Immunisation medical exemptions on the Australian Immunisation Register (AIR) 011-10060000

The recording of immunisation medical exemptions on the AIR is governed by legislation:

• A New Tax System (Family Assistance) Act 1999, and
• the Australian Immunisation Register Act 2015

The References page contains links to the Acts.

Family Assistance Act 1999

A child must meet immunisation requirements to be considered eligible for Family Tax Benefit (FTB) or childcare fee assistance. Payments may be stopped or reduced if a child does not meet requirements. If a child is unable to have a vaccine for a medical reason, an immunisation medical exemption must be recorded on AIR. This ensures their immunisation status is considered as up to date (not overdue) and will not impact negatively on payment eligibility and assessments.

AIR Act 2015 – Mandatory reporting

Under the Australian Immunisation Register Act 2015 it is mandatory for all vaccination providers to report the following to the AIR:

• COVID-19 vaccinations administrated on or after 20 February 2021
• Influenza vaccinations administered on or after 1 March 2021
• NIP vaccinations administered on or after 1 July 2021, and
• Japanese encephalitis virus (JEV) vaccines administered on or after 21 December 2022

The Australian Immunisation Register Rule 2015 lists the specific vaccines, the data elements to report, and how and when to report these, specifically:

• an individual must be up to date with immunisations, be on a catch-up schedule or have an immunisation medical exemption recorded on the AIR
• only certain medical practitioners are eligible to certify immunisation medical exemptions, and
• that notification of immunisation medical exemptions must be made in the form and manner required by the Secretary, Department of Social Services (DSS)

There are 2 types of immunisation medical exemptions recorded on the AIR:

• medical contraindication to a vaccine or a component of a vaccine, and
• natural immunity to a disease

Note: Service Officers do not offer medical or policy advice on immunisation medical exemptions. Refer customers to their medical practitioner or vaccination provider for advice. Medical practitioners can refer to the Australian Immunisation Handbook or seek further advice from their state or territory health department. See the Resources page for links.

The Australian Immunisation Handbook states a medical contraindication is:

• a medical condition, or
• risk factor in an individual that makes getting a specific vaccine potentially harmful to that individual

Therefore, the individual should not be vaccinated with that vaccine or component during the recorded medical exemption period.

For COVID-19 medical exemptions see Proof of vaccination and the Australian Immunisation Register (AIR).

Medical exemptions due to a medical contraindication are assessed and determined by eligible medical providers, and can be recorded on the AIR for a vaccine as either:

• permanent medical exemption there is no end date, or
• temporary medical exemption - the end date is in the future

The individual may also be considered up to date for the purposes of:

• meeting requirements for family assistance payments
• overdue reminder letters and overdue reports for providers
• child care and school enrolments

Valid reasons for eligible providers to record a permanent immunisation medical exemption on the AIR due to a medical contraindication are:

• previous anaphylaxis (to vaccine/vaccine component)
• significant immunocompromise (for live attenuated vaccines only)

Valid reasons for eligible providers to record a temporary immunisation medical exemption on the AIR due to a medical contraindication are:

• acute major medical illness
• significant immunocompromise of short duration (live attenuated vaccines only)
• the individual is pregnant (live attenuated vaccines only)

Service Officers must record all the vaccine brands the medical practitioner has ticked on the form. Even if they contain the same antigens (components), non-live and live.

Generic vaccine codes can be recorded. For example, generic diphtheria (GF) or generic tetanus (GT). See Navigate AIR system for full list of vaccine codes.

Natural immunity is when an individual is assessed as not requiring a vaccination because they previously contracted a disease/s and, as a result, have developed natural immunity to that disease. Natural immunity:

• is recorded for diseases, unlike medical contraindications, which are recorded for vaccines and their components
• is confirmed by a laboratory test or physician based clinical diagnosis
• has no end date
• for only hepatitis B, measles, mumps, rubella, varicella (chicken pox), and Q fever are recorded on the AIR

Recording a natural immunity to a disease means the individual is not required to receive that disease component of a vaccine. An individual is considered up to date with immunisations for the purposes of:

• meeting requirements for family assistance payments
• overdue reminder letters, and overdue reports for providers
• child care and school enrolments

The Department of Health and Aged Care may consider the individual due/overdue for any remaining antigens in the vaccine. For example, if an individual has a recorded natural immunity to mumps, they may be due/overdue for measles and rubella. This will display on their immunisation history.

From 14 April 2024, vaccination providers will be able to report a temporary or permanent medical contraindication to ‘influenza vaccines’ instead of reporting each individual brand.

The Immunisation History Statement will show the medical contraindication as ‘influenza vaccine’.

The vaccine codes for recording on the AIR mainframe are:

• vaccine code - FLUMC
• antigen code - FLU
• operator code - F1

The Australian Technical Advisory Group on Immunisation (ATAGI), clinical guidance for vaccination providers, states a temporary medical contraindication to COVID-19 vaccines are not recommended for longer than 6 months.

Staff can only record a temporary medical exemption for COVID-19 for a maximum of 6 months and must assess each AIR - immunisation medical exemption form (IM011) on its own merits.

If providers lodge the same IM011 form multiple times, do not:

• make a new assessment, or
• return the form to the provider

The IM011 form includes all COVID-19 vaccines approved by the Therapeutic Goods Administration (TGA) to be administered in Australia. It is not possible to record a medical exemption for COVID-19 vaccines that are not approved for use in Australia. COVID-19 antiviral medications cannot be recorded on the AIR because they are not vaccines.

Escalate quality control issues to the AIR Local Peer Support (LPS).

See Proof of vaccination and the AIR for more details about:

• proof of vaccination for COVID-19, and
• medical exemptions to vaccinations

See Resources for ATAGI Expanded Guidance on temporary medical exemptions for COVID-19 vaccines.

If the IM011 form:

• has only one COVID-19 vaccine selected and ‘ALL COVID-19’ in the ‘Other' field, the exemption should be recorded for all COVID-19 vaccines approved to be administered in Australia from the date of processing or recording
• states the individual has had a previous anaphylaxis to other vaccines, and COVID-19 has been selected. Note: the form is to be processed regardless of when the previous anaphylaxis occurred
• is for a temporary medical exemption with an end date of more than 6 months, and COVID-19 vaccines are selected:
• call the provider/practice and inform them that the form will be processed, however the COVID-19 medical exemption can only be recorded for a maximum of six months
• advise the provider to update their records and inform the individual
• process any non-COVID-19 vaccine/s as per the date certified by the provider on the form
• if contact with the provider is unsuccessful, staff must send a Z2935 letter by post or using (HPOS) Messages (depending on how the form was received)

Note: Staff should process any non-COVID-19 medical exemptions as per the dates certified by the provider and any COVID-19 medical exemptions for a maximum of six months.

Some states and territories have developed a medical contraindication form to grant exemptions for COVID-19 to use in their state. These forms are generally used for employment purposes, and:

• are acceptable under state and territory public health orders as evidence of a medical contraindication to COVID-19 vaccinations
• cannot be recorded on the AIR

If a caller asks about getting a state or territory medication exemption form for COVID-19 vaccines recorded on the AIR, staff must tell callers to speak to their vaccination provider.

Under the Australian Immunisation Register Act 2015, the following medical practitioners can record a medical exemption on the AIR:

• 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, or
• Medicare’s Vocational Register of General Practitioners
• General practice registrars on an approved 3GA training placement
• Paediatricians
• Public health physicians
• Infectious diseases physicians
• Clinical immunologists

The Resources page contains information about specialty codes.

The Process page contains information about how to search for a provider's specialty code in Provider Directory System (PDS).

The Health Insurance Act 1973 does not deem the following practitioners to be equivalent to general practitioners. Therefore, the Australian Immunisation Register Act 2015 deems the following medical practitioners not eligible for recording immunisation medical exemptions on the AIR:

• Those specialising in oncology
• Practitioners on an old specialist pathway
• Non-vocationally registered general practitioners
• After hours medical practitioners
• Those with no relevant Australian Health Practitioner Regulation Agency (AHPRA) registration

The Resources page contains information about specialty codes.

A medical practitioner (provider) with an end dated specialty code is not eligible to record an immunisation medical exemption regardless of the signature date on the IM011 form. Ineligible, end dated or suspended medical practitioners are not able to make updates to the AIR.

In these cases, Service Officers must not record details from the IM011 form.

The AIR can only accept an immunisation medical exemption notification from an eligible medical practitioner:

• online directly through the AIR site
• through their Practice Management Software (if software has this function), or
• by completing an IM011 form and lodging it:
• online using HPOS Messages Form Upload function
• post, or
• fax

The AIR cannot accept medical exemption notifications sent by:

• other forms that are not IM011, reports or statements
• vaccine trial or test group notifications
• serology or clinical test results
• provider/practice letterhead
• statutory declarations
• verbal updates
• state and territory health department immunisation medical exemption forms

Note: if unsure whether the AIR approves a document for use, escalate to AIR Local Peer Support.

An amendment to a currently recorded medical exemption may be required if:

• the Provider reported incorrect details, and/or
• Services Australia made a processing error

The Process page includes amendment requests the agency may get and what is required for the request to be addressed. This may include:

• explaining why the request cannot be actioned
• the provider resubmitting the IM011 form
• the provider submitting a request in writing through a secure online channel (HPOS)

Vaccination objections (formerly referred to as ‘conscientious objection’) are not recorded on the AIR. The A New Tax System (Family Assistance) Act 1999 removed the provisions for conscientious objection exemptions to immunisation from 1 January 2016.