Get Commonwealth Of Kentucky Certificate Of Medical Exemption

Completing the Commonwealth of Kentucky Certificate of Medical Exemption is an essential step for parents and guardians seeking to document a child's medical exemption from vaccination. This guide offers an easy-to-follow approach to filling out the form accurately online.

Follow the steps to complete the form efficiently.

1. Click ‘Get Form’ button to access the form and open it in your preferred editor.
2. Begin by filling in the child's full name, including their last name, first name, and middle name in the designated fields.
3. Enter the child's birthdate in the space provided, ensuring the correct format is followed.
4. Next, provide the name of the parent or guardian in the specified area.
5. Complete the parent's or guardian's address, including street, city, state, and zip code.
6. Indicate the specific health or physical conditions that are recognized contraindications to the administration of the required vaccinations.
7. In the section labeled 'Vaccine(s) Contraindicated,' clearly specify the vaccines that are contraindicated for the child.
8. Document the dates when each immunization was administered if applicable, filling in the month, day, and year in the respective fields for each vaccine listed.
9. After verifying all entered information, obtain the certification from a licensed healthcare professional, who must sign the form and provide the date.
10. Ensure that the name of the healthcare office or licensed healthcare facility is included in the specified space.
11. Finally, save your changes, and choose to download, print, or share the completed form as necessary.

Take action now to complete and submit your documents online for a smoother process.