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Flu Vaccination Medical Exemption Form
MMS staff member: After the form below has been filled out by your treating medical provider, please visit
umms.org/FluVaxExemptions to complete an online declination
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How to fill out flu vaccination medical exemption
How to fill out flu vaccination medical exemption
01
Speak with a healthcare provider to determine if you are eligible for a flu vaccination medical exemption.
02
Provide documentation supporting your medical condition that prevents you from receiving the flu vaccine.
03
Fill out any required forms provided by your healthcare provider or employer.
04
Submit the completed exemption form to the appropriate parties for approval.
Who needs flu vaccination medical exemption?
01
Individuals with severe allergies to the components of the flu vaccine.
02
Individuals with a history of Guillain-Barre syndrome.
03
Individuals with a documented severe adverse reaction to a previous flu vaccine.
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What is flu vaccination medical exemption?
Flu vaccination medical exemption is a document that allows individuals to be exempt from getting the flu vaccine due to medical reasons.
Who is required to file flu vaccination medical exemption?
Individuals who are unable to receive the flu vaccine due to medical reasons are required to file a flu vaccination medical exemption.
How to fill out flu vaccination medical exemption?
To fill out a flu vaccination medical exemption, individuals must provide medical documentation from a healthcare provider explaining why they are unable to receive the flu vaccine.
What is the purpose of flu vaccination medical exemption?
The purpose of flu vaccination medical exemption is to ensure that individuals with valid medical reasons are exempt from getting the flu vaccine.
What information must be reported on flu vaccination medical exemption?
The flu vaccination medical exemption must include medical documentation from a healthcare provider explaining the medical reason for exemption.
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