Nc Immunization Exemption Form

Immunization Exemption Form Fill Out and Sign Printable PDF Template

Nc Immunization Exemption Form. Learn more about these exemptions, and the process for requesting an exemption for your children. Medical exemption (pdf, 170 kb) (dhhs 3987) use this form for true contraindications, i.e.

Immunization Exemption Form Fill Out and Sign Printable PDF Template
Immunization Exemption Form Fill Out and Sign Printable PDF Template

Retain a copy for the patient’s file. Web nc medical exemption statement form dhhs 3987 purpose: Provide documentation to support the request (clinic notes, labs, etc). Submission of certificate to college or universities. Web north carolina law provides for two types of exemptions from required immunizations. To provide physicians licensed to practice medicine in north carolina with a mechanism to request a medical exemption to a required immunization(s), pursuant to g.s. Attach a copy of the most current immunization record. Use this form for true contradictions and precautions. Web included are the following: They are medical and religious.

Web included are the following: Web nc medical exemption statement form dhhs 3987 purpose: To provide physicians licensed to practice medicine in north carolina, a mechanism to certify, pursuant to g.s. Restitution required when vaccine spoiled due to provider negligence. Physician’s request for medical exemption (pdf, 136 kb) (dhhs 3995) Medical exemption (pdf, 170 kb) (dhhs 3987) use this form for true contraindications, i.e. Retain a copy for the patient’s file. Web instructions complete and sign the form. Use this form for true contradictions and precautions. Web included are the following: Attach a copy of the most current immunization record.