non-medically exempt. Instructions for parent or guardian: 1. Fill out the dates in chronological order even if your child received a vaccine outside of the
Additional exemptions: • Children 7 years of age and older: A history of 3 doses of DTaP/DTP/DT/Td/Tdap and 3 doses of polio vaccine meets the minimum.
www.health.state.mn.us/immunize. Name: Birthdate: Minnesota law requires children enrolled in child care early childhood Immunization Exemption Form.
www.health.state.mn.us/immunize. Immunization Record for. Students Attending Post-Secondary Schools in Minnesota. Students: Return this completed form to
15 Health Standards; Immunizations; School Children; Subd. 3 (d) to file a. Religious/Conscientious Exemption to all vaccinations. Respectfully. Parent(s)
Document medical and/or non-medical exemptions in section 1. • Verify history of chickenpox (varicella) disease in section 2. • Provide consent to share
Complete section 1A or 1B to certify immunization status and section 2A to document medical exemptions (including a history of varicella disease) and 2B to
medical or non-medical exemption. We suggest you give parents the MDH Child Care or Early Childhood. Program Immunization Form found on Vaccines for.
La ley de Minnesota obliga a que los niños matriculados en cuidados infantiles programas para la primera infancia o la escuela estén vacunados contra
Minnesota law requires children enrolled in school to be immunized against certain diseases or file a legal medical or conscientious exemption. Student
STATE OF MINNESOTA COUNTY OF (name of parent or guardian) Name Instructions: Complete section 1 to document a medical or non-medical exemption section 2 to
7 nov 2022 · Exemptions from immunizations is under subdivision 3 Forms Exemptions can be obtained by utilizing the appropriate sample immunization record
SECTION 1 (Medical Exemption) to be completed by physician: Non-medical exemption: A child is not required to have an immunization that is against their parent
Complete section 1A or 1B to certify immunization status and section 2A to document medical exemptions (including a history of varicella disease) and 2B to
Certify Immunization Status Complete A or B to indicate child's immunization status A Medical exemption: No child is required to receive an immunization if
I object to the administration of vaccine to my child named above and therefore request exemption from the immunization requirements of regulations under the
Minnesota Conscientious Exemption to Vaccination Prepared by the Vaccine Safety Council of Minnesota http://vaccinesafetycouncilminnesota org/
A completed request for an exemption using either the medical exemption form or religious exemption form Acceptable COVID-19 Vaccines are those approved or
COVID?19 Vaccination Medical Exemption Request Form Form Number UM 1912 COVID-19 Vaccination Medical Exemption Request 2022-06-17 pdf