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COVID-19 VACCINATION MEDICAL EXEMPTION REQUEST FORM J#:___ Name: ___ Department: ___Physician Attestation: In compliance with the Presidents Executive Order and ILL Board Directive, Jackson State
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Obtain a medical exemption form from your healthcare provider or employer.
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Fill out the form completely and accurately, providing any necessary medical information and documentation.
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Who needs jsumsnethumanresourceswp-contentcovid-19 vaccination medical exemption?

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Individuals who have a medical condition or history that contraindicates receiving the COVID-19 vaccination.
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It is a form that individuals can fill out to request an exemption from receiving the COVID-19 vaccination based on medical reasons.
Individuals who are unable to receive the COVID-19 vaccination due to medical reasons are required to file the exemption.
To fill out the exemption form, individuals need to provide relevant medical documentation supporting their inability to receive the COVID-19 vaccination.
The purpose of the exemption is to provide individuals with a legitimate medical reason for not receiving the COVID-19 vaccination.
The exemption form must include detailed medical documentation explaining why the individual cannot receive the COVID-19 vaccination.
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