Get Mi Dch-0713 2024-2025

Filling out the MI DCH-0713 form is essential for ensuring that a child who has specific health concerns is exempt from certain immunization requirements. This guide will provide you with clear, step-by-step instructions to help you complete the form accurately and efficiently online.

Follow the steps to fill out the MI DCH-0713 form online.

1. Press the ‘Get Form’ button to obtain the form and open it in your preferred editor.
2. In Section 1, please print or type the necessary information. Begin with the child's name, including their last name followed by their first name. Ensure that you complete the field for the child's birth date using the format Month/Date/Year.
3. Next, provide the name of the parent or guardian, along with their telephone number and home address. Fill in the city, state, and zip code as required.
4. Identify which specific immunization is medically contraindicated by selecting the appropriate options from the list provided.
5. You must indicate the reason for exemption in the designated field, ensuring that it aligns with the medical contraindications.
6. Proceed to Section 2, where you will enter the date until which the exemption shall continue, formatted as Month/Day/Year.
7. Print or type the physician’s name (MD/DO) and their office address, completing the city, state, and zip code fields as well.
8. Finally, include the physician’s telephone number, signature, and the date of signing. These details validate the exemption.
9. Once all fields are completed, you can save your changes, download the filled form, print it for submission, or share it as needed.

Complete your MI DCH-0713 form online today to ensure your child’s health needs are met effectively.