Get Nj Imm-53 2019-2026

Filling out the NJ IMM-53, the medical exemption request form for mandatory immunizations, can be straightforward when you follow a guided approach. This document serves to assist users in completing the form accurately, ensuring that all necessary information is provided for exemptions to be considered valid.

Follow the steps to successfully complete the NJ IMM-53 form.

1. Click the ‘Get Form’ button to obtain the form and open it in your editing application.
2. Fill out the form completely. All form fields are required unless indicated as optional. Start by entering the name of the student along with other identifying information.
3. For each vaccine for which an exemption is requested, check the corresponding box. Indicate whether the exemption is Temporary by specifying the valid date or Permanent.
4. For each vaccine exemption requested, check applicable ACIP contraindications or precautions as noted on the form.
5. If the contraindication or precaution is not included in Table 1, mark the ‘Other’ option and provide a detailed explanation. Ensure that the indication does not appear in Table 2 and follows ACIP/AAP guidelines.
6. Sign and date the Attestation Statement at the end of the form to confirm the accuracy of the information.
7. Provide a copy of the completed form to the requester or directly to the relevant school, preschool, or child care center.
8. Keep a copy of the form for your own records.

Start filling out the NJ IMM-53 form online now to ensure timely processing of your medical exemption request.