Australian Immunisation Register (AIR) - immunisation medical exemption form (IM011)

Use this form if you would like to notify us of an individual’s vaccination exemption due to a medical contraindication or natural immunity.

Only eligible health professionals can use this form.

General practitioners defined by the Health Insurance Act 1973 as:

  • fellows of the Royal Australian College of General Practitioners
  • fellows of the Australian College of Rural and Remote Medicine
  • on Medicare’s Vocation Register of General Practitioners.

You’re also eligible to use this form if you’re one of these. A:

  • practice registrar on an approved 3GA training placement
  • paediatrician
  • public health physician
  • infectious diseases physician
  • clinical immunologist.

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

If you have a disability or impairment and use assistive technology, there are other ways you can do your business with us. You can use self service or request someone to deal with us on your behalf. If you can’t access our forms, please contact us. We can help you access, complete and submit them.

Page last updated: 23 October 2019