Get Mi Dch-0713 2021

The MI DCH-0713 is a critical medical contraindication form required for children in Michigan to receive exemptions from specific immunization requirements. This guide provides step-by-step instructions on how to complete the form online, ensuring you have the necessary information ready and filled out correctly.

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

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Enter the child's name in the specified format: Last, First, Middle Initial, ensuring that all required fields are filled in accurately.
3. Fill in the child's date of birth using the format Month/Day/Year, which is a critical detail for the processing of the form.
4. Provide the name of the parent or guardian responsible for the child, ensuring clarity and correctness in spelling.
5. Include the home address of the family, which must be complete and accurate for contact purposes.
6. Record a valid telephone number that can be used to reach the parent or guardian if needed.
7. Specify the name of the preschool program, childcare center, or school that the child is enrolled in, as this is a necessary detail for verification.
8. Indicate the specific immunization(s) that are medically contraindicated by checking the relevant boxes provided.
9. Provide a reason for the exemption clearly in the space provided, which is essential for the legitimacy of the request.
10. Indicate the duration of the exemption by filling in the end date for the exemption period in the Month/Day/Year format.
11. Print the physician's name (MD/DO) clearly, as this is required for validation of the medical contraindication.
12. Fill in the physician’s office address and telephone number accurately to ensure they can be contacted for verification if necessary.
13. Obtain the physician’s signature and date it to finalize the authorization of the contraindication.
14. Once completed, save changes, and you may download, print, or share the completed form as needed.

Begin filling out the MI DCH-0713 form online for your child's medical exemption today.