Verification of medical conditions form (SU684)

Use this form to verify medical conditions affecting your capacity to work if you need an Employment Services Assessment.

This form must be completed by a medical practitioner.

This is not a medical certificate. If you are seeking a temporary exemption from your Mutual Obligation or participation requirements because you are temporarily incapacitated for all work your treating doctor needs to complete a Medical Certificate.

 
This PDF is fillable. Download this form and complete it on your device, or print it and complete it by hand.

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Page last updated: 27 August 2017