Medical Certificate

You can complete and lodge Medical Certificates through Health Professional Online Services (HPOS).
Go to servicesaustralia.gov.au/healthprofessionals

When to use this form Medical Practitioners needing help with

The information you provide to us will help Services Australia this form
make decisions about your patient for the following: If you need assistance to complete this form or help with
Exemption from Mutual Obligation Requirements selecting the appropriate consultation item for completing this
form, call us on 132 150.
People paid JobSeeker Payment or Youth Allowance, and
some receiving Parenting Payment or Special Benefit may Accessing Medical Certificate forms
be required to actively seek work, study and/or participate • Consider completing and lodging Medical Certificates
in activities to help them find and keep work. For example, through Heath Professional Online Services (HPOS), for
undertake preparation for suitable work, or participate in an more information go to: HPOS – Services Australia
approved training program course or activity.
• For bulk supplies, email the information requested
People with a short-term incapacity because of an illness or in the re-order form supplied in this pad to:
injury, may seek an exemption from actively seeking work, MEDI.ONLINE@servicesaustralia.gov.au
study or participating in activities.
• Or, complete and post the re-order form supplied in this pad
A temporary incapacity exemption should be requested for
only the period medically required and may be granted for an
initial maximum period of 13 weeks. Confidentiality of information
The personal information that is provided by your patient
Exemption for people with a serious illness for the purpose of this certificate must be kept confidential
People with a serious illness may seek a long-term exemption under section 202 of the
from the need to actively seek work, study or participate in Social Security (Administration) Act 1999.
activities.
It cannot be disclosed to anyone else unless authorised by
A serious illness exemption may be granted for up to law. There are penalties for offences against section 202 of
12 months (with a possible extension of up to 6 months). the Social Security (Administration) Act 1999.
Exemption from Disability Support Pension
participation requirements Release of medical information
When a person has a short-term illness or injury, including The Freedom of Information Act 1982 allows for the disclosure
temporary exacerbation of a long-term or permanent of medical or psychiatric information directly to the individual
condition, they may seek an exemption from participating in concerned. If there is any information in the medical
these activities. certificate, which, if released to your patient, may harm their
A temporary incapacity exemption should be requested for physical or mental well-being, attach a statement identifying
only the period medically required and may be granted for an the information and briefly state why you believe it should not
initial maximum period of 13 weeks. be released directly to the patient. Similarly, specify any other
special circumstances, which should be taken into account
Accessing support for job seekers and people with when deciding on the release of the medical certificate.
an illness, injury or disability
People with an illness, injury or disability may be eligible Privacy and your personal information
to access government-funded employment services
and programs to assist them to find and keep work. An The privacy and security of your personal information is
assessment may be conducted to decide the most appropriate important to us, and is protected by law. We collect this
support and assistance. information to provide payments and services. We only share
your information with other parties where you have agreed, or
where the law allows or requires it. For information, go to
Returning this Medical Certificate
www.

servicesaustralia.gov.au/privacy
Return this form and any supporting documents:
• online using the Health Professional Online Services (HPOS).
For more information, go towww.

servicesaustralia.gov.au/healthprofessionals
• give it to your patient to lodge with Services Australia or
upload using their online account.

SU415.2208
Additional information for medical practitioners completing the Medical Certificate

Classification – • Less than 13 weeks – functional impact is expected to fully resolve within 13 weeks and
functional impact of includes temporary exacerbations of permanent conditions.
medical condition • 13 weeks up to 24 months – functional impact is expected to persist for 13 weeks up to
24 months, and includes temporary exacerbations of permanent conditions. May be receiving
treatment or rehabilitation for cancer/leukemia, severe stroke, acquired brain injuries, serious
burns, and serious physical injuries. This could include severe mental health conditions for
which the person is receiving treatment in an institutional setting.
• 24 months or more – functional impact expected to persist beyond 24 months and not likely
to improve with treatment.

Diagnosis List your patient’s diagnosed medical conditions that have a functional impact on their ability
to do any work, study or participate. Please provide a specific clinical diagnosis if available,
including staging and/or disease classification.
For example,
• ‘cervical spondylosis’ rather than ‘neck pain’
• ‘major depressive disorder’ or ‘adjustment disorder with depressed mood’ rather than
‘depression’.
If your patient has more than 2 conditions that have a functional impact, you will need to provide
the details on a separate medical certificate.

Capacity to work, This relates to your assessment of the patient’s capacity to do any work, study or participate in
study or participate in activities and:
activities • includes any other suitable work, and not just previous work. This is any work that a person is
capable of doing and not just work the person prefers or what they are qualified for
• should not take into account non-medical factors such as age, work experience, education or
language barriers.

Treatment Detail past, current and future/planned treatment for listed conditions.
This includes symptom management and functional rehabilitation treatment, as well as curative
treatment.

Functional impact Detail the day-to-day functional impact the listed conditions have on the patient, including how it
affects their ability to work, study or participate in activities.
Functional impacts may be physical and non-physical impacts of a condition.
For example:
• how long a person can sit or stand for
• how well they can interact with other people, or
• how well they can concentrate.
Please include your opinion about any assistance or interventions that may help your patient to
find and keep a job. For example, a rehabilitation or pain management program, study, training
and job readiness program.

Serious illness A serious illness can include:

• cancer/leukemia
• severe stroke
• acquired brain injury
• severe burns
• severe physical injury requiring long recovery period, and
• severe mental health conditions with treatment in an institutional setting.

SU415.2208
 Medical Certificate
(SU415)
Centrelink customers can lodge this online, go to servicesaustralia.gov.au/centrelinkuploaddocs
www.

Patient’s details
CRN Date of birth DD / MM / YYYY
Family name
Home address
First name

Second name Postcode

Conditions impacting work, study or participation in activities Past, current and planned treatment (for listed conditions)
Primary condition
Specific Diagnosis:

Date of onset (if known) DD / MM / YYYY Capacity to work, study or participate in activities
The duration of the current functional impact of this condition is expected Can this patient do any work, study or participate in activities of 8 or
to be (including a temporary exacerbation of a permanent condition) more hours per week?
Less than 13 weeks No
13 weeks up to 24 months Yes Give details below
24 months or more How many hours can they work, study or participate in activities on
Will this result in an average life expectancy of 24 months or less? average each week?
No
Yes How long will this incapacity last?
Does this condition meet one of the serious illness categories outlined on From DD / MM / YYYY To DD / MM / YYYY
previous page?
No
Your details
Yes
Doctor’s name (print in BLOCK LETTERS)
Secondary condition
Specific Diagnosis:
Qualifications

Provider no.
Surgery/Medical Centre/Hospital name

Date of onset (if known) DD / MM / YYYY Address

The duration of the current functional impact of this condition is expected
to be (including a temporary exacerbation of a permanent condition)
Less than 13 weeks
13 weeks up to 24 months Postcode
24 months or more
Phone number
Other conditions Signature
Are there any other conditions impacting capacity to work, study or
participate in activities?
No
Yes Provide the details of the conditions Date
on a separate medical certificate
DD / MM / YYYY
Functional impact (for listed conditions)

CLK0SU415 2208

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Privacy notice Privacy and your personal information
The privacy and security of your personal information is important to us, and is protected by law.
We collect this information so we can process and manage your applications and payments,
and provide services to you. We only share your information with other parties where you have
agreed, or where the law allows or requires it. For more information, go to www.

servicesaustralia.gov.au/privacy

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