Dhhs 3987 form-2026

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The document is a Medical Exemption Statement from the North Carolina Department of Health and Human Services, specifically for the Immunization Branch. It provides guidelines for physicians to document true contraindications and precautions related to immunizations for patients. The form must be completed by a physician, signed, and submitted to schools or childcare programs as proof of medical exemption from vaccinations. It outlines specific contraindications and precautions for various vaccines, emphasizing that certain medical conditions may prevent vaccination or require deferral.

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Click ‘Get Form’ to open the dhhs 3987 form in the editor.
Begin by filling out the patient information section, including the name, date of birth, and address of both the patient and parent/guardian.
Indicate the school or child care program that the patient is associated with.
Review the list of vaccines and check any applicable contraindications or precautions that apply to the patient. Be sure to document any specific reactions as required.
Complete the section regarding when the exemption ends and provide your name as a physician, ensuring it is printed clearly.
Attach a copy of the most current immunization record before finalizing your submission.
Retain a copy for your records and return the original form to the requesting party.

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How to get a religious exemption form for vaccinations?

There are a number of ways that someone can prove strongly held religious beliefs that getting the vaccine would contradict. Writing a formal letter requesting exemption. Getting a close friend, family member or fellow member of the clergy to write a letter. Filling out and submitting a religious exemption request form:

What qualifies as a religious exemption in NC?

North Carolina law allows people to be exempt from vaccine requirements if they have religious beliefs that conflict with immunization. If you or your child shouldnt get a vaccine because of religious beliefs, write a statement of objection: North Carolina doesnt have a form or a template for religious exemptions.

What is a valid religious exemption reason?

California removed its personal and religious exemption option in 2015. Parent/guradian must complete an online educational module to receive a non-medical exemption. Connecticut removed its religious exemption option in 2021.

How do I get a religious exemption for vaccines in NC?

Objection to vaccination was also related to: faith in divine protection and healing for Protestants, Catholics, Jewish and Muslims (10); the use of aborted fetal cells for vaccines production among Amish and Catholic communities (including during the COVID-19 outbreak when Senior Catholic leaders from the US and

What is a good cause for immunization exemption?

Parents can ask for a medical exemption if a vaccine wouldnt be safe for their child. Reasons that children can get an exemption include: They have a disease or take medicine that weakens their immune system. They have a severe allergy to a vaccine or an ingredient in it.