Covid-19 Vaccine Exemption Form

Resources PROMIC Exemption Forms These are downloadable and printable COVID-19 Vaccine self exemption forms that you can complete either online or by hand supplied by. Exemptions for conditions listed in section 44 special warnings and precautions for use in the Summary of Product Characteristics for each of the approved COVID-19 vaccines.

Lsu Officially Announces Its Vaccine Mandate

Medical contraindications and precautions for immunizations are based on the most recent General Recommendations of the Advisory Committee on Immunization.

Covid-19 vaccine exemption form. First middle last Primary Phone. ID Date of Birth. COVID 19 VACCINE MEDICAL EXEMPTION FORM Name of Student.

Name of ParentGuardian if under 18. Professionals for Medical Informed Consent and Non-Discrimination PROMIC SELF EXEMPTION FORMComplete and print this form and present it to challenge any discrimination that you receiveDOCTOR TO SIGN EXEMPTION. Address1 2 city state zip PatientParent Email Address.

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