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Name___DateofBirth___University ID___
REQUESTFORMEDICALEXEMPTIONFROMUNIVERSITYOFDENVER
COVID19BOOSTERVACCINATIONREQUIREMENT
TheColoradoDepartmentofPublicHealth&Environment(CACHE), theColoradoDepartmentofHigherEducation,
andtheUniversityofDenver(DU)stronglysupportrequiringfullvaccinationofstudentsagainstCOVID19toreturn
toinpersonlearningandoncampusactivities
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How to fill out request for medical exemption

How to fill out request for medical exemption
01
Obtain medical documentation from your healthcare provider stating the medical condition that requires the exemption.
02
Fill out the request form provided by your employer or school, including your personal information and the details of your medical condition.
03
Attach the medical documentation to the request form.
04
Submit the completed request form and medical documentation to the appropriate person or department for review and approval.
Who needs request for medical exemption?
01
Individuals who have a medical condition that prevents them from receiving a vaccination or following a certain medical protocol.
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What is request for medical exemption?
A request for medical exemption is a formal application submitted to a relevant authority seeking exemption from a mandated medical treatment, such as vaccinations, based on individual health concerns or medical conditions.
Who is required to file request for medical exemption?
Individuals who cannot receive certain medical treatments or vaccinations due to health issues, allergies, or contraindications as determined by a licensed healthcare provider are required to file a request for medical exemption.
How to fill out request for medical exemption?
To fill out a request for medical exemption, individuals typically need to provide personal information, details of the medical condition, a statement from a healthcare provider, and any supporting documentation that verifies the need for exemption.
What is the purpose of request for medical exemption?
The purpose of a request for medical exemption is to allow individuals with legitimate medical concerns to opt out of mandatory medical treatments or vaccinations while ensuring that their health needs are properly documented and recognized.
What information must be reported on request for medical exemption?
The request for medical exemption must include personal identification information, medical history relevant to the exemption request, details about specific vaccines or treatments being exempted, and a signed statement or letter from a healthcare provider.
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