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Oregon Health Authority Nonmedical Exemption Certificate Form

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Immunizations in the order they were received* Middle Initial Segundo Nombre Birthdate Fecha de Nacimiento Mailing Address Direcci n City Ciudad State Estado Zip Code Codigo Postal Vaccines Diphtheria/Tetanus/Pertussis DTaP Tdap Td Non medical Home Telephone Number N mero de Tel fono Parents or Guardians Names Nombre de los padres o guardian Dose 1 mm/dd/yy Dose 2 Dose 3 Dose 4 Dose 5 Booster Dose Tdap Polio IPV or OPV Varicella Chickenpox VZV or VAR o Check here if child has had chickenpox...

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What is the Oregon Health Authority Nonmedical Exemption Certificate

The Oregon Health Authority Nonmedical Exemption Certificate is a form that allows parents or guardians to exempt their children from certain vaccination requirements for school entry based on nonmedical reasons. This certificate is essential for families who choose not to vaccinate for personal, philosophical, or religious beliefs. It is important to understand that this exemption is specific to Oregon and adheres to state laws regarding immunization status in educational settings.

How to obtain the Oregon Health Authority Nonmedical Exemption Certificate

To obtain the Oregon Health Authority Nonmedical Exemption Certificate, parents or guardians must complete a specific process. This includes accessing the form through the Oregon Health Authority's website or obtaining a physical copy from local health departments. The form requires the signature of a healthcare provider, confirming that the parent or guardian has discussed the risks and benefits of vaccination. Once completed, the certificate must be submitted to the child’s school or childcare facility.

Steps to complete the Oregon Health Authority Nonmedical Exemption Certificate

Completing the Oregon Health Authority Nonmedical Exemption Certificate involves several steps:

  • Access the exemption form from the Oregon Health Authority’s official website.
  • Fill out the required information, including the child's details and the parent's or guardian's information.
  • Schedule a consultation with a healthcare provider to discuss vaccination options.
  • Obtain the healthcare provider's signature on the form.
  • Submit the completed certificate to the appropriate school or childcare facility.

Legal use of the Oregon Health Authority Nonmedical Exemption Certificate

The legal use of the Oregon Health Authority Nonmedical Exemption Certificate is governed by state law. This certificate must be presented to schools or childcare facilities to ensure compliance with Oregon's immunization requirements. It is legally binding when properly filled out and submitted. Failure to comply with the submission requirements may result in the child being excluded from school or childcare until the necessary immunizations are completed or the exemption is accepted.

Key elements of the Oregon Health Authority Nonmedical Exemption Certificate

Key elements of the Oregon Health Authority Nonmedical Exemption Certificate include:

  • Child's Information: Full name, date of birth, and school or childcare facility.
  • Parent or Guardian Information: Name and contact details of the parent or guardian requesting the exemption.
  • Healthcare Provider's Information: Name and signature of the healthcare provider who discussed vaccination options.
  • Reason for Exemption: A statement indicating the nonmedical reason for the exemption.

State-specific rules for the Oregon Health Authority Nonmedical Exemption Certificate

Oregon has specific rules regarding the Nonmedical Exemption Certificate. Parents or guardians must ensure that the exemption form is completed and submitted before the child's school enrollment deadlines. Additionally, the state requires that the exemption be renewed periodically, and parents may need to provide updated documentation to maintain compliance with state regulations. Understanding these rules is crucial for ensuring that children can attend school without interruption.

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Related links to Oregon Health Authority Nonmedical Exemption Certificate
COVID-19 Non-Medical Exemption Form

In order to receive an approved Non-Medical Exemption, you are required to view an. Oregon Health Authority or Oregon Tech sanctioned COVID-19 vaccine ...Read more

department of health and human ser tment of ...

May 9, 2008 — Processes for obtaining nonmedical exemptions to state immuni- zation laws. Am J Public Health 2001;91:645–8. 9. Smith PJ, Chu SY, Barker LE ...Read more

Oregon Health Authority : Nonmedical Vaccine Exemptions

There are two ways to claim a nonmedical vaccine exemption in Oregon. Option 1: Watch an online vaccine education module and submit a certificate of completion.Read more

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