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.

Page last updated: 13 February 2019