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  • Vaccine Refusal Form For Adults

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Adult Patient Refusal to Vaccinate Form Patient s Name: Patient s ID # My health care provider, has advised me that I should receive the following vaccine shots: Recommended 5 5 5 5 Vaccines Influenza.

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To claim a religious exemption, the parent or person requesting the exemption must write a statement of their religious objection to immunization, including the name and date of birth of the person for whom the exemption is being requested.

Parents can ask for a medical exemption if a vaccine wouldn't be safe for their child. Reasons that children can get an exemption include: They have a disease or take medicine that weakens their immune system. They have a severe allergy to a vaccine or an ingredient in it.

Reasons that children can get an exemption include: They have a disease or take medicine that weakens their immune system. They have a severe allergy to a vaccine or an ingredient in it. They had a serious reaction to a vaccine in the past.

A medical exemption is allowed when a child has a medical condition that prevents them from receiving a vaccine. All but three states offer nonmedical exemptions for religious or philosophical reasons.

CDC sets the immunization schedules based on ACIP's recommendations. The childhood and adolescent schedules are also approved by the American Academy of Pediatrics (AAP), the American Academy of Family Physicians (AAFP), and the American College of Obstetricians and Gynecologists.

No major religions prohibit vaccinations, and some consider it an obligation because of the potential to save lives. Many religions, however, provide that each individual has the right to decide whether or not to use vaccines according to his or her own moral conscience.

All adults need a seasonal flu (influenza) vaccine and Td or Tdap vaccine (Tetanus, diphtheria, and pertussis) but there may be additional vaccines recommended for you. Learn more about which vaccines you may need if you have any of these conditions: Asplenia.

For parents who refuse one or more recommended immunizations, document your conversation and the provision of the VIS(s), have a parent sign the Refusal to Vaccinate form, and keep the form in the patient's medical record.

Georgia law allows for two types of exemptions from the immunization requirements: medical and religious. Each child must have one of two items on file either a valid Georgia Immunization Certificate (Form 3231) or a signed, notarized statement, which is called an affidavit of religious exemption.

If your child missed a dose of vaccine, they do not need to start the whole series over again. Your child can pick up where they left off, regardless of the time that has passed between doses. However, it is best to follow the recommended schedule as closely as possible.

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© Copyright 1997-2025
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Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
Industries
Forms in Spanish
Localized Forms
State-specific Forms
Forms Kit
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232