Optional Medical Exemption Form for Physicians

Effective January 1, 2016, California no longer allows parents/guardians to submit personal belief exemption from vaccinations required for school and childcare.

California law continues to permit licensed physicians (MD, DO) to provide documentation, when appropriate, for medical exemptions from vaccinations required for childcare and school entry.

The California Immunization Coalition in collaboration with the American Academy of Pediatrics, California and the California Academy of Family Physicians have developed an optional form for use in documenting a medical exemption. Licensed physicians (MD, DO) may simply complete this form or provide a letter containing the same information to the parent/guardian.

For more information and frequently asked questions about the new law go to www.shotsforschool.org

MedicalExemptionzToRequiredImmunizations Final01-31-2016-SAMPLE

 

To receive a copy for use in your practice, please email us at [email protected] or go to the American Academy of Pediatrics – CA (CA-AAP) or California Academy of Family Physicians (CAFP) to download the form directly.

 

 

 

 

 

CIC offers a variety of resources to support your local immunization efforts. We are constantly adding helpful tools, materials and links, so check back often!

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