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There is no requirement under the law that a school district communicate to parents regarding the availability of medical exemptions to immunizations or the process that the district uses in  evaluating them. But sharing this kind of information upon request can minimize misunderstandings.

School nurses generally are responsible for determining whether a school has received all  required medical paperwork – physicals and immunizations – for students. Principals and school nurses should have a protocol  to consult with each other whenever a request for a medical immunization is received.

When such a request is received, the district may wish to communicate to the parent that the law requires the district to exclude the student within 14 calendar days (up to 30 days in very limited circumstances)  unless immunizations are received or there is sufficient information to grant a medical exemption.

The principal or his/her designee should advise parents who request medical exemptions that the  request will be reviewed in accordance with the law and regulations as expeditiously as possible,  and that if the exemption is not granted, the student cannot remain in school for more than 14 days  (again, 30 days in limited circumstances). The district has no discretion in this regard.

In evaluating the application, the district may need the assistance of the family or the child’s physician(s). If the school physician believes it would be helpful to speak directly with the  child’s physician(s), the parents should be asked to complete a HIPAA-waiver in the form preferred  by the treating physician, so that the treating physician can speak with the school physician.

Parents should know that a delay in the provision of information may result in a denial of the exemption, and exclusion from school.

The family can also be advised that the district is permitted to, and may, seek input from professionals when making its decision. This could include, but may not be limited to, the school  physician, the local health agency, or other experts.

Finally, if an exemption is denied, parents should be informed of the reasons, in writing, and  advised that they can appeal to the commissioner of education. Also, the law requires districts to  inform local health authorities and provide parents with a self-developed consent form in which the parent can allow vaccination by local health authorities. Consult with your school  attorney to develop a letter to parents and a consent form.

– Heather Cole, Ferrara Fiorenza, P.C.


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