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 a:

  • practice registrar on an approved 3GA training placement
  • paediatrician
  • public health physician
  • infectious diseases physician, or
  • clinical immunologist
 
This PDF is fillable. Download this form and complete it on your device, or print it and complete it by hand.
This information was printed Thursday 23 May 2019 from https://www.humanservices.gov.au/organisations/health-professionals/forms/im011 It may not include all of the relevant information on this topic. Please consider any relevant site notices at https://www.humanservices.gov.au/individuals/site-notices when using this material.

Page last updated: 13 February 2019