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Medical and Religious Exemptions from Vaccinations for School Attendance

• Medical exemption policy
• Requesting a medical exemption
• Religious exemption policy
• Requesting a religious exemption
• Board of Health statement on religious exemptions

Medical Exemption Policy

To request a medical exemption from one or more required vaccinations, the MSDH Medical Exemption Request (Form 139-M) must be completed and signed by the child's pediatrician, family physician, or internist who is duly licensed in Mississippi. Children receiving specialized or tertiary care outside of the state may have medical exemption requests completed and signed by their tertiary care physician.

All exemptions submitted by a Mississippi licensed pediatrician, family physician, or internist will be accepted based on the Medical Exemption guidelines below. Medical exemption requests completed and signed by a tertiary care physician outside of the state will be reviewed on a case by case basis.

Review of all medical exemption requests will be conducted at the Mississippi State Department of Health by the State Epidemiologist or Deputy State Epidemiologist.

Once the request is reviewed and accepted, a Certificate of Medical/Religious Exemption (Form 122) will be issued. Only the Certificate of Medical/Religious Exemption (Form 122) signed and dated by the State Epidemiologist or Deputy State Epidemiologist provides official, documented proof that a child has been issued an exemption by MSDH. The original Certificate of Medical/Religious Exemption (Form 122) will be housed at MSDH with a copy mailed to the parent and the requesting physician.

Follow up and request for additional information will be conducted by the State Epidemiologist or Deputy State Epidemiologist for out-of-state medical exemption requests if needed. The parent and the requesting physician will be contacted in the event that the out-of-state medical exemption request is not accepted.

Requesting a Medical Exemption

MSDH is receiving a large number of phone calls for appointments for religious exemption requests. If you have trouble reaching our appoint line, please be patient as we work to handle the large volume of calls.

Any requested medical exemption will be allowed if it meets the following guidelines

• An MSDH Medical Exemption Request (Form 139-M) must be completed and signed by the child's pediatrician, family physician, or internist who is duly licensed in Mississippi.
• Medical exemption requests completed and signed by a tertiary care physician outside of the state will be reviewed on a case by case basis.
• The same pediatrician, family physician, internist, or tertiary care physician must indicate on Form 139-M the medical condition of the child seeking exemption and indicate the exemption status for each of the listed vaccines.
• Form 139-M must be submitted to the Mississippi State Department of Health Epidemiologist or Deputy State Epidemiologist.
• The State Epidemiologist or Deputy State Epidemiologist will mail a copy of the Certificate of Medical/Religious Exemption (Form 122) to the parent and the pediatrician, family practitioner, internist, or tertiary care physician who submitted the Medical Exemption Request. The original Certificate of Medical Exemption (Form 122) will be housed at MSDH.

Data regarding medical exemptions will be maintained in the Immunization area of the MSDH website. See the report at the end of this page.

The exemption expiration date will be based on the circumstances for the exemption, and will be no less than one school year unless otherwise indicated on the request.

• Download Exemption Request (Form 139-M)

This policy will not amend the school law Section 41-23-37, Mississippi Code of 1972. Children with a Certificate of Medical Exemption who are not adequately immunized will be excluded from school if there is a threat of vaccine preventable diseases occurring in the community. The child will be excluded until the infectious disease is no longer present, or is no longer a threat to the safety and welfare of the child or other children in the school.

Questions regarding the medical exemption process or the medical exemption request form should be directed to the MSDH Office of Immunization at (601) 576-7751.

The medical exemption request form should be sent to the Mississippi State Department of Health central office in Jackson:

Mississippi State Department of Health
570 E. Woodrow Wilson, O-350
Attn: Immunization Office
Post Office Box 1700
Jackson, MS 39215-1700

Telephone: (601) 576-7751
Fax: (601) 576-7686

The State Epidemiologist or Deputy State Epidemiologist can also be reached at (601) 576-7725.

Religious Exemption Policy

The Mississippi State Board of Health strongly supports K-12 vaccination as a primary means of protecting our children from vaccine preventable communicable diseases and the resulting adverse outcomes.
Full statement from the State Board of Health

To request a religious exemption from one or more required vaccinations for Mississippi school entry, the parent or guardian must complete the MSDH Religious Exemption Request (Form 139-R) and submit to the County Health Department (appointment is required: 855-767-0170).

Requesting a Religious Exemption

Any requested religious exemption will be accepted by MSDH, and a Certificate of Medical/Religious Exemption issued if following guidelines are met.

1. An MSDH Religious Exemption Request (Form 139-R) must be completed, signed, and submitted to the County Health Department (appointment is required) by the child’s parent or guardian. Appointments can be made by calling 855-767-0170.
2. At the County Health Department appointment:
   • The parent/guardian will watch a Vaccine Education video and will be given the opportunity to ask questions.
   • An MSDH Nurse will discuss the benefits and risks of immunizations with the parent/guardian.
   • An MSDH Nurse will inform the parent/guardian that if any vaccine-preventable diseases for which the child has not been adequately immunized are occurring in or threatening to occur in the community, the child will, for the safety and benefit of him/herself and other children, be excluded from day care/school until the infectious disease is no longer present or is no longer a threat to the safety and welfare of the child or other children in the day care/school.
3. The County Health Department will submit the completed Form 139-R to the Mississippi State Department of Health, Office of Immunizations.
4. The State Epidemiologist or Deputy State Epidemiologist will accept and sign any Religious Exemption request that includes all the required components. MSDH will mail a copy of the signed Certificate of Medical/Religious Exemption (Form 122) to the parent and the daycare or school indicated on the Religious Exemption Request. The original Certificate of Medical/Religious Exemption (Form 122) will be housed at MSDH.

• Download the Religious Exemption Request (Form 139-R)

Data regarding medical/religious exemptions will be posted annually and will be maintained in the Immunization area of the MSDH website.

Questions regarding the religious exemption process or the religious exemption request form should be directed to the Office of Immunizations at (601) 576-7751.