Thank you very much for your help. Actually Express entry draws completed today cut off was 472 , I have score of 480. So far I did not get any email from regarding ITA getting anxious about it.Hello. If you’re applying under the Express Entry Program, you have the option of getting an exam before you apply. This is called an upfront medical exam. See https://www.canada.ca/en/immigration-refugees-citizenship/services/application/medical-police/medical-exams/requirements-permanent-residents.html
Inland vs Outland; makes reference to where the applicant is located