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COVID-19 Notification


This form is for the notification of COVID-19 by medical practitioners to the Victorian Department of Health & Human Services, as scheduled by the Public Health and Wellbeing Regulations 2019. This form should take 3-5 minutes to complete and you should retain a copy for your records. Further information on COVID-19 can be found at the department's website: https://www.dhhs.vic.gov.au/novelcoronavirus
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 or to provide the information requested on this form.
Fields marked with * are required
Stop - do not complete this form.
Only confirmed cases of COVID-19 should be notified to the department via this notification form.If you feel this case may be of public health significance and would like to notify, please call 1300 651 160.

Notifier Details


Please provide your full details below.
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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


Notifications of COVID-19 are 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.
Fields marked with * are required

Case Details


Notifications of COVID-19 are 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.
Fields marked with * are required

Case identification