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.
Download and complete the Australian Immunisation Register (AIR) - immunisation medical exemption form.
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
- 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.
This PDF is fillable. You can fill it out on your device, or print it and complete it by hand.
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: 7 October 2021
This information was printed 7 October 2021 from https://www.servicesaustralia.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.servicesaustralia.gov.au/individuals/site-notices when using this material.