Medical Examination For An Australian Visa: Costs

Medical examination
for an Australian visa
This form is for applicants who are requested to undergo a

medical examination as part of an application for an Australian
visa. Forms 1071i Health requirement for permanent entry to
Australia and 1163i Health requirement for temporary entry
to Australia provide further information.
The Department of Immigration and Border Protection (the
department) is authorised to collect the personal information
on this form under section 60 of the Migration Act 1958.
When you complete this form and give it to the panel
physician or clinic, the Commonwealth of Australia becomes
the owner of the personal information on the form. The panel
physician is required to send the form to the department.
Form
26
If you have not lodged a visa application and a significant

health condition is identified which may impact on your ability
to meet the health requirement you will not be provided with
an opinion of the Medical Officer of the Commonwealth until
after you lodge your visa application.
Costs
The costs of health examinations are paid by you directly to
the panel physicians or clinics undertaking the examinations.
There may be additional costs if further tests or couriers are
required.
Outside Australia
Your responsibilities
You must truthfully disclose your medical history and details
of any known medical conditions.
If outside Australia you must attend the same panel
physician during the course of your health examinations.
Visa subclass and visa name

To assist the department to link your health examinations with
your visa application you must write the visa subclass number
and the name of the visa you are applying for on page6 of this
form.
If you are an applicant for a visa under Australias Offshore

Refugee and Special Humanitarian Program the Australian
Government will cover the costs of your health examinations.
In Australia
If you are in Australia and you have applied for a protection
visa, special arrangements may apply in regard to the costs of
health examinations.
How to make an appointment for your medical

examination
For example:
Subclass 405 Investor Retirement
Subclass 600 Sponsored Family Visitor stream
Subclass 890 Business Owner
Outside Australia
This information is required for the visa decision-maker to

process your visa application.
In Australia
To undertake a medical examination outside Australia, please

contact your closest panel physician. For details see
www.immi.gov.au/contacts/panel-doctors/
You can find the visa subclass number and the name of the
visa on the departments website
www.immi.gov.au/immigration.htm
To undertake a medical examination in Australia you must

contact the nearest Medibank Health Solutions office on
1300 361 046. You can make an online booking at
www.medibankhealth.com.au
Completing health examinations before you lodge your

visa application
Note: If you are in Australia and you have applied for a

protection visa, you must see a panel physician at a Medibank
Health Solutions city premises, not an Approved Medical
Practitioner (AMP) in a regional area.
In some circumstances, the department allows visa applicants

to complete health examinations before they lodge their visa
application. The departments website provides information
on where this is possible. For details see
www.immi.gov.au/allforms/health-requirements
You must undertake the required health examinations, as
requested by the panel physician.
Please be aware that if you do complete your health
examinations before lodging your visa application you may
need to undertake additional health examinations if:
you later lodge a visa application for a different visa
subclass;
For women
Women should not attend this medical examination during
menstruation as blood will taint the urinalysis.
What to bring to the examination

Any prescription spectacles or contact lenses that you
may wear.
Where you have a known medical condition, any existing
specialist reports.
Identification
you decide to stay in Australia for a longer period;

you do not complete all the required health examinations;
or
your health examinations expire prior to a decision being
made on your visa application.
A valid original passport is the form of identity documentation

preferred by the Australian Government.
You must bring a valid original passport with you where
possible.
COMMONWEALTH OF AUSTRALIA, 2014
26 (Design date 03/14) - Page 1
There are limited circumstances in which the department will

accept alternative identity documentation. For details see
www.immi.gov.au/allforms/health-requirements/arranginghealth-exam.htm
Panel physicians are required to confirm the identity of
individuals who present at their clinic for Australian
immigration health examinations.
If you do not bring acceptable identification documentation to
the medical examination the processing of your visa
application may be delayed or may not proceed if the panel
physician is not satisfied with the identification
documentation.
Immunisation
Visa applicants are encouraged to be immunised against
infectious diseases before travelling to Australia. Visa
applicants who are unable to arrange their immunisation
before departure from their home country are encouraged to
seek advice on arrival in Australia. The Australian state and
territory health authorities assist people to obtain general
medical help and advice, including immunisation.
Note: If you are a refugee, humanitarian or protection visa

applicant special arrangements regarding identification may
apply.
Parents are strongly encouraged to have their children

immunised against hepatitis B, diphtheria, tetanus, pertussis
(whooping cough), poliomyelitis, haemophilus influenzae
type-b (Hib), pneumococcal and meningococcal infections,
mumps, measles, rubella and varicella (chickenpox). Babies
between the ages of 2 and 8 months of age (only) are also
encouraged to be immunised against rotavirus.
What tests may be required
Parents should bring any immunisation records for their

children with them to Australia.
Permanent visas
Rubella vaccinations are strongly encouraged for women of

child-bearing age.
All applicants for permanent visas to Australia 15 or more

years of age are required to undergo Human
Immunodeficiency Virus (HIV) testing. Applicants for
permanent visas under 15 years of age must also undergo HIV
testing if they are being adopted, have a history of blood
transfusions, or have other clinical indications.
Note: These requirements also apply to applicants applying
for a provisional visa that has a permanent visa pathway.
Temporary visas
Applicants for temporary visas to Australia are not normally
required to undergo HIV testing except for certain groups, as
advised in the departments Procedures Advice Manual, or if
the panel physician decides it is indicated.
Important information about privacy

Your personal information is protected by law, including the
Privacy Act 1988. Important information about the collection,
use and disclosure (to other agencies and third parties,
including overseas entities) of your personal information,
including sensitive information, is contained in form 1442i
Privacy notice. Form 1442i is available from the departments
website www.immi.gov.au/allforms/ or offices of the
department. You should ensure that you read and understand
form 1442i before completing this form.
Doctors, dentists, nurses and paramedics

Applicants intending to work as (or studying to be) a doctor,
dentist, nurse or paramedic are required to undergo a chest
x-ray and medical examination as well as HIV, Hepatitis B and
C testing.
Medical information
Medical information such as a chest x-ray is used to assess an
applicants standard of health. After a decision has been made
on the visa application it is usual for the department to retain
the medical information. The medical information is retained
by the department for use when assessing the applicants
health in the future and for panel physician audits to ensure
the quality of work undertaken by the panel physician
network.
Please keep these information pages for your reference

Form
Medical examination
for an Australian visa
26
How to complete this form
YOUR PHOTOGRAPH
Applicant
Complete Part A and Part B before attending the medical examination.

All questions must be answered.
Complete Part C in the presence of the examining physician.
Examining
physician
Certify in writing across the top of the photograph and on the form (without
obliterating the image) that it is a true likeness of the examinee. Date to be included.
Sight valid passport/national identity document (if provided) and record
passport/national identity document number below.
You must ensure the applicant has provided answers to all the questions in Part A
and Part B before the applicant signs the declaration at Part C.
Complete Part D.
If you are an Approved Medical Practitioner in Australia you cannot conduct a
medical examination of a protection visa applicant.
In Australia
If you need to bring a photo(s)
to the medical appointment at
Medibank Health Solutions,
they will advise you at the time
you make your appointment.
Certify in writing across the bottom of the photograph and on the form (without
Person
obliterating the image) that it is a true likeness of the examinee. Date to be included.
taking blood
Outside Australia
Please firmly attach a
recent passport size
photograph of yourself to
the form by staples or
other means. Another
copy of the same photo
should be used for
form 160 (if required).
To be completed by EXAMINING PHYSICIAN (or staff)

Valid passport sighted?
Yes
Details of national identity card or identity number issued to the applicant by

his/her government (if applicable).
Note: If the applicant is the holder of multiple identity numbers because he/
she is a citizen of more than one country, you need to enter the identity
number on the card from the country that the applicant lives in.
Passport number
Country of passport
Passport and photograph verified?
No
Yes
Please attach a copy of the bio-data page of the passport

sighted to identify the applicant. The copy should be certified
by the examining physician.
No
Reason not presented
National identity
card number
Country of issue
Applicants full name (as it appears in passport or national identity card)
Family name
Given names
DAY
Please attach a copy of the national identity card sighted to

identify the applicant, if applicable. The copy should be certified
by the examining physician.
MONTH
YEAR
Date of birth
Sex
Male
Female
Office use only

File number/PRID/CID
Date of application
Visa class
Name and address of
office processing the
application
Part A Applicants details
12 Have you lodged a visa application?
To be completed by the applicant before attending the medical

examination. Please use a pen and write neatly in English using
BLOCK LETTERS.
Your full name (as it appears in your passport)
No
At which office do you intend to lodge an application?
Yes
At which office?
Family name
13 Have you undertaken a health examination for an
Given names
Australian visa in the last 12 months?

DAY
MONTH
Date of birth
Sex
Your telephone numbers
No
Yes
Male
AREA CODE
NUMBER
Office hours
) (
After hours
) (
14 Are you:
Your residential address
POSTCODE
Intended occupation/activity in Australia
Countries in which you have lived in the last 5 years
Permanently
YEARS
(a) a protection visa applicant?
No
Yes
(b) an unaccompanied minor refugee child?
No
Yes
(c) a refugee who has lived or is living in a camp?
No
Yes
(d) a child for adoption by an Australian resident?
No
Yes
(e) an Australian State or Territory Welfare

Supported child?
No
Yes
(f) a non-migrating family member of an applicant? No
Yes
15 In Australia, will you be:
How long do you intend staying in Australia?

Temporarily
MONTHS
(a) attending or teaching classes?
No
Yes
(b) working in childcare/creche?
No
Yes
(c) working or studying to be a doctor, dentist,

nurse or paramedic?
No
Yes
For how long?
If you are applying for a temporary visa, would you like your health to
be assessed up-front for a permanent stay in Australia?
No
Yes
10 If you are in Australia:
YEARS
MONTHS
how long have you been here?

what visa subclass do you currently hold?
11 What is the visa subclass number and name of the visa that you are
applying for?
For more information please refer to page 1 of this form.
Give details (including HAP ID if available)
Female
COUNTRY CODE
YEAR
Part B Applicants medical history

If yes, list the relevant details, including dates
16 Have you ever been diagnosed with, or had to
No
Yes
No
Yes
No
Yes
No
Yes
20 Have you ever been told you are HIV positive?
No
Yes
21 Do you have, or have you ever had, hepatitis,
No
Yes
No
Yes
23 Do you have high blood sugar/diabetes?
No
Yes
24 Do you have heart problems, including high
No
Yes
25 Do you have a blood condition?
No
Yes
26 Do you have bladder or kidney problems?
No
Yes
27 Do you have a physical or intellectual
No
Yes
No
Yes
take treatment for, Tuberculosis (TB)?
17 Have you ever been in close contact at work

or at home with a person known to have
Tuberculosis (TB)?
18 Have you ever been admitted to hospital and/or

received medical treatment for an extended
period for any reason (including for a major
operation or treatment of a psychiatric illness)?
19 Do you suffer, or have you ever suffered, from

mental health problems?
problems with your liver or yellowing of the skin?
22 Do you have, or have you had, cancer in the

last 5 years?
blood pressure or a heart condition that you

were born with?
disability that make it difficult for you to

function (for example, to move around or
learn) or work full-time?
28 Do you need to take drugs or drink

alcohol regularly?
29 Please list any prescribed pills or medication

(excluding oral contraceptives, over-the-counter
medication and natural supplements) you are taking
DAY
30 For female applicants Are you pregnant?
No
Yes
MONTH
YEAR
What is the expected date of birth?
Part C Applicants declaration

To be signed and dated by the applicant in the presence of the
examining physician.
Before signing this declaration you must have completed all the
questions in Part A Applicants details and Part B Applicants
medical history.
A parent or guardian should sign on behalf of a child under 16 years of
age. In exceptional circumstances a child under 16 may sign if he or
she is able to understand and verify the information given on the form.
31 I declare the information I have provided on this form is correct and I

have answered all questions.
I understand that if I have given false or misleading information, my

application may be refused, and any visa issued may be cancelled.
I agree to the examining physician contacting my treating doctor to
discuss and seek further information about any medical condition(s)
that may relate to my health assessment for a visa.
I understand that the Commonwealth of Australia becomes the
owner of the information on this form and that the panel physician is
required to send the form to the department.
I have read the information on page 2 at Medical information and I
consent to the Department of Immigration and Border Protection
retaining my medical information.
I consent to the Department of Immigration and Border Protection
passing on relevant health information to the panel physician(s) who
examined me for comment. The reasons for this release of
information may include, but are not limited to, investigation of
inconsistencies between the panel physicians examination and a
subsequent health assessment, investigation of a complaint against
the panel physician or follow up with the panel physician of adverse
audit results. Such information will be shared in order to ensure the
quality of the work undertaken by the panel physician network.
Applicants
signature
DAY
MONTH
YEAR
Date
If signing on behalf of a child under 16 years of age
Name of parent or guardian
Relationship
to child
Part D Physical examination to be completed by the examining physician

DAY
MONTH
YEAR
Date of examination
Please answer ALL questions in English.
For Hepatitis B, C and HIV testing, please ensure that pre and post-test counselling are carried out in accordance with local arrangements, including
advice on vaccination for close contacts of those testing Hepatitis B surface antigen positive.
Parents should be present when children are examined.
Was a chaperone present during the examination?
No
Yes
Height and weight
Blood pressure (required for all persons 15 or more years of age) Systolic
Eyes (including fundoscopy)
Centimetres
Normal
Kilograms
Diastolic
Abnormal
Best distance visual acuity (with or without correction)
Declined
Right
Left
Urinalysis
Blood
Complete for all persons 5 or more years of age, and those

persons under 5years of age where clinically indicated.
In women, where an abnormality occurs due to menstruation, please
repeat and record urinalysis following completion of menstruation.
Protein
For a repeated test at a

later date Date repeated
DAY
MONTH
YEAR
Glucose
Blood
Protein
Glucose
Note: If you notice any abnormalities in response to the following questions, you must provide details of the physical examination.
Cardiovascular system
Normal
Abnormal
Respiratory system
Normal
Abnormal
For current or previous tuberculosis, provide date and duration

of treatment and names, strengths and dosages of drugs used.
Please enclose old chest x-ray films.
Nervous system: Sequelae of stroke

or cerebal palsy, other neurological
disabilities
Normal
Abnormal
Gastrointestinal system
Normal
Abnormal
Musculosketal system
(including mobility for all persons
60 or more years of age)
Normal
Abnormal
10 Endocrine system
Normal
Abnormal
11 Mental and cognitive status
Normal
Abnormal
12 Intellectual ability
Normal
Abnormal
13 Ear/nose/throat/mouth
Normal
Abnormal
14 Hearing
Normal
Abnormal
15 Developmental milestones
Normal
(if less than 5 years of age)
Abnormal
Not applicable
16 Skin and lymph nodes
Normal
Abnormal
17 Breast examination where
Normal
Abnormal
clinically indicated
Not applicable
18 Are there any physical or mental conditions
No
Yes
which may prevent this person from attending

a mainstream school, gaining full employment
or living independently now or in the future?
19 Evidence of drug taking
Absent
Present
(eg. venous puncture marks)

If insufficient space, attach additional details
Pathology results
Please refer to Part B of the Instructions for medical and radiological examination of Australian visa applicants to see whether the following
blood tests are required, or perform if clinically indicated and comment on the clinical indication(s).
Note: Attach the pathology report(s) to this form.
If required:
20 Human Immunodeficiency
Results of initial test

Negative
Positive
Negative
Positive
Negative
Positive
Negative
Positive
Virus test (HIV)
21 Hepatitis B surface antigen

blood test
22 Hepatitis C antibody
blood test
23 Syphilis Test (VDRL or RPR)

Obtain and attach VDRL, RPR
or equivalent test results for:
refugees 15 or more years
of age who have lived in a
camp or are living in
camps (see Question
14(c), of PartA
Applicants details);
any other person where
clinically indicated.
If initial test is positive, repeat and perform

confirmatory test and record results
ALL VISA APPLICANTS

For ALL VISA APPLICANTS except protection visa applicants or Australian state or territory supported visa applicants in Australia
24 Examination grading
Please consider the information that you have recorded regarding this client and provide a grading on their medical examination below.
Supporting comments must be provided if you decide to provide a B grading.
No significant history or abnormal findings present
Significant history or abnormal findings present
Please list significant history or abnormal findings
For PROTECTION visa applicants or STATE OR TERRITORY WELFARE SUPPORTED CHILD visa applicants in Australia only
25 Examination grading
Please consider the information that you have recorded regarding this client and provide a grading on their medical examination below.
Supporting comments must be provided if you decide to provide a B grading.
Note: This is not a rating of whether the applicant will meet the health criteria.
No significant history or abnormal findings related to

public health present
Significant history or abnormal findings present that may

indicate that the applicant has a disease or condition that
is, or may result in the applicant being, a threat to public
health in Australia or a danger to the Australian community.
Note: Any relevant results and reports should be referred
to a Medical Officer of the Commonwealth for opinion
Please list significant history or abnormal findings related to public health
26 Declaration
This declaration must be signed and dated by the panel physician who personally performed the examination.
I declare that I have examined the applicant and that this is a true and correct record of my findings.
Place of
examination
Postal address
Panel
physicians
signature
DAY
Contact telephone
number
COUNTRY CODE
(
AREA CODE
) (
NUMBER
)
MONTH
YEAR
Date
POSTCODE
Full name
(please print)
Email address
Note: Australia requires any person over one year of age to hold an international yellow fever vaccination certificate if, within the 6 days
prior to their arrival in Australia, they have stayed overnight or longer in a declared yellow fever infected country, in Africa or South America.
For visa applicants outside Australia Do not give the form and report(s) to the applicant. You may, however, provide the applicant with
a copy of your report(s) for their records. Place the form and report(s) inside a secured envelope and return it directly to the office of the department
specified in the attached covering letter, the return address specified in the Office use only section on page 5 of this form or in the Where to send
Australian visa medicals document.
For protection visa applicants Forward the form and report(s) according to local arrangements with Medibank Health Solutions.

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Medical examination

for an Australian visa

This form is for applicants who are requested to undergo a

If you have not lodged a visa application and a significant

Visa subclass and visa name

If you are an applicant for a visa under Australias Offshore

How to make an appointment for your medical

This information is required for the visa decision-maker to

To undertake a medical examination outside Australia, please

To undertake a medical examination in Australia you must

Completing health examinations before you lodge your

Note: If you are in Australia and you have applied for a

In some circumstances, the department allows visa applicants

What to bring to the examination

you decide to stay in Australia for a longer period;

A valid original passport is the form of identity documentation

COMMONWEALTH OF AUSTRALIA, 2014

26 (Design date 03/14) - Page 1

There are limited circumstances in which the department will

Note: If you are a refugee, humanitarian or protection visa

Parents are strongly encouraged to have their children

What tests may be required

Parents should bring any immunisation records for their

Rubella vaccinations are strongly encouraged for women of

All applicants for permanent visas to Australia 15 or more

Important information about privacy

Doctors, dentists, nurses and paramedics

Please keep these information pages for your reference

COMMONWEALTH OF AUSTRALIA, 2014

How to complete this form

Complete Part A and Part B before attending the medical examination.

To be completed by EXAMINING PHYSICIAN (or staff)

Details of national identity card or identity number issued to the applicant by

Please attach a copy of the bio-data page of the passport

Reason not presented

Please attach a copy of the national identity card sighted to

Office use only

26 (Design date 03/14) - Page 3

Part A Applicants details

12 Have you lodged a visa application?

To be completed by the applicant before attending the medical

Your full name (as it appears in your passport)

At which office do you intend to lodge an application?

13 Have you undertaken a health examination for an

Australian visa in the last 12 months?

Your telephone numbers

Your residential address

Intended occupation/activity in Australia

Countries in which you have lived in the last 5 years

(a) a protection visa applicant?

(b) an unaccompanied minor refugee child?

(c) a refugee who has lived or is living in a camp?

(d) a child for adoption by an Australian resident?

(e) an Australian State or Territory Welfare

(f) a non-migrating family member of an applicant? No

15 In Australia, will you be:

How long do you intend staying in Australia?

(a) attending or teaching classes?