Vaccine Exemption Form

April 3, 2001

Ginny has scanned the vaccine exemption card for the state of Pennsylvania.

Anyone in our Commonwealth is able to use this form... I suggest that you print

it out... The information that you should write in the line available to write

your reasons should be the exact same words that are used in the religious

exemption... Don't add any more and or chose any other wording... This way

your exemption will not be denied...

----- Original Message -----

From: Ginny Schoenman

Phyl

The vaccine exemption form is attached.

Love and hugs,

Gin

August 28, 2007

Yes—

Texas Vaccine Exemption Information

2005-2006 Texas Vaccine Exemption Information

The state of Texas in law grants and acknowledges the right of parents to

exempt their children from vaccination requirements for day care, school,

and college for reasons of conscience including a religious belief or for

medical reasons. In 2003, the Texas legislature passed changes to the

statutes expanding the reasons a parent can claim an exemption but the

Health Department has questionably also increased the bureaucratic red tape

necessary for claiming the exemption. There are specific procedures for

requesting an official state form and submitting it to the school or for

completing a medical exemption that all take some time so please don't wait

until the last minute to get your papers in order.

For everyone claiming an exemption for the first time after 9/1/03, you must

comply with the new law. If you've submitted an old religious exemption

prior to 9/1/03 you are grandfathered under the old law (see notes below)

and do not need a new form. The vaccine exemption forms for reasons of

conscience including a religious belief are only for students claiming a

vaccine exemption for the first time after 9/1/03 when the new law went into

effect. If you need to request forms from the state health department, you

can do it by fax, mail, or personal visit. If you send it by mail, we

suggest sending it registered mail with a receipt so you can keep track of

your request. If you send it by fax, set your fax machine to print out a

delivery receipt. We would like to keep track of the Health Department's

processing time.

According to the Texas Dept. of Health:

Written requests must be submitted through the U.S. Postal Service,

commercial carrier, fax at , or by hand-delivery to:

1946

DSHS Immunization Branch

1100 West 49th Street

Austin, Texas 78756

Hand-delivered requests may be submitted to the DSHS, Immunization Branch,

between 8 a.m. and 5 p.m. Mondays through Fridays. ALL affidavit forms will

be mailed to you via U.S. Postal Service. No requests will be filled at the

time of hand-delivery.

Affidavit form requests will be processed and mailed within one week from

the receipt of the request. If additional information is needed in order to

process the affidavit, you will be notified;

The letter must include the following information:

* Full name of each child for whom a form is requested (first,

middle, and last);

* Date of birth of each child for whom a form is requested;

* Parent or legal guardian’s complete return mailing address,

including zip code;

* Number of forms needed for each child (not to exceed five forms

per child)

Electronic mail or telephone requests cannot be processed.

The official Texas Department of State Health Services affidavit form must

be notarized and submitted to school officials. The form must be submitted

within 90 days from the date it is notarized.

The school will accept only official affidavit forms developed and issued by

the Texas Department of State Health Services (DSHS), Immunization Branch..

No other forms or reproductions will be allowed.

(SOURCE: http://www.tdh.state.tx.us/immunize/school_exclusion.htm)

IT IS OUR OPINION THAT PARENTS SHOULD OBTAIN A WRITTEN NOTE FROM THE SCHOOL

ACKNOWLEDGING RECEIPT OF THE EXEMPTION FORM. IF THE SCHOOL LOOSES THE FORM

THEY CAN KICK YOUR KIDS OUT OF SCHOOL. IF YOU HAVE A WRITTEN RECEIPT FROM

THE SCHOOL THAT YOU SUBMITTED THE FORM, YOU CAN PUT THE RESPONSIBILITY BACK

ON THE SCHOOL TO GO FIND IT AND KEEP YOUR CHILD IN SCHOOL.

It is also our opinion that the department is outside of the law requiring

that parents submit their children's names to get a form especially since

the law requires the department to develop a blank form. They are also

exceeding their authority in the statute by putting 2 year expirations on

the new forms as the statute specifies no expiration. This bullying behavior

is putting the department at risk for a legal challenge. However, for now,

until this is legally challenged, these are the dictatorial procedures the

DSHS has set up.

Ignorant school officials around the state are denying kids admission to

school if they have an old religious exemption affidavit saying they need

one of the new forms from the health department. THIS IS NOT TRUE! If you

hear this is happening in your district, please call the superintendent's

office and give them this link to the state health department where it

clearly says you don't need a new form. Also, when you transfer schools, the

old religious exemption letter is still part of your child's record and you

do not need a new one as long as it was part of your child's record prior to

9/1/03.

http://www.tdh.state.tx.us/immunize/docs/faq_exemption.pdf

On the bottom of page 2, it says:

Q. If a child currently has a religious exemption for vaccinations on file

with the school, do they need to obtain a new vaccine exemption for reasons

of conscience affidavit?

A. No. Students who are currently exempt from vaccination for religious

beliefs and already have an affidavit on file at the school they attend do

not need a new vaccine exemption affidavit form. The religious exemption on

file remains valid.

Also on page 2 it says:

Q. What if my child changes schools?

A. The vaccine exemption affidavit is part of the child’s school records and

should be sent to the new school with other school records.

Additionally, some schools, daycare facilities and colleges are saying they

don't have to accept the exemption. This is wrong - the law grants parents

this right and the schools and daycares can't take this right away. For

your convenience, we've posted links to the state statutes directly below.

The other option for parents to exempt their child from state immunization

requirements is with a medical exemption written by a doctor. This is

intended for families with children with health concerns or a past history

of reactions. While this option bypasses the bureaucratic red tape with the

new conscientious/religious exemption, the pressures on doctors to not write

these are great and it may be difficult to get a doctor who acknowledges a

vaccine reaction to substantiate that in writing by issuing an exemption

because of pressures being put on them to deny acknowledgement of vaccine

reactions.

Regardless, most families and physicians are not aware the exemption statute

was greatly expanded last session to make it much easier for a doctor to

write to protect a child from future reactions. No longer do they have to

say the vaccine would definitively harm the child but that it instead poses

a risk to the child. Any M.D. or D.O. licensed to practice medicine in the

United States can write the letter stating that " in the physician's opinion,

the vaccine required poses a significant risk to the health and well-being

of the child or any member of the child's household. " If the letter also

says this is for a lifelong condition, (the condition does not need to be

named) the exemption never has to be renewed. Otherwise it has to be renewed

annually. The doctor just needs to write it out on a piece of paper and

sign it. In this case, you can keep the original and give the school a copy.

Here is a sample medical exemption letter:

Medical Exemption to Immunization

In my opinion, the required immunizations pose a significant risk to the

health and well-being of (name of child). This is a lifelong exemption

for lifelong conditions.

Doctor's name, signature, and date

Laws Which Allow For Exclusions from Vaccine Requirements

Children and Education including Colleges:

* Texas Education Code, Health and Safety Chapter Section

<http://www.capitol.state.tx.us/statutes/docs/ED/content/htm/ed.002.00.00003

8.00.htm#38.001.00> 38.0001 - Immunization Requirement Exceptions

* Texas Education Code, Title 3 Higher Education Section

<http://www.capitol.state.tx.us/statutes/docs/ED/content/htm/ed.003.00.00005

1.00.htm#51.933.00> Chapter 51.933 - Immunization Requirements; Exceptions

* Texas Administrative Code Title 25 Part 1 Section 97 -

<http://info.sos.state.tx.us/pls/pub/readtac$ext.ViewTAC?tac_view=5 & ti=25 & pt

=1 & ch=97 & sch=B & rl=Y> Immunization Requirements in Texas Elementary and

Secondary Schools and Institutes of Higher Education

(this section contains vaccine requirements by rule, provisional enrollment,

and exemptions)

Day Care:

* Human Resource Code, Section 42.043 - Rules for

<http://www.capitol.state.tx.us/statutes/docs/HR/content/htm/hr.002.00.00004

2.00.htm#42.043.00> Immunizations and Exemptions

Health Care Providers:

* Texas Administrative Code Title 25 Part 1 Rule § 97.101-

<http://info.sos.state.tx.us/pls/pub/readtac$ext.ViewTAC?tac_view=5 & ti=25 & pt

=1 & ch=97 & sch=D & rl=Y> Statewide Immunization of Children by Hospitals,

Physicians, and other Health Care Providers

State of Texas:

* Texas Health and Safety Code, Section 161.004 - Statewide

<http://www.capitol.state.tx.us/statutes/docs/HS/content/htm/hs.002.00.00016

1.00.htm#161.004.00> Immunization of Children

-------------------------------------------------------

My best,

Jeff Sell, Esq.

Director of Chapters & Membership

Autism Society of America

7910 Woodmont Ave., Suite 300

Bethesda, MD 20814-3067

ext. 104 (office)

(cell)

(fax)

(e-fax)

www.autism-society.org

jzsell@...

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From: Texas-Autism-Advocacy

[mailto:Texas-Autism-Advocacy ] On Behalf Of

Sent: Tuesday, August 28, 2007 6:18 PM

To: Texas-Autism-Advocacy

Subject: VACCINE REFUSAL FORM

Is there a standard vaccine refusal form on the grounds of " religious

rights " . Our little girl (4 yrs) is being made to either provide the

form or get vaccinated.

thanks...

August 28, 2007