This is from their website:
As of October 1, 2023, you no longer need to get an upfront medical examination before you submit your application for permanent residence through Express Entry.
After you submit your complete application for permanent residence, we’ll send you instructions on how to get your medical exam done. Please wait for our instructions before going for a medical exam.
AND
If you’ve never completed an IME,
As of October 1, 2023, you no longer need to get an upfront medical examination before you submit your application for permanent residence through Express Entry.
After you submit your complete application for permanent residence, we’ll send you instructions on how to get your medical exam done. Please wait for our instructions before going for a medical exam.
AND
If you’ve never completed an IME,
- upload a blank document in the upload field of the Express Entry Profile Builder when submitting your application, and
- wait for us to send you further instructions on when to get your medical exam