Australian Childhood Immunisation Register (ACIR) forms
The following ACIR forms can be downloaded by clicking on the underlined links.
- Application to Register as an Immunisation Provider [PDF, 87Kb]
- Immunisation providers (other than general practitioners) should use this form to register with the ACIR before sending immunisation data. - Payment Account Details for Immunisation Providers [PDF, 135Kb] - General practitioners must complete this form to receive payment for immunisation data sent to the ACIR. Other immunisation providers may update their bank account or credit union details recorded on the ACIR using this form.
- Immunisation history form [PDF, 79Kb] - used to report immunisation details to the ACIR when another immunisation provider performed the vaccination service.
Note: printed copies of this form will not appear in triplicate. - Immunisation encounter form [PDF, 74Kb] - used to report immunisation details to the ACIR when you performed the immunisation service.
- Immunisation encounter header form [PDF, 68Kb] - used in conjunction with the Immunisation encounter form.
- Stationery order form for NT & QLD [PDF, 39Kb] - used by Northern Territory and Queensland immunisation providers to order immunisation stationery.
- Stationery order form [PDF, 86Kb] - used by immunisation providers, excluding those in the Northern Territory and Queensland, to order immunisation stationery.
- Medical contraindication form [PDF, 137Kb] - used to record a reason why a vaccine should not be given to a child.
- Conscientious objection form [PDF, 131Kb] - used to record a parent or guardian's conscientious objection to their child being immunised.
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Last updated: 26 June, 2008