COMMONWEALTH OF KENTUCKY CERTIFICATE OF MEDICAL EXEMPTION 2026

1. Click ‘Get Form’ to open the COMMONWEALTH OF KENTUCKY CERTIFICATE OF MEDICAL EXEMPTION in our editor.
2. Begin by entering the child's name and birthdate in the designated fields. Ensure accuracy as this information is crucial for identification.
3. Next, fill in the name of the parent or guardian along with their address, including street, city, state, and zip code.
4. In the section regarding health conditions, specify any recognized contraindications to vaccines. Clearly list the vaccine(s) that are contraindicated.
5. Document the dates of immunizations administered for each vaccine listed. Use the provided format (Month/Day/Year) for consistency.
6. Ensure that a licensed healthcare provider certifies the form by signing and dating it at the bottom. Include their office or facility name.
7. Once completed, save your document and share it with your child’s school or facility as required.

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