Medical Contraindication Form - Michigan - michigan 2025

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  1. Click ‘Get Form’ to open it in the editor.
  2. Begin by entering the child's full name in the designated field, ensuring accuracy for official records.
  3. Next, input the child's birth date in the format of Month/Day/Year to confirm their age.
  4. Specify the preschool program, childcare center, or school name where the child is enrolled.
  5. Indicate which immunizations are medically contraindicated by checking the appropriate boxes next to each vaccine listed.
  6. Provide a detailed reason for exemption in the space provided, ensuring clarity for health officials.
  7. Fill in the expiration date of the exemption using Month/Day/Year format.
  8. Print and complete the physician's name and address, along with their telephone number.
  9. Ensure that the physician signs and dates the form before submission.

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A medical waiver should be completed and signed by the childs physician and should state the contraindication, vaccine involved, and time period during which the child is prevented from receiving the vaccine. The parents/caregivers have valid religious or philosophical beliefs which prevent receipt of a vaccination.
Michigan allows philosophical and religious waivers, which means that no one seeking an immunization waiver for their child is denied. If a child cant receive a vaccine because of a medical condition, they will need a medical exemption form from their doctors office.
All states currently require children to be vaccinated against certain diseases in order to attend public schools. School vaccination requirements are an important tool for reducing the spread of diseases and increasing vaccination coverage rates.
2 If the child has not received these vaccines, documented immunity/waiver is required. During disease outbreaks, incompletely vaccinated children may be excluded from school. Parents and guardians choosing to decline vaccines must obtain a certified non-medical waiver from a local health department.
Michigans school vaccine waiver rates hit 6.2% in the 2024-2025 school year, the highest since 2013, data from the Michigan Department of Health and Human Services (MDHHS) showed. Waivers have also steadily increased since 2021, during the pandemic.
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