Yes, no worries, it can happen that someone receives the medical examination request before receiving the Acknowledgement of Receipt (AOR) letter. This is not uncommon, especially with spousal sponsorship applications. The timing of the medical exam request depends on when IRCC orders the exam, while the AOR is usually sent as an official confirmation that they have received the submitted documents. So, if someone receives the medical request before the AOR, it doesn't mean there's a problem with their application, and the process can still continue as usual. By the way, when and how did you receive your BIL (Biometrics Instruction Letter)? I see your application was submitted on September 12.