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Request for Medical Exemption from MMR, Varicella and/or Tdap Vaccine Vaccines: MMR Varicella Tdap Date of Request: ___ Name: ___ Phone___ DOB: ___/___/___ SITE: Abington Jefferson Northeast TJUH

How to fill out request for medical exemption

How to fill out request for medical exemption

1. Obtain medical documentation from a healthcare provider outlining the medical condition that requires an exemption
2. Fill out the necessary form provided by the organization requiring the exemption
3. Attach the medical documentation to the form
4. Submit the completed form and documentation to the appropriate department or individual for review

Who needs request for medical exemption?

1. Individuals with medical conditions that prevent them from complying with certain requirements or regulations
2. Employees seeking accommodations in the workplace due to medical reasons
3. Students requesting exemptions from school vaccination requirements

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What is request for medical exemption?

A request for medical exemption is a formal application submitted by an individual to be excused from certain medical requirements or obligations, such as vaccinations, due to specific health conditions.

Who is required to file request for medical exemption?

Individuals who have health conditions that preclude them from meeting medical requirements, such as vaccinations, 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 complete a designated form, provide necessary medical documentation, and explain the medical reasons for the exemption.

What is the purpose of request for medical exemption?

The purpose of a request for medical exemption is to ensure that individuals with legitimate health concerns are not required to fulfill certain medical requirements that could endanger their health.

What information must be reported on request for medical exemption?

The request for medical exemption must include personal information such as the individual's name, date of birth, nature of the medical condition, physician's statement, and any supporting medical documentation.