exists so that an Australian clinic knows the person and sees them at intervals. The applicant signs the undertaking, the Department grants the visa, and the undertaking's obligations begin on arrival. The condition does not affect the visa's work, study or travel rights.

The health undertaking

The undertaking is made on Form 815 and is an agreement to do four things: to contact the Health Undertaking Service in the state or territory of residence within the period stated after arrival, which is usually four weeks; to attend the clinic it refers you to for an examination and whatever tests it considers necessary, typically a chest x-ray and a review, with follow-up at intervals for a period of months to a couple of years; to complete any treatment the clinic recommends, which for latent infection may be a course of preventive medication the person can accept or decline on medical advice; and to tell the service of any change of address. The examinations are at public clinics and are free. The undertaking is signed in ImmiAccount or on the form when the Department asks, before grant, and an applicant who declines to sign is not granted the visa. For an applicant already in Australia, the first contact is made from the grant rather than from arrival.

Other conditions that carry an undertaking

The same instrument is used where the examination finds hepatitis B or C, HIV, or certain other conditions that are managed rather than cured, and where the visa can be granted with the condition, which depends on the cost assessment and, for permanent visas, on the waiver where one exists. The undertaking links the person to specialist follow-up in Australia; it is not a treatment obligation except where the clinic recommends treatment, and it is not a restriction on the visa. An applicant asked to sign for one of these conditions has met the health requirement, or has had it waived, and the undertaking is the last step rather than a further hurdle. The health waiver guide covers the cost limb and the waiver.

The delay and your current visa

A sputum culture adds two months to a decision; a treatment course adds six or more. An applicant in Australia on a bridging visa is covered by it for the duration, because the bridging visa runs until the application is decided. An applicant on a substantive visa that will expire during the tests has to be sure the application was lodged before expiry so that a bridging visa exists; an applicant outside Australia whose offshore application waits simply waits, and a visitor visa to come in the meantime is examined on the health question too. An employer waiting for a sponsored worker, or a student for a course start, is told the reason for the delay, which is health and not the Department's queue. The processing delay guide sets out what can and cannot be hurried.

After arrival

1. Within the period on the undertaking, contact the Health Undertaking Service for the state you live in; the Department's grant letter gives the contact.
2. Attend the appointment the clinic gives, with the undertaking and the grant letter.
3. Keep each follow-up appointment until the clinic discharges you, and tell the service if you move.
4. Accept or decline preventive treatment on the clinic's advice; declining is permitted where the clinic says so, and is recorded.
5. Keep the discharge letter, because a later permanent application will ask about the condition and the undertaking.

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General information only, current at October 2026; not advice on your own case. Public Interest Criteria 4005 and 4007 and the health undertaking provisions of the Migration Regulations 1994, and the Department’s health examination and health undertaking arrangements, as at the date above; medical questions are for the panel doctor and the treating physician, and the Health Undertaking Service’s requirements are its own. Outcomes depend on the Department’s assessment of each application; no registered migration agent can guarantee a result (Code of Conduct, Migration Agents Regulations). Keshab Chapagain, MARN 1576536.