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Notifiable Condition

This form is used for the statutory required notification of conditions scheduled by the Public Health and Wellbeing Regulations 2009 to the Victorian Government Department of Health & Human Services. Further information about notifying cases, printable forms and privacy fact sheets are available on the department's website.
The form should take 3-5 minutes to complete and you should retain a copy for your records.Please ensure that the case has been informed of the following: their diagnosis,that you are providing this information to the department (as required by the Health Records Act 2001), andthat the department may contact them for further information about their illness.Commonwealth and State privacy legislation does not negate the responsibility to notify the specified conditions nor to provide the information requested on this form.
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Notifier (your) details

Notification via this online form is specifically for medical practitioners.If you are from a primary school, aged care facility, childcare facility, or another relevant agency, please call 1300 651 160 to notify, and/or visit the below links for further information on your requirement to notify. For a copy of the school exclusion table, and information on notifications required by primary schools and childcare centres:
For information on notification and management of outbreaks in facilities:
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Email used for correspondence and information only - no identifying patient information will be sent by email
You can save time filling out the form by ticking the checkbox below. Your Notifier Details will be saved and future use of this form on this computer will automatically populate with your Notifier Details.Do not tick the checkbox below if this is a public/shared computer as it may compromise your privacy and security.
By unticking the checkbox below the Notifier Details that have been saved on this computer will be removed.
Notifier Details prefilled

Case Details

Notification of the selected disease is required to be provided to the department fully identified. Timely public health action will be greatly assisted by your full identification of the patient, and their address and contact details.
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Case Identification