<>/Metadata 513 0 R/ViewerPreferences 514 0 R>> HIB k, =ah}/e,'Tb%];CF-Y-Z=ZQAJL\DTZ*^O1Qx[7IY7P'` Y\f" uCW/R{&]{h&.Y-]q7#0rQN;7;3q`mVjyxm$ppTkBzx+x" Wywoa}~@'G PDy3hyHE. Email: immunization.section@arkansas.gov. PLEASE NOTE: Incomplete forms will be returned for completion. 4815 West Markham Mail Slot 48 Immunization Requirements for Daycares and Schools. Medical exemptions to the COVID-19 vaccine have been a hot-button topic. FLU VIS. It establishes an immunization goal of 95% of each school's student population and requires . The University of Arkansas for Medical Sciences mandates influenza, MMR, Tdap, Covid-19, Varicella. By checking the box below, I am requesting an exemption from this vaccine. Korin Miller is a freelance writer specializing in general wellness, sexual health and relationships, shopping, and lifestyle trends, with work appearing in Womens Health, Self, Prevention, Forbes, Daily Beast, and more. Tdap (Tetanus, Diptheria, Pertussis) Q: What are the immunization requirements for colleges, schools, and daycares? If aSMART Health Card compatible verifier app is not available, you may present the paper copy of your SMART Health Card. NOTE: You MUST have access to a printer before you start the online application process. They are available in local health departments and many physicians offices. 1 and Hepatitis B (for those exposed to blood and body fluids, vaccinations for all of its employees. A new Exemption Form Must Be Completed Every School Year. Complete and mail, fax or email to: NH Immunization Reporting Form for NH's 22-23 All Rights Reserved. TD (Tetanus, Diphtheria) However, this might not mean that you can't be vaccinated at all. Health Insurance Marketplace is a registered trademark of the Department of Health and Human Services. %PDF-1.5 Additional information on SMART Health Cards is available here. An application requesting an exemption must be submitted for each child and for each child care or school the student attends. Arkansas Immunization Exemption Application Centers for Disease Control and Prevention. The COVID-19 SMART Health Care QR Code is not connected to the WebIZ. Vaccine clinics and events may also be available in your area through hospitals, health care providers, or your worksite. Answer: Here. The application may be completed by parents or guardians of students or by students who are 18 years of age or older. 4 0 obj What Are the Differences Between the Pfizer and Moderna COVID-19 Vaccines? Unless granted a legally-required exception because of a disability or because of a sincerely held religious belief, practice, or observance, all covered federal employees are required to be vaccinated against COVID-19 and to provide documentation concerning their vaccination status to their employing agency. 2017 Arkansas Department of Health. ATTN: Exemptions However, as the situation surrounding COVID-19 continues to evolve, it's possible that some data have changed since publication. Health.com uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. There are several actions that could trigger this block including submitting a certain word or phrase, a SQL command or malformed data. 2017 Arkansas Department of Health. UAMS Form for Medical Exemption from Covid-19 Vaccination . When you receive a COVID-19 vaccination record from the Arkansas Department of Health or your health care provider and the record is from the state immunization information system, WebIZ, the record will contain your COVID-19 vaccination history and a 2D barcode, commonly known as a QR code. What Conditions Can Get You a Medical Exemption From the COVID-19 Vaccine? When you receive a COVID-19 vaccination record from the Arkansas Department of Health or your health care provider and the record is from the state immunization information system, WebIZ, the record will contain your COVID-19 vaccination history and a 2D barcode, commonly known as a QR code. PLEASE NOTE: The form requires a signature and seal of a Notary Public. Hepatitis A x[mo)aOvVU4IjzM~ 6p7yx;]6a8=-BG Click to reveal Code Ann. download the latest version for free right now to be sure, install the most recent version of Adobe Reader software, Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Georgia, Hawaii, Illinois, Indiana, Iowa, Kansas, Louisiana, Michigan, Mississippi, Missouri, Montana, Nebraska, New Hampshire, North Carolina, North Dakota, Ohio, Oklahoma, Oregon, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, West Virginia, Wisconsin, Wyoming, California, Colorado, Idaho, Kentucky, Maine, Massachusetts, Minnesota, Nevada, New Jersey, New Mexico, New York, Pennsylvania, Rhode Island, Vermont, Washington, Chrome and Firefox users: Choose "Save Link As", Microsoft Edge users: Choose "Save Target As", Safari users: Choose "Download Linked File as". Screening Checklist HIB A medical exemption is due to a patient having a contraindication to the vaccine, meaning getting it could be bad for their health. All Rights Reserved. Each time you receive an additional dose of COVID-19 vaccine, you will need to obtain a new COVID-19 SMART Health Card to ensure all vaccinations are included on your card and in your QR code. Arkansas Immunisation Exemption Application. This website allows you to submit an application for exemption. 7500 Security Boulevard, Baltimore, MD 21244. 4815 West Markham Street Little Rock, Arkansas 72205-3867 Cell (501) 661-2000 . Quick Fact: Immunization requirements shall not apply if the parents/legal guardian of the child or the student objects on the grounds that immunization conflicts with the religious or philosophical beliefs of the parent/guardian or student. 2 0 obj For information, inquiries, feedback and comments contact us. The Arkansas Board of Health requires that all children attending childcare facilities and public or private schools in the State of Arkansas be immunized against vaccine-preventable diseases and also requires that all students attending colleges and universities in the State of Arkansas be immunized against measles, mumps, and rubella. Complete and mail, fax or email to: Arkansas Department of Health, ATTN: Exemptions 4815 West Markham - Mail Slot 48 Little Rock, AR 72205. Meningococcal ACWY The application may be completed by parents or guardians of students or by students who are 18 years of age or older. Your medical provider must complete Part 2 of this form. When youre ready to fill out the exemption application: Youll need to have a recent version of Adobe Reader software installed on your computer to open the exemption application. And while plenty of people may claim they have a medical exemption from getting vaccinated, legitimate medical exemptions are "very uncommon," William Schaffner, MD, an infectious disease specialist and professor at the Vanderbilt University School of Medicine, told Health. The QR code may be scanned into an app on your smartphone and used to verify your COVID-19 vaccination history at places that have a SMART Health Card compatible verifier app, such as airports, business, and large venues. Current Revision Date: 02/2022 Authority or Regulation: 5 U.S.C. What conditions could cause someone to be medically exempted from the COVID-19 vaccine? PLEASE NOTE: The form requires a signature and seal of a Notary Public. Varicella (Chickenpox), 2023-2024 College Immunization Exemption Application If you verified you right-clicked and your Adobe is up-to-date, Check if you qualify for a Special Enrollment Period. endobj endobj The form asks. If you do not have access to a printer, you will need to complete the paper form of the application. <> A goal of the Arkansas Department of Health is to control and prevent the spread of these diseases by providing vaccines to local health units in each county and over 500 non-health department facilities in Arkansas. 4815 West Markham Street Little Rock, Arkansas 72205-3867 Telephone (501) 661-2000, Arkansas Immunization Exemption Application. If you do not have access to a printer, you will need to complete the paper form of the application. % The University of Arkansas for Medical Sciences is mandating COVID-19 vaccination for all its employees, non-employees and students. It mostly boils down to allergies and allergic reactions to vaccine ingredients said Dr. Schaffner. For information regarding mass flu clinics and school flu clinics, please contact your local publichealth unit. For people who experience this or another adverse event following a shot, the CDC encourages you to report it to the Vaccine Adverse Event Reporting System (VAERS). 3 0 obj Answer:Patients should contact the clinic or provider who gave the immunization. For information, inquiries, feedback and comments contact us. Rochelle Collins, DO, is a board-certified family medicine physician and assistant clinical professor of family medicine at Quinnipiac University. A physician statement outlining medical reasons for an exemption of a specific immunization is to be submitted to the Medical Director of the Immunization Section with the exemption form. Nine of the 146 veterans home employees have requested covid-19 vaccine exemptions, and all nine were still being processed Friday, Harper said. 75.119.198.104 You are asked to sign that you havereviewed the Vaccine Information Statements, that you understand the risks and benefits of the vaccines, and that you still choose to request an exemption. Office of Performance Management Quality Improvement and Evaluation, 2023-2024 Childcare-School Immunization Exemption Application, 2022-2023 Childcare-School Immunization Exemption Application, 2023-2024 College Immunization Exemption Application, 2022-2023 College Immunization Exemption Application, Immunizations Required for AR Daycares & Schools, NH Immunization Reporting Form for NH's 22-23, Recommended Immunizations for Children (Birth through 6 Years), Recommended Immunizations for Preteens and Teens (7-18 Years), Recommended Immunizations for Adults (19 Years and Older) by Age and Medical Condition, Recommended Immunization Schedule for Children and Adolescents aged 18 Years or Younger, Recommended Immunization Schedule for Adults. This form must also be signed by a Notary . You are responsible for retaining the original letter. Hepatitis A Exemptions shall be granted only by the Arkansas Department of Health. Here's a list of the Comirnaty/Pfizer-BioNTech vaccine ingredients: While we're at it, here's a list of the ingredients in the Moderna COVID-19 vaccine: And the ingredients for the Johnson & Johnson COVID-19 vaccine: For each vaccine, the contraindication is the same: You shouldn't get it if you have had a severe allergic reaction to one of the ingredients in the vaccine. Signature of Patient/Parent/Guardian: Please sign here ___________________________Date__________________ RELEASE AND ASSIGNMENT: Sun Apr 30 2023 06:24:07 GMT-0700 (Pacific Daylight Time) Loading. An application with a notarized signature of the parent or guardian must be submitted each school year to the Department of Health. 2023-2024 Childcare-School Immunization Exemption Application Incomplete forms will be returned for completion. TD (Tetanus, Diphtheria) If you believe there are COVID-19 vaccinations missing from your COVID-19 SMART Health Card, you may reach out to the site where you received the vaccination to have it added to the WebIZ system. Meningococcal ACWY For information, inquiries, feedback and comments contact us. "Getting vaccinated is important," said Dr. Schaffner. Getting the COVID-19 Vaccine: What to Expect Before, During, and After Your Appointment, Is the COVID-19 Vaccine Safe for Everyone? %PDF-1.7 If you believe there are COVID-19 vaccinations missing from your COVID-19 SMART Health Card, you may reach out to the site where you received the vaccination to have it added to the WebIZ system. HB1977 and SB739 would require employers that mandate vaccinations to provide an exemption process for workers, including requiring them to produce a negative antigen test once a week or proof of. When approved, exemptions will be effective for the start of the Fall session and go through the Summer sessions. 2023-2024 Childcare-School Immunization Exemption Application Each request for exemption, regardless of the reason, is evaluated individually by Student and Employee Health Services, and if needed, the Office of Human Resources. By getting shots on time, you can protect your child and yourself from disease and protect others at home, daycare, school, or work. Eligible Arkansans can make an appointment with a vaccine provider. A vaccine exemption Affidavit is a document that is sworn by you and signed before a notary public (including a notary or a paralegal) in order to establish your request to be exempt from the COVID-19 vaccine.

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