Nc Immunization Exemption Form. Provide documentation to support the request (clinic notes, labs, etc). Web north carolina law provides for two types of exemptions from required immunizations.
Forms PACK 3842
Web included are the following: 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). Retain a copy for the patient’s file. To provide physicians licensed to practice medicine in north carolina, a mechanism to certify, pursuant to g.s. Use this form for true contradictions and precautions. Learn more about these exemptions, and the process for requesting an exemption for your children. Restitution required when vaccine spoiled due to provider negligence. The state also allows exemptions based on “bona fide religious beliefs.” it does not, however, grant. Web instructions complete and sign the form. They are medical and religious.
Medical exemption (pdf, 170 kb) (dhhs 3987) use this form for true contraindications, i.e. 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. Retain a copy for the patient’s file. To provide physicians licensed to practice medicine in north carolina, a mechanism to certify, pursuant to g.s. Provide documentation to support the request (clinic notes, labs, etc). The state also allows exemptions based on “bona fide religious beliefs.” it does not, however, grant. Web included are the following: Both of these exemptions require a signature by a physician in north carolina. Physician’s request for medical exemption (pdf, 136 kb) (dhhs 3995) Web nc medical exemption statement form dhhs 3987 purpose: Web (08/03/2020)revised medical exemption statement and physician’s request for medical exemption forms memo;
