Printable Immunization Exemption Form Tennessee The state s immunization requirements consider the current schedule published by the Centers for Disease Control and Prevention CDC and endorsed by the American Academy of Pediatrics AAP and American Academy of Family Physicians AAFP Tennessee s list of required immunizations is created through the normal open rule making process
Tennessee Department of Health CERTIFICATE OF IMMUNIZATION Child s Name Last name first name middle Birthdate Section 1a Religious Exemption mm dd yy Parent Guardian Name Last name first name middle Phone please include area code xxx xxx xxxx Address Hib Child Care Only 5 years Pneumococcal PCV Child Care Only 5 years When opting out an individual s basic identifying information such as name and date of birth remains in TennIIS If any healthcare provider or electronic medical record system attempts to submit vaccine records for that individual the vaccine data will be unable to update immunization information on that record
Printable Immunization Exemption Form Tennessee
Printable Immunization Exemption Form Tennessee
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I have reviewed the CDC website information regarding the indicated immunizations at cdc gov vaccines pubs vis default htm and understand the possible risks of not receiving immunizations include becoming infected with the disease death transmitting vaccine preventable disease to others exclusion from school or house quarantine during an ou In the absence of an epidemic or immediate threat of an epidemic a student may attend school exempt from the legal requirement of proof of immunization if the parent or guardian submits a signed written statement that immunizations conflict with the parent s or guardian s religious tenets and practices affirmed under the penalties of perjury
Update December 1 2021 The Tennessee Comptroller s Office suspended exemptions issued under the provisions of Public Chapter 6 of the 2021 Third Extraordinary Session after a federal court judge in Kentucky issued a preliminary injunction on Tuesday November 30 This form must be completed and signed noting the exemption Please keep a record of this form in the event it is requested MEDICAL EXEMPTION The following immunization s is are medically contraindicated for this student employee Measles Mumps Rubella Influenza Varicella Hepatitis B Series TD Tdap Other Reason for exemption s
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If you are new to Tennessee and need your child s vaccination information transferred to an Official Tennessee Immunization Certificate to enroll them in school childcare or for another purpose bring your child s immunization records to your Tennessee healthcare provider or any local Health Department in Tennessee for a validated Official Submit Your Immunization Records Print Instructions Step 1 Complete online tuberculosis Students can submit their immunizations records or the immunizations exemption form online using the Student Health patient portal University of Tennessee Student Health Center 1800 Volunteer Blvd Knoxville TN 37996 3102
Through TennIIS authorized users can access the Immunization Certificate Validation Tool ICVT to print out validated Official Immunization Certificates for children with complete records validation failure reports for children with incomplete records and temporary certificates for children who are as up to date as possible A Tennessee proposal prohibiting the government from mandating COVID 19 vaccination and allowing religious exemptions cleared the Senate 20 8 Thursday despite concerns the bill could lead to
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https://www.tn.gov/health/cedep/immunization-program/ip/immunization-requirements.html
The state s immunization requirements consider the current schedule published by the Centers for Disease Control and Prevention CDC and endorsed by the American Academy of Pediatrics AAP and American Academy of Family Physicians AAFP Tennessee s list of required immunizations is created through the normal open rule making process
https://www.tn.gov/content/dam/tn/health/documents/TN_Immunization_Certificate_Sample.pdf
Tennessee Department of Health CERTIFICATE OF IMMUNIZATION Child s Name Last name first name middle Birthdate Section 1a Religious Exemption mm dd yy Parent Guardian Name Last name first name middle Phone please include area code xxx xxx xxxx Address Hib Child Care Only 5 years Pneumococcal PCV Child Care Only 5 years
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Printable Immunization Exemption Form Tennessee - Update December 1 2021 The Tennessee Comptroller s Office suspended exemptions issued under the provisions of Public Chapter 6 of the 2021 Third Extraordinary Session after a federal court judge in Kentucky issued a preliminary injunction on Tuesday November 30
