Get Mi Dch-0713 2022

The MI DCH-0713 form is essential for parents and guardians seeking a medical exemption for their child's immunizations in Michigan. This guide provides detailed instructions tailored to assist users in completing the form accurately and efficiently.

Follow the steps to successfully complete the MI DCH-0713 form online.

1. Press the 'Get Form' button to access the MI DCH-0713 form and open it in the online editor.
2. Begin by filling out the child's full name in the designated field, ensuring to include the last name, first name, and middle initial as required.
3. Enter the date of birth for the child in the specified format: month, day, and year.
4. Provide the name of the parent or guardian responsible for the child in the appropriate field.
5. Input the home address of the parent or guardian. Make sure the address is complete for proper identification.
6. Fill in the telephone number of the parent or guardian in the designated area.
7. State the name of the preschool program, childcare center, or school that the child is enrolled in, ensuring accuracy.
8. Indicate the immunizations that are medically contraindicated by checking the respective boxes for DTaP, polio, hepatitis B, MMR, Haemophilus influenzae type b, pneumococcal conjugate, varicella, or meningococcal conjugate.
9. Specify the reason for the exemption in the provided space, referring to the appropriate resources if necessary.
10. State the expiration date of the exemption in the format of month, day, and year.
11. Print the name of the certifying physician, ensuring to include their credentials (MD/DO) as required.
12. Fill in the office address of the physician in the appropriate space.
13. Provide the telephone number of the physician's office.
14. Have the physician sign the form and date it in the designated areas to validate the exemption request.
15. Once all fields are completed, save your changes, download the form, print it for physical submission, or share it as necessary.

Complete your MI DCH-0713 form online to ensure your child's health requirements are met.