Get Nc Dhhs 3987 2020-2026

Filling out the NC DHHS 3987 form is crucial for certifying a medical exemption for immunizations in North Carolina. This guide provides step-by-step instructions to help you complete the form accurately and efficiently.

Follow the steps to fill out the NC DHHS 3987 form online.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by entering the Name of Patient and Date of Birth (DOB) at the top of the form. Ensure that all names and dates are accurate and legible.
3. Next, provide the Name of Parent or Guardian along with their Primary Phone number. This information is essential for any follow-up communication.
4. Fill in the Home Address for the Patient or Parent, including the County. This helps identify the area of residence associated with the medical exemption.
5. Indicate the Name of the Child Care, School, College, or University that the patient is affiliated with. This ensures proper context for the exemption.
6. Review the contraindications listed in the form. For each vaccine, check all contraindications that apply to the patient. Make sure to accurately highlight any significant medical history.
7. Complete the section that requires the physician's information. A licensed physician in North Carolina must provide their name, contact number, and address.
8. Have the physician sign and date the form to validate the exemption. This step is essential for the acceptance of the form.
9. Ensure that you attach a copy of the most current immunization record to the form before submission.
10. Finally, retain a copy of the completed form for your records and return the original to the individual or agency requesting the documentation.

Complete your documents online to ensure timely submission and compliance.