I declare that the information I have provided in terms of my medical history and during my immigration health examinations as recorded in eMedical are true and correct.

I understand that:

• my personal details and health information are being collected in the eMedical system to enable the Department of Home Affairs (Home Affairs) officers to determine whether or not they are satisfied that I meet the health criteria for an Australian visa(s);
• Home Affairs can collect and use my personal and sensitive information entered into eMedical in accordance with the Privacy Act 1988 (the Privacy Act);
• required health examinations must be completed and assessed prior to a visa decision being made. If the information I have provided is not stored within the eMedical system, the processing of my visa application will be delayed, and my visa application may be refused if I fail to complete the required health examinations;
• if I have provided any false or misleading information to Home Affairs as part of my immigration health examination, my visa application(s) may be refused and/or any visa subsequently issued cancelled;
• the Home Affairs privacy policy contains information about how I can access the information stored in eMedical, seek the correction of such information, complain about a breach of any Australian privacy laws or codes of practice that apply to Home Affairs, and how Home Affairs deals with such complaints. This privacy policy is available at: https://www.homeaffairs.gov.au/access-and-accountability/our-commitments/plans-and-charters/privacy-policy ;
• the Home Affairs privacy notice is available at: https://immi.homeaffairs.gov.au/form-listing/forms/1442i.pdf . Important information about the collection, use and disclosure (to other agencies and third parties, including overseas entities) of my personal information, including sensitive information, is contained in this notice;
• further information about eMedical and arrangements in place to protect my personal information where stored in eMedical is available on the Home Affairs website at: https://immi.homeaffairs.gov.au/help-support/tools/emedical ;
• Home Affairs’ contact details are outlined on the Home Affairs website at: https://immi.homeaffairs.gov.au/help-support/contact-us/offices-and-locations ;
• if I consent to the disclosure of my personal (including sensitive) information that APP 8.1 (contained in Sch 1 to the Privacy Act) will not apply in relation to the cross border disclosure of this information. This means that the Department of Home Affairs does not need to take such steps as are reasonable in the circumstance to ensure that the overseas recipient does not breach the APPs in relation to the information disclosed.

I consent to:

• my personal and sensitive information (such as my medical information) being collected and stored in the eMedical system that is hosted by Home Affairs, and automatically submitted to Home Affairs for the purposes of assessing whether or not I meet the health requirement for current or future Australian visa applications;
• Home Affairs storing my digital photograph(s) which may be used by Home Affairs for client identification purposes in addition to the immigration health examination process;
• Home Affairs retaining my medical information, including any x-ray images uploaded to eMedical, beyond the finalisation of my visa application, for the purposes of considering future applications I may make for a visa to Australia;
• the Commonwealth of Australia becoming the owner of the information entered into eMedical and that this information will be passed to Home Affairs;
• Home Affairs may destroy my personal data (including digital x-ray images and photographs) stored in eMedical after a certain period of time where consistent with Home Affairs’ archiving obligations and any current disposal authorities. Consequently, if I do not request a copy of this data from the clinic I attend when undergoing my immigration health examinations, it may not be available for me to retrieve at a later date;
• Home Affairs disclosing my personal information, including information about my health and any complaint I may lodge, to the relevant radiologists/panel doctors and clinic administrative staff. The reasons for this disclosure will be to investigate and resolve inconsistencies, complaints or audit recommendations; and
• my personal information (including my sensitive information) stored in eMedical including but not limited to my health case identifier (HAP ID), medical results, treatment(s), bio details and digital photographs to be disclosed to:
  • for Refugee and Humanitarian applicants and/or visa holders:
    • Australian Government health agencies;
    • for the Department of Home Affairs to administer and deliver Humanitarian Settlement Program (HSP), Community Support Program (CSP), or Community Refugee Integration and Settlement Pilot (CRISP) support to me, which may include:
      • health and settlement service providers, approved proposing organisations, and examining doctor(s) – this may include eMedical clinics of my choice involved in the processing of my case outside Australia, (such as the International Organization for Migration (IOM) [via their Migrant Management Operational System (MiMOSA)] or other eMedical clinic) for the purposes of recording my health information and other personal information relating to my visa application and facilitating my travel to Australia;
      • Assisted Passage Contractors (including any subcontractors) for the purposes of assisting me and / or my dependents to attend appointments with panel physicians and clinics empanelled by Home Affairs Migration Health and to facilitate the safe travel of myself and / or my dependents to Australia, amongst other things;
      • Home Affairs’ migration medical service provider, and State and Territory health agencies;
  • for clients granted Refugee and Humanitarian visas who have a proposer or Australian supporter, my HAP ID to be disclosed to my proposer or Australian supporter in Australia for the purpose of arranging a Comprehensive Health Assessment, appointment with a specialist migrant or refugee health service, or general practitioner experienced in managing refugee health issues following my arrival in Australia;
  • Australian Government agencies, State and Territory health agencies authorised to receive information relating to adoption, border control, business skills, citizenship, education, health assessment, health insurance, health services, law enforcement, payment of pensions and benefits, taxation, superannuation, review of decisions, child protection and registration of migration agents;
  • Australian law enforcement, health agencies and international agencies, including overseas recipients in the United Kingdom, the United States of America, Canada and New Zealand, for the purposes of identity checking and panel management, including complaint investigation. [Note: if you are applying for a refugee or humanitarian visa, Home Affairs will only disclose this information to another country if it is reasonably satisfied that this information will not be disclosed to your country of claimed persecution];
  • my identifying information as defined in s 336A of the Migration Act 1958 (such as my photograph, height and weight measurements) being disclosed to eMedical clinics of my choice involved in the processing of my case outside Australia (such as the IOM [via MiMOSA] or other eMedical clinic) and Assisted Passage Contractors (including any subcontractors), if applicable.

Client declaration – COVID-19 related health information (if applicable)

I understand that:

• I may be offered a COVID-19 vaccination or asked to submit proof of my COVID-19 vaccination, by the panel physician (or the IOM). I acknowledge that it is entirely voluntary to receive a COVID-19 vaccination, or to submit proof of my COVID-19 vaccination during the health examination. My decision on this will not impact whether or not I meet the health requirement for the purposes of being granted a visa. However, I may be required to submit proof of vaccination status as an entry requirement when entering Australia;
• If I receive a COVID-19 vaccination, or provide proof of my COVID-19 vaccination, this information will be collected by the panel physician (or the IOM) and submitted in eMedical. The information in eMedical will then be collected by Home Affairs to fulfil emergency management functions in supporting the response of the Australian Government and State and Territory governments to the COVID-19 outbreak. This information may be disclosed to the Australian Government Department of Health and/or State and Territory health departments to assist with Australia’s response to COVID-19, as required;
• The COVID-19 vaccination information collected in eMedical may be integrated with other Home Affairs systems for the purposes of data matching and verification;
• Where applicable, my COVID-19 vaccination information may be disclosed to relevant Commonwealth, State and Territory health authorities, and/or settlement service providers, specialist migrant or refugee health services, or a general practitioner experienced in dealing with refugee health issues, for the purpose of the settlement of migrants and humanitarian entrants. This may include for the purposes of being offered additional vaccinations as part of the primary dose, or a booster shot;
• Home Affairs has a privacy policy that contains information about how I can access the information stored in eMedical, seek the correction of such information, complain about a breach of any Australian privacy laws or codes of practice that apply to Home Affairs, and how Home Affairs deals with such complaints. This privacy policy is available at: https://www.homeaffairs.gov.au/access-and-accountability/our-commitments/plans-and-charters/privacy-policy ;
• Further information about eMedical and arrangements in place to protect my personal information where stored in eMedical is available on the Home Affairs website at: https://immi.homeaffairs.gov.au/help-support/tools/emedical ;
• Home Affairs’ contact details are outlined on the Home Affairs website at: https://immi.homeaffairs.gov.au/help-support/contact-us/offices-and-locations;

If I receive a COVID-19 vaccination or submit proof of my COVID-19 vaccination during my health examination, I consent to:

• Home Affairs collecting and using my personal (including sensitive) information submitted in eMedical, to support any response of the Australian Government and State and Territory governments to a COVID-19 outbreak. This includes the collection of the type of COVID-19 vaccination received, date(s) of COVID-19 vaccination, and whether or not I consent to receiving the COVID-19 vaccination;
• Home Affairs disclosing my personal (including sensitive) information submitted in eMedical to the Australian Government Department of Health and/or State and Territory health departments, to assist with Australia’s response to COVID-19, as required;
• Home Affairs using and disclosing my personal (including sensitive) information collected in eMedical for the purposes of being integrated with other Home Affairs systems for data matching and verification;
• Home Affairs disclosing my personal (including sensitive) information (where applicable) to relevant Commonwealth, State and Territory health authorities, and/or settlement service providers, Assisted Passage contractors (including any subcontractors), specialist migrant or refugee health services, or a general practitioner experienced in dealing with refugee health issues, for the purposes of my settlement arrangements in Australia (where applicable), including being contacted to receive further COVID-19 vaccinations or booster shots, if required.