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Religiously-based exemptions from the vaccination requirements for student attendance in school have been eliminated in New York State. That significant change to the state Public Health Law presents an opportunity for school districts to re-familiarize themselves with the only remaining basis for an exemption to the immunization requirements: the medical contraindication.

Public Health Law Section 2164(8) provides that “[i]f any physician licensed to practice medicine in this state certifies that [a required] immunization may be detrimental to a child’s health, the requirements of this section shall be inapplicable until such immunization is found to no longer be detrimental to the child’s health.”

The New York State Department of Health (DOH) has prepared a form for physicians which is available at https://www.health.ny.gov/forms/doh-5077.pdf. Schools cannot accept any other form of request for an exemption.

State regulations provide that no student shall be admitted to school without information from a physician licensed to practice in New York State who certifies, to the satisfaction of the principal or person in charge of the school “that immunization may be detrimental to the child’s health.”

The physician must:

  • Express the opinion that immunizing a child presents a greater risk to the child’s health than the risk of contracting a vaccine-preventable disease, consistent with guidance from the U.S. Centers for Disease Control (see https://www.cdc.gov/vaccines/hcp/acip-recs/general-recs/contraindications.pdf).

  • Provide sufficient information to identify a medical contraindication to one or more specific immunizations.

  • Specify the length of time the immunization is medically contraindicated.


On July 16, 2019, the Department of Health warned physicians regarding the serious potential consequences of their failure to ensure the integrity and compliance of serologic testing and false physician statements regarding students’ contraindications for medical exemption.

Districts can also check that the physician is indeed licensed to practice in New York State by visiting www.nydoctorprofile. com.

It is important to remember that there are many different immunizations required for students to attend school. One “red flag” that warrants additional scrutiny involves a physician checking boxes indicating that the child should receive none of the all eight types of immunizations that are indicated on the form.

School districts are empowered under law and regulation to insist on clarity: which specific vaccines are medically contraindicated, and what is the basis for the contraindication?

While principals or the person in charge of the school are responsible for ensuring that unvaccinated students are excluded from school, they should routinely enlist the aid of a school nurse or physician in reviewing exemption application forms. It is also proper for school officials to contact DOH for information and expert opinion. Schools with questions about medical exemptions may contact the DOH Bureau of Immunization,

School Assessment Unit at (518) 474-1944 or This email address is being protected from spambots. You need JavaScript enabled to view it.. Schools should be aware that physicians must designate a date upon which the exemption ends, if possible. There is a presumption in the statute itself (“…until such immunization is found to no longer be detrimental to the child’s health”) that a period of medical contraindication for a particular vaccination will end, and that the student will eventually be able to be immunized. School districts should request an ending date if that line has been left blank.

Any immunization exemption is valid for a maximum of one year. School nurses are in the best position to track the expiration of medical exemptions, and to follow-up with parents to ensure that immunizations are timely received once there is no longer a threat to the student’s health associated with being inoculated.

Members of the New York State Association of School Attorneys represent school boards and school districts. This article was written by Heather Cole of Ferrara Fiorenza P.C.

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