- What it is for
- This form is used to provide medical information to the Department of Home Affairs to support a person seeking assistance for a medical reason under the Status Resolution Support Services (SRSS) Program, helping the department decide how long support may be required.
- Who completes it
- A treating medical practitioner or health specialist completes the certificate for their patient, who then provides it to their SRSS service provider for submission.
- Information it collects (in general terms)
- It gathers patient identifying and contact details and clinical information provided by the practitioner, including diagnosed conditions, functional impact, treatment plans, assessed capacity to work, expected duration of incapacity, whether a serious illness category is met, and the practitioner's details and signature.
- When it is used
- It is used when an SRSS client's medical condition affects their capacity to work and the department needs a practitioner's assessment to inform decisions about the level and duration of support.
This site is not affiliated with the Australian Government. Forms are completed and lodged in your own ImmiAccount; this platform never submits anything to the department.