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

Use this form if you don’t have access to the AIR site or software. You can use it to record an individual’s immunisation medical exemption.

If you’re an eligible health professional (or their HPOS delegate), you can quickly update medical exemptions by using either:

  • the AIR site using HPOS (you’ll need an individual PRODA account)
  • vaccination reporting software.

If you need help linking your HPOS account to AIR, call the AIR Internet helpdesk. For help with PRODA, call the PRODA helpdesk.

If you’re unsure whether your software can transmit medical exemptions, contact your software developer.

If you submit an immunisation medical exemption using the form upload function in HPOS Messages:

  • it must be lodged using the HPOS account of the health professional who signed the form, or their nominated HPOS delegate
  • it can take up to 14 days to update an individual’s AIR record.
  • we may contact you to confirm the details

Download and complete the Australian Immunisation Register (AIR) - immunisation medical exemption form.

Only eligible health professionals can use this form.

These are 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:

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

ATAGI clinical advice

The Department of Health website provides Australian Technical Advisory Group on Immunisation (ATAGI) Expanded Guidance on temporary medical exemptions for COVID-19 vaccines.

To fill in this form digitally you will need a computer and Adobe Acrobat Reader, or a similar program. You can download Adobe Acrobat Reader for free. If you can’t complete the form digitally, you can print it, complete it by hand and return it to us following the instructions on the form.

If you have a disability or impairment and use assistive technology, you may not be able to access our forms. If you can’t, please contact us. We can help you access, complete and submit them.

Page last updated: 4 April 2022