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Dated factual snapshot · captured 2026-07-15

Departmental form summaries: a searchable copy of published facts from an earlier capture. Records are not rechecked for each release and may have changed or been withdrawn. Confirm the current record at the official source before relying on it.

Source: Australian Government Department of Home Affairs. Official source · Creative Commons Attribution 3.0 Australia.

About this copy

Original factual summaries describing what each official form is for and who lodges it. No form fields, layout or text are reproduced; the official PDF remains the only form.

Platform-authored navigation; no lawyer or registered migration agent reviewed this catalogue. It does not assess eligibility, points or suitability for any person.

Purpose

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 lodges 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.

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.

Official form

Open the Department's own PDF or instructions page.

Open official form 1567