Medical Impact Statement
Special consideration is specifically intended to support
students who have recently experienced unexpected acute
illness or injury that is short-term in nature. Requests for
special consideration on medical grounds must be supported
by a Medical Impact Statement (MIS). This is to ensure that
our special consideration assessment process is fair and
equitable. Please issue the statement only in respect of an
illness, injury or other medical circumstances being presented.
The information you provide will help us determine the
appropriate form of consideration such as an extension,
alternative task or a deferred exam.
Who can complete this form?
The MIS is to be completed and signed by a treating
medical/health practitioner who is not a family member or a
close association of the student. The practitioner must be:
• Australian Health Practitioner Regulation Agency
(AHPRA) registered General Practitioners (GPs),
• Registered Counsellor (being a member of one of the
APS, the AASW, or the ACA)
• Other AHPRA registered practitioners which diagnose
and treat medical conditions.
The University does not need to know details of the condition,
we only require relevant information regarding the severity of
the impact or the degree of impairment to make an informed
Assessing the degree of impairment:
The degree of impairment/impact should be based on the
condition/circumstances that you have observed. Please
follow the below guidelines:
• Hospitalised or incapacitated: for the purpose of
special consideration, is defined as unable to function
as a result of recovering from a surgery or serious
medical condition at a hospital, psychosis episodes
and other life-threatening medical conditions. The
student is not permitted to attend an examination,
study or undertake any assessments.
• Severe: the impact of the condition is very serious and
is likely to last more than two weeks. The student is
significantly affected and should not attend an
examination during the period specified on the MIS.
The student cannot complete university assessments
or the level of performance will be substantially
• Moderate: the impact of the condition is not severe
and is likely to last for one to two weeks. The student
may be able to attend an examination and undertake
university assessments and the level of performance
is moderately affected.
• Minor: the condition has not had a significant impact
(e.g. mild illness during or close to assessment
submission date). The student is able attend an
examination and continue with their studies and
assessments. Their level of performance is slightly
Incomplete form will not be accepted, please ensure that the
following information is included:
• the practitioner’s name, contact details, provider or
registration number and signature
• the date of the consultation
• an assessment by the practitioner of the duration and
degree of impact on the student’s ability to attend
classes, study/sit exams, or complete assessment
• the date the form was written and signed.
La Trobe University appreciates you taking the time to help our
student assess the impact of their medical condition.
Useful information for students
If your medical circumstances are affecting upcoming or
overdue assessment tasks, please ask your treating
practitioner to complete this form. You must apply for Special
Consideration online and upload the signed MIS within three
business days (inclusive) of the assessment task date.
Applying for special consideration does not guarantee that
special consideration will be granted. While your application is
under assessment, you must continue your assessment task
to the best of your ability and submit it as soon as you are able.
For long-term or ongoing medical circumstances, please
contact Equity and Diversity
(latrobe.edu.au/students/support/wellbeing) for specialised
In addition to the special consideration, the University offers a
range of support services including counselling, IT, financial
and Learning support and programs. Please visit Student
Submitting falsified document is considered fraud and the
University treats this matter seriously. This could result in
suspension, exclusion from the University and/or legal
penalties. As a student, you must be aware of your obligations
and responsibilities under the General Misconduct Statute.