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/immigratio...l-exams/requirements-permanent-residents.html
Inland vs Outland; makes reference to where the applicant is located
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.