Religious Exemption Request Seasonal Influenza Vaccine printable pdf
Nc Immunization Exemption Form. They are medical and religious. Web instructions complete and sign the form.
Religious Exemption Request Seasonal Influenza Vaccine printable pdf
To provide physicians licensed to practice medicine in north carolina, a mechanism to certify, pursuant to g.s. 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. The state also allows exemptions based on “bona fide religious beliefs.” it does not, however, grant. Retain a copy for the patient’s file. Web included are the following: Web like all states, north carolina provides for medical exemptions from immunizations. Attach a copy of the most current immunization record. Physician’s request for medical exemption (pdf, 136 kb) (dhhs 3995) They are medical and religious. Web (08/03/2020)revised medical exemption statement and physician’s request for medical exemption forms memo;
Web like all states, north carolina provides for medical exemptions from immunizations. Physician’s request for medical exemption (pdf, 136 kb) (dhhs 3995) To provide physicians licensed to practice medicine in north carolina, a mechanism to certify, pursuant to g.s. Both of these exemptions require a signature by a physician in north carolina. Attach a copy of the most current immunization record. Retain a copy for the patient’s file. Restitution required when vaccine spoiled due to provider negligence. Web included are the following: Web instructions complete and sign the form. Medical exemptions for required immunizations will only be granted upon submission of either a medical exemption statement (dhhs 3987) or physicians request for medical exemption (dhhs 3995). Medical exemption (pdf, 170 kb) (dhhs 3987) use this form for true contraindications, i.e.
