Get the free Meningococcal Exemption Form 2.19.19
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Occupational Health Network 833 Chestnut Street, Suite 205 Philadelphia, PA 19107 Jesus Jefferson.edu STATEMENT OF EXEMPTION TO COLLEGE AND UNIVERSITY STUDENT VACCINATION Students name Date of Birth
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How to fill out meningococcal exemption form 21919
How to fill out meningococcal exemption form 21919
01
To fill out the meningococcal exemption form 21919, follow these steps:
02
Obtain a copy of the form from a healthcare provider or the relevant authority.
03
Read the form carefully to understand the information and requirements.
04
Provide personal details such as your name, date of birth, and contact information.
05
Answer the questions accurately and truthfully based on your situation.
06
If required, provide supporting documentation or medical records as evidence for exemption.
07
Review the completed form to ensure all information is accurate and complete.
08
Sign and date the form as required.
09
Submit the form to the appropriate authority or healthcare provider as instructed.
10
Keep a copy of the filled-out form for your records.
Who needs meningococcal exemption form 21919?
01
Meningococcal exemption form 21919 is needed by individuals who are seeking an exemption from receiving the meningococcal vaccine.
02
Typically, individuals may require this form if they have a medical condition or documented contraindication that prevents them from receiving the vaccine.
03
Specific eligibility criteria for exemption might vary depending on the local regulations and healthcare guidelines.
04
It is advised to consult with a healthcare provider or the relevant authority to determine if you qualify for a meningococcal exemption and require form 21919.
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