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General Practitioner Form

Immunisation Register (IM011.1609)

A downloadable General Practitioner form for healthcare professionals.
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About this form

Used by general practitioners and authorised health professionals to notify the Department of Human Services when an individual has a valid medical contraindication or natural immunity that exempts them from vaccination. It records the reason for exemption, applicable vaccines, and evidence such as clinical diagnosis or laboratory results. Heidi automatically pre-fills the patient’s details and relevant clinical information from the consultation, helping clinicians complete accurate exemption notifications quickly and in compliance with national immunisation requirements.

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How to use this form

1

Download the PDF

Click the download button to save the form to your device

2

Print or fill digitally

Print the form for handwritten use or fill it out using a PDF editor

3

Use in your practice

Integrate the completed form into your patient records and workflows

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Specialty

General Practitioner

Downloads

6 times

Type

Form

Last edited

13.11.2025

Created by

Lachlan Reid

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