Get Medical Immunization Exemption Form - Colorado.gov 2020-2026
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How to fill out the Medical Immunization Exemption Form - Colorado.gov online
Completing the Medical Immunization Exemption Form is a crucial step for students in Colorado who require an exemption from vaccination requirements. This guide will provide you with detailed instructions on how to accurately fill out the form online, ensuring you meet all necessary requirements.
Follow the steps to successfully complete your exemption form online.
- Press the ‘Get Form’ button to access the Medical Immunization Exemption Form and open it in your document editor.
- Begin by filling out the student information section. Input the student's last name, first name, and optional middle name. Provide the date of birth, gender, and address details, including street number, street name, unit number (if applicable), P.O. Box (if applicable), city, state (CO), zip code, email address, and phone number.
- Next, complete the parent or guardian section. Enter the last name, first name, and optional middle name of the individual completing the form. Indicate the relationship to the student by selecting the appropriate box (mother, father, or guardian) and fill in their address details, including street number, street name, unit number (if applicable), P.O. Box (if applicable), city, state (CO), zip code, email address, and phone number.
- Proceed to the school or licensed child care facility information. Enter the name of the school or facility, school district, and address details, including city, state (CO), and phone number. If not applicable, check the appropriate box.
- In the required vaccines section, check each vaccine that is being declined. Options include Hepatitis B, DTaP/Tdap, Hib, IPV, PCV13 or PPSV23, MMR, and Varicella.
- You must list the medical contraindications for each vaccine declined by providing a detailed explanation of why vaccination would endanger the student’s life or health or is medically contraindicated.
- Finally, obtain the required signature from a physician, advanced practice nurse, or delegated physician assistant. Include their signature and the date.
- After completing the form, save all changes, and ensure you review the form for any errors before downloading, printing, or sharing it as needed.
Complete your Medical Immunization Exemption Form online today to ensure your compliance with Colorado’s vaccination requirements.
Yes, vaccines are generally mandatory for school attendance in Colorado. Schools require proof of vaccination to ensure the health and safety of all students. If you are opting out of vaccinations for your child, you can apply for a Medical Immunization Exemption Form - Colorado to comply with state educational regulations while respecting your choices.