MICHIGAN - IMMUNIZATION EXEMPTIONS by State (includes current statutes, letters & forms)
IMMUNIZATION EXEMPTIONS by State (includes current statutes, letters & forms)Michigan
Current Statutes & Laws: http://www.909shot.com/state-site/Michigan.htm
Medical, Religious & Philosophical
A child is exempt if a parent of the child presents a written statement to the administrator of the child's school that the child should not be immunized because of religious convictions or other objection to immunization.
PDF
documents (.pdf)
A special reader, Acrobat Reader software for
Windows(TM), Macintosh(TM), MS-DOS(TM), SGI(TM), and Sun(TM) is required
and is available free from Adobe.
Download
Acrobat Reader:
Exemption Letters & Forms...
Birth Exemptions:
For those who are planning a hospital birth but want to evade invasive routine post natal procedures such as a Hep B shot, vitamin K injection, newborn screening, or the application of silver nitrate in the newborn's eyes, a very specific birthing plan must be submitted to the hospital in advance of the birth. Hospital staff must be informed, in advance, of your needs, wants and desires where your baby and birthing experience are concerned. The same applies to midwives.
Vitamin K Injection...
The prescribing information on Vitamin K shot states that fatalities are an adverse reaction according to the Merck pharmaceutical package insert.
(.pdf) http://www.fda.gov/medwatch/SAFETY/2003/03Feb_PI/AquaMEPHYTON_PI.pdf"WARNING - INTRAVENOUS USE Severe reactions, including fatalities, have occurred during and immediately after the parenteral administration of AquaMEPHYTON® (Phytonadione)."Alternatives to Vitamin K Prophylaxis...
fatalities=death
Although oral vitamin K is not licensed for use as a drug by the FDA, drops for oral administration are available. Typically, one drop contains 2 mg. of vitamin K. Contact a midwife in your area, or a birthing supply company (such as birthwithlove.com), or Scientific Botanicals (206 527-5521) where your health care provider can order liquid vitamin K directly.
Here's another much safer alternative that your chiropractor or naturopath can order for you.
http://www.bioticsresearch.com/Products/BioK.htm
A good organic whole food diet along with lots of leafy green vegetables is all that is necessary to prevent vitamin K deficiency in newborns.
Sample Vaccine Letters From this website... http://www.vaccines.bizland.com/letters.htm
Most states now require the Hepatitis B vaccine for newborns. Many parents are also cornered by emergency room personnel during accident visits. Hospitals nationally are under pressure to utilize every opportunity to score a "hit." If your pediatrician understands your views, get him involved with the hospital. As a last resort, protect your right to receive quality care in the following manner. (Usually, you'll never find anybody in the hospital to sign this simple form):
"I certify that the (Name of Vaccine)________ vaccine being administered to (Name of Child)_________ is free from all known and yet unknown zoonotic or human viruses or viral fragments and will not cause acute or chronic illness in the recipient due to viral contamination or as a reaction to the components of this vaccine. (Signature of Physician and Date)_________."
If you do get a signature, hold on to the form.
(Links to model birth plan letter and acceptance of responsibility)
Acceptance of Responsibility. http://www.vaclib.org/legal/accept1.htm
Model Birth Plan Letter for Hospital Births. You can attach an exemption from immunizations. In some states, there are religious exemptions from newborn screening tests such as PKU, etc...
(.doc) Model Letter
for Hospital Births (Model11425.doc) Model Birth Plan Letter for Hospital Births. This one is more detailed. You can attach an exemption from immunizations. In some states, there are religious exemptions from newborn screening tests such as PKU, etc...
(.doc) Model
letter for hospital births 2.doc (11426)Model Birth Plan Letter for Hospital Births for an adopted child...
Model letter for hospital births for adoptions -- Dear Doctor and Medical Staff.doc (11427)
(.doc) VaccineTruth.net/letters/Model
letter for hospital births for adoptions.doc
The above documents can also be made available in WordPerfect 
(.wpd)
format.
Please email us at Exemptions Contact Page
if you want the model birth plan letters in WordPerfect.
Or you can
do your own model birth plan letter online...
Hospital Birth Preference
Plan ~ Birth Naturally, LLC
http://www.birthnaturally.org/GentleBirth/hospitalplan.html
The
birth plan arrangements and letter should be turned in before delievery
date.
This "Refusal to Permit Medical Treatment" form is optional
to use.
"Refusal to Permit Medical Treatment" form
Refusal to
Permit Medical Treatment. A generic form. (.pdf) http://www.scpie.com/riskmgmt/forms/refusal_treatment.pdf
It
would be good idea to use with the AFFIDAVIT below AND model
birth plan letter. I hope someone uses this affidavit, model birth plan
letter and refusal forms, and succeeds. We want to hear about it when
someone is successful with this. The ACCEPTANCE OF
RESPONSIBILITY is imperative in exercising your rights for legal
exemptions from forced medical experimentation and legalized bioterrorism.
DO be prepared to fight for your baby's rights!
Birth plan
religious AFFIDAVIT text below. Use with model birth plan letter and/or
refusal forms, and edit as needed...
AFFIDAVIT is available in
Microsoft Word
(.doc) and WordPerfect (.wpd)
format. Contact us.
AFFIDAVIT
I/We, _________________________, Sui Juris, Free, Natural Flesh and Blood Human Being(s), state Citizen(s) of the Michigan Republic affirm: Be it known to all courts, governments, and other parties that:
Being (a person/people) of Strong Christian Morals, it is against (my/our) Deep, Sincerely Held, Religious Convictions to accept the injection of any foreign substance into (my Body/our Bodies) or the Body of (my/our) Child. This includes, but is not limited to, any and all, Vaccinations, Shots, Tests for Diseases, Oral Vaccines, Epidermal Patches and in any other way that Live or Killed Bacterium, Viruses, Pathogens, Germs, or any other Microorganisms, may be introduced into or upon (my/our) newborn's body.
This written statement to exempt (my/our) newborn from any immunizations, newborn screening, and the Vitamin K shot, because (Iwe) hold genuine and sincere personal religious beliefs which are inconsistent with these medical procedures & experimentation. The practice of vaccination and the injection or application of any foreign substance is contrary to (my/our) conscientiously held religious beliefs and practices, and violates the free exercise of (my/our) religious principles.
The Hepatitis-B vaccine supposedly protects against a disease that is only transmitted through multiple sexual partners or street IV drug users and therefore usurps (my/our) parental authority to condemn such activity in (my/our) child. The acceptance of this vaccine promotes sexual promiscuity and immoral behavior in direct contradiction to the teachings of (my/our) faith.
The prescribing information on Vitamin K shot states that fatalities are an adverse reaction according to the Merck pharmaceutical package insert.
http://www.fda.gov/medwatch/SAFETY/2003/03Feb_PI/AquaMEPHYTON_PI.pdf
"WARNING - INTRAVENOUS USE Severe reactions, including fatalities, have occurred during and immediately after the parenteral administration of AquaMEPHYTON® (Phytonadione)."A conflict arises because (my/our) religious convictions are predicated on the belief that all life is sacred. God's commandment "Thou Shall Not Kill" applies to the practice of injection of carcinogenic substances that can kill.
(We / I) {First and Last name(s)}, as the {(parent (s) /guardian(s)} of (name of newborn child) are exercising (our/my) rights under the First Amendment of the US Constitution and [insert Michigan immunization/testing exemptions birth statutes here, if applicable] to receive Religious Exemption from Vaccination, ALL injections, & testing.
Applicable law has been interpreted to mean that a religious belief is subject to protection even though no religious group espouses such beliefs or the fact that the religious group to which the individual professes to belong may not advocate or require such belief. Title VII of the Civil Rights Act of 1964 as amended Nov. 1, 1980; Part 1605.1-Guidelines on Discrimination Because of Religion.
Our legal rights are guaranteed by the free exercise clause of the First Amendment to the U.S. Constitution. Recent court decisions have upheld the rights of individuals seeking exemptions from immunizations based upon personal and religious reasons. On the U.S. Supreme Court level in Frazee V. Illinois Dept. of Security, 489 U.S. 829, it was found that a state may not deny an exemption simply because a person is not a member of a formal religious organization.
The Lord Jesus Christ and Our Creator are the only source of protection of (my body/our bodies) and that of (my/our) family that (I/we) can accept.
(I/We) affirm that vaccination & injections of any foreign substances and proteins conflict with (my/our) religious beliefs as stated above. Therefore, (I/we) would request that you accommodate (my/our) religious beliefs and practices by exempting (my/our) newborn child from any vaccinations, injections and testing of any kind.
Rest assured that (my family and I/our family) do practice a form of immunization that keeps our immune systems strong and is in keeping with Biblical principles.
Further Affiant Saith Not
The use of notary below is for identification only, and such use does NOT grant any jurisdiction to anyone.
Subscribed and sworn, without prejudice, and with all rights reserved, (Print Name Below)
_______________________________________________________________,
Principal, by Special Appearance, in Propria Persona, proceeding Sui Juris.
_______________________________
Signature of Affiant
ACKNOWLEDGMENT
state of Michigan
county of _________________:
On this _______ day of ______________, 200__, before me
personally appeared __________________________________, to me known to be the person described in and who executed the foregoing instrument and acknowledged that he executed the same as his free act and deed, for the purposes therein set forth.
_______________________________________
(Notary Public)
My Commission Expires ______________________________, 200___
The above AFFIDAVIT is available in Microsoft Word
(.doc) and WordPerfect (.wpd)
format.Click here to Contact Donna.
Postnatal - 2 months (first "well baby" visit):
If you do take your new baby to an MD as opposed to a naturopath and/or chiropractor, please be aware and careful of any forms you sign.
We're referring to those "Refusal To Vaccinate" forms put out by the American Academy of Pediatrics. Go to this page below and find out why signing this form is very dangerous. We all know about these forms and how they can be used to undermine parental rights...
http://www.vaclib.org/legal/donotsign.htm
State Form Required: No. However, there is a state exemption form that can be used. Schools are using their own forms or the ones provided by Neola.
"By endorsing this particular waiver, parents would essentially be signing an admittance of neglect and or "abuse" for refusing vaccines. The language contained in this waiver could put parents and caregivers in jeopardy down-the-line if they should ever find themselves in the courts due to their child's health problems, when confronted with child protective services, divorce, or just about any matter pertaining to that child that could be used against the parent(s).
Please read any waiver provided by your child's doctor carefully before signing. Instead, offer a formally written and signed letter that simply says that you do not wish to vaccinate your child. If you are unsure of the language in the waiver, buy some time by telling your doctor that you need to consult with a lawyer before signing it. "
Anai Rhoads Ford
Human Rights Journalist
Why Signing a Waiver to Avoid Vaccines Can Be Considered Abuse by Anai Rhoads Ford, released 15 November 2005.
http://www.anairhoads.org/
Media Contact (703) 491-1903
Daycare & Preschools: Same as schools. Can use one of the forms below.
Schools:
Michigan Opposing Mandatory Vaccines M.O.M. Form
(.pdf) http://www.momvaccines.org/momform.pdf
(.pdf) http://www.vaccinationnews.com/dailynews/March2002/Michigan%20M.O.M.%20Vaccination%20exemption%20form.pdf
The State of Michigan Immunization Waiver Form
(.pdf) http://www.momvaccines.org/miform.pdf
Sample form to paste into a Word document... http://www.earlyonmichigan.org/SampleLetters.htm
Western School District
Parma, MI 49269
Western High School
Immunization Waiver Form
State of Michigan, Department of Community Health
(this is a link to the site)
(.pdf) http://web.archive.org/web/20030702023614/http://www.salineguide.com/mom/miform.pdfOakland County Schools
State of Michigan Immunization Waivers
Religious/Conscientious
English
(.pdf) http://www.vaclib.org/letters/waiver_eng.pdf
Spanish
(.pdf) http://www.vaclib.org/letters/waiver_spanish.pdfMedical Exemption
English
(.pdf) http://www.vaclib.org/letters/med_waiver_eng.pdfSpanish
(.pdf) http://www.vaclib.org/letters/med_waiver_spa.pdfNeola Forms for some Michigan public school districts...
Eastern Upper Peninsula Intermediate School District
Immunization Waiver 5320 F3 (Generic Form)
Easternupisd-mi fm5320F3
(.pdf) http://www.neola.com/Easternupisd-mi/search/forms/fm5320F3.pdf
The following schools can also use the above fm5320F3
Note: Some schools may ask for an additional statement. If that's the case, use the M.O.M. form above.
Warren Consolidated
IOSCO ISD
Dickinson-Iron Intermediate School District
Clarkston Community Schools
Ubly Community Schools
Fruitport Community Schools
Hillsdale Community Schools
Reed City Area Public School
Wexford-Missaukee Intermediate School District
Union City Community Schools
Carson City-Crystal Area Schools
Menominee Intermediate School District
Johannesburg-Lewiston Schools
Sturgis Public Schools
Benzie County Central School District
Traverse Bay Area Intermediate School District
Mt. Pleasant Public Schools
Columbia School District
Otsego Public Schools
Marquette Area Public Schools
Lawton Community Schools
Reading Community School District
Cheboygan-Otsego-Presque Isle ISD
All the above schools can use the Neola Medical exemption waiver form:
(.pdf) http://www.neola.com/whitmorelake-mi/search/forms/fm5320F2.pdf
Some of the Immunization Waiver 5320 F3 and Medical Contraindication 5320 F2 forms are generic, meaning courtesy of the Michigan Department of Health. If your school is not listed, then download one of the generic forms marked (Generic Form)
The forms not marked (Generic Form) means it's specific for that school and the school's name is mentioned on form. The Generic forms may also be used for daycare and preschools.
Bangor Public Schools
Immunization Waiver 5320 F3 (Generic Form)
(.pdf) http://www.neola.com/bangor-mi/search/forms/fm5320F3.pdf
Medical Contraindication 5320 F2 (Generic Form)
(.pdf) http://www.neola.com/bangor-mi/search/forms/fm5320F2.pdf
Rogers City Area Schools
Immunization Waiver 5320 F3 (Generic Form)
(.pdf) http://www.neola.com/rogers-mi/search/forms/fm5320F3.pdf
Medical Contraindication 5320 F2 (Generic Form)
(.pdf) http://www.neola.com/rogers-mi/search/forms/fm5320F2.pdfTraverse Bay Area Intermediate School District
Immunization Waiver 5320 F3 (Generic Form)
(.pdf) http://www.neola.com/traversebayarea-mi/search/forms/fm5320F3.pdf
Medical Contraindication 5320 F2 (Generic Form)
(.pdf) http://www.neola.com/traversebayarea-mi/search/forms/fm5320F2.pdfLakeview Community Schools
Immunization Waiver 5320 F3 (Generic Form)
(.pdf) http://www.neola.com/lakeviewcommunity-mi/search/forms/fm5320F3.pdf
Medical Contraindication 5320 F2 (Generic Form)
(.pdf) http://www.neola.com/lakeviewcommunity-mi/search/forms/fm5320F2.pdfCLARKSTON COMMUNITY SCHOOLS
Immunization Waiver 5320 F2 (Spanish)
FORMULARIO PARA EXONERACIÓN DE IMMUNIZACIÓN
(.pdf) http://www.neola.com/clarkston-mi/search/forms/fm5320F2.pdf
Medical Contraindication 5320 F2 (Spanish)
FORMULARIO PARA EXONERACIÓN POR CONTRAINDICACIÓN MÉDICA
(.pdf) http://www.neola.com/clarkston-mi/search/forms/fm5320F1.pdf
(For an English Form use the Generic forms above or below)
Whitmore Lake Public Schools
Immunization Waiver 5320 F3 (Generic Form)
(.pdf) http://www.neola.com/whitmorelake-mi/search/forms/fm5320F3.pdfMedical Contraindication 5320 F2 (Generic Form)
(.pdf) http://www.neola.com/whitmorelake-mi/search/forms/fm5320F2.pdfCalhoun Intermediate School District
Immunization Waiver 5320 F3 (Generic Form)
(.pdf) http://www.neola.com/calhounisd-mi/search/forms/fm5320F3.pdfMedical Contraindication 5320 F2 (Generic Form)
(.pdf) http://www.neola.com/calhounisd-mi/search/forms/fm5320F2.pdfWarren Consolidated
Immunization Waiver 5320 F3 (Generic Form)
(.pdf) http://www.neola.com/warrenconsolidated-mi/search/forms/fm5320F3.pdfMedical Contraindication 5320 F2 (Generic Form)
(.pdf) http://www.neola.com/warrenconsolidated-mi/search/forms/fm5320F2.pdfIosco Regional Educational Service Agency
Immunization Waiver 5320 F3 (Generic Form)
(.pdf) http://www.neola.com/iosco-mi/search/forms/fm5320F3.pdfMedical Contraindication 5320 F2 (Generic Form)
(.pdf) http://www.neola.com/iosco-mi/search/forms/fm5320F2.pdfKingsley Area Schools
Immunization Waiver 5320 F3 (Generic Form)
(.pdf) http://www.neola.com/kingsleyarea-mi/search/forms/fm5320F3.pdfMedical Contraindication 5320 F2 (Generic Form)
(.pdf) http://www.neola.com/kingsleyarea-mi/search/forms/fm5320F2.pdfEastern Upper Peninsula Intermediate School District
Immunization Waiver 5320 F3 (Generic Form)
(.pdf) http://www.neola.com/Easternupisd-mi/search/forms/fm5320F3.pdf
Medical Contraindication 5320 F2 (Generic Form)
(.pdf) http://www.neola.com/Easternupisd-mi/search/forms/fm5320F2.pdfBad Axe Public Schools
Immunization Waiver 5320 F3 (Generic Form)
(.pdf) http://www.neola.com/badaxe-mi/search/forms/fm5320F3.pdfMedical Contraindication 5320 F2 (Generic Form)
(.pdf) http://www.neola.com/badaxe-mi/search/forms/fm5320F2.pdfHuron Intermediate School District
Bad Axe, MI 48413
Immunization Waiver Form
(.pdf) http://www.hisd.k12.mi.us/specstuserv/Imm%20Waiver.pdfMedical Contraindication Form
(.pdf) http://www.hisd.k12.mi.us/specstuserv/Cont%20Form.pdfWexford-Missaukee Intermediate School District
Immunization Waiver 5320 F3 (Generic Form)
(.pdf) http://www.neola.com/wexfordmissaukee-mi/search/forms/fm5320F3.pdfMedical Contraindication 5320 F2 (Generic Form)
(.pdf) http://www.neola.com/wexfordmissaukee-mi/search/forms/fm5320F2.pdfMt. Pleasant Public Schools
Immunization Waiver 5320 F3 (Generic Form)
(.pdf) http://www.neola.com/mtpleasant-mi/search/forms/fm5320F3.pdfMedical Contraindication 5320 F2 (Generic Form)
(.pdf) http://www.neola.com/mtpleasant-mi/search/forms/fm5320F2.pdfQuincy Community Schools
Immunization Waiver 5320 F3 (Generic Form)
(.pdf) http://www.neola.com/quincy-mi/search/forms/fm5320F3.pdfMedical Contraindication 5320 F2 (Generic Form)
(.pdf) http://www.neola.com/quincy-mi/search/forms/fm5320F2.pdf
Hard copy from a Michigan chiropractor can be sent if desired:
If you would like a copy of the Public Health Code that refers to your right and your children's right to refuse this dangerous practice of vaccinations, and a copy of the IMMUNIZATION WAIVER FORM, SEND $2.00 AND A SASE TO: DR. WILLIAMS, 200 EAST CHICAGO ST., COLDWATER, MICH. 49036. http://www.superdoc1.com/page2.html
Here's an online HTML version of the vaccination exemption form.
http://www.michiganmilitia.org/html/vaccination%20exemption.html
Opt-Outs:
Military Recruiters:
STUDENT OPT OUT FORM regarding the
RELEASE OF NAME, ADDRESS, AND TELEPHONE NUMBER TO MILITARY RECRUITERS
(.pdf) http://www.militaryfreeschools.org/PDF/optout2.pdfUNDERGROUND ACTION ALLIANCE STUDENT OPT OUT FORM
(.pdf) http://www.militaryfreezone.org/opt_out.pdf
(.doc)
http://veterans4peace.org/opt_out.docSAMPLE ENGLISH - BINGUAL FORMS FOR OPTING OUT
Act to Protect Your Privacy from Military Recruiters
(.pdf) http://www.afsc.org/pacificsw/documents/Opt-Out-Form.pdf
STUDENT OPT-OUT - Google Search
STUDENT OPT-OUT NOTICE regarding the instruction of sexuality to children:
STUDENT OPT-OUT NOTICE Valid in all 50 states
(.pdf) http://www.ccv.org/images/StudentOptOutNotice.PDF (.pdf) http://www.catholiccitizens.org/content/img/f26422/opt%20out%20notice.pdf
(.html) http://www.ccv.org/images/StudentOptOutNotice.htm
Entire packet...
(.doc) http://www.mfc.org/respect/Website/Links%20on%20Web%20Page/Opt-Out%20Packet.docSTUDENT OPT-OUT NOTICE - Google Search
Colleges:
AFFIDAVIT for Michigan Adult (college or Employment religious exemption) ... Edit as needed...
AFFIDAVIT is available in Microsoft Word
(.doc) and WordPerfect (.wpd)
format. Contact us.AFFIDAVIT
I, _________________________, Sui Juris, Free, Natural Flesh and Blood Human Being, state Citizen of the Ohio Republic affirm: Be it known to all courts, governments, and other parties that:
Being a person of Strong Christian Morals, it is against my Deep, Sincerely Held, Religious Convictions to accept the injection of any foreign substance into my Body. This includes, but is not limited to, any and all, Vaccinations, Shots, Tests for Diseases, Oral Vaccines, Epidermal Patches and in any other way that Live or Killed Bacterium, Viruses, Pathogens, Germs, or any other Microorganisms, may be introduced into or upon my body.
This written statement to exempt myself from the immunization requirement, and the Mantoux (PPD) Tuberculin Test, because I hold genuine and sincere personal religious beliefs which are inconsistent with these medical procedures and experimentation. The practice of vaccination and the injection of any foreign substance is contrary to my conscientiously held religious beliefs and practices, and violates the free exercise of my religious principles.
The attenuated virus used to produce the Rubella vaccine (RA27/3) was obtained from an aborted fetus and then cultivated on fetal tissue from another aborted baby (WI-38), and is also in the rubella portion of the MMR-II vaccine. The Chickenpox vaccine containing WI-38, MRC-5 and Hepatitis-A vaccine (MRC-5) were obtained from human babies that were electively aborted. A conflict arises because my religious convictions are predicated on the belief that all life is sacred. God's commandment "Thou Shall Not Kill" applies to the practice of abortion. The acceptance of these vaccines promotes abortion and violates the Sixth Commandment of "Thou Shall Not Kill". The Hepatitis-B vaccine protects against a disease that is only transmitted through multiple sexual partners or street IV drug users. The acceptance of this vaccine promotes sexual promiscuity and immoral behavior in direct contradiction to the teachings of my faith.
I, {First and Last name}, am exercising my rights under the First Amendment of the US Constitution and [insert Michigan college exemption statute here or leave blank for employment situations] to receive Religious Exemption from Vaccination & testing.
Applicable law has been interpreted to mean that a religious belief is subject to protection even though no religious group espouses such beliefs or the fact that the religious group to which the individual professes to belong may not advocate or require such belief. Title VII of the Civil Rights Act of 1964 as amended Nov. 1, 1980; Part 1605.1-Guidelines on Discrimination Because of Religion.
The Lord Jesus Christ and Our Creator are the only source of protection of my body and that of my family that I can accept.
I affirm that vaccination & injections of foreign proteins conflict with my religious belief as stated above. Therefore, I would request that you accommodate my religious beliefs and practices by exempting me from the college vaccination and TB testing requirement.
Rest assured that I do practice a form of immunization that keeps my immune system strong and is in keeping with Biblical principles.
Further Affiant Saith Not
The use of notary below is for identification only, and such use does NOT grant any jurisdiction to anyone.
Subscribed and sworn, without prejudice, and with all rights reserved, (Print Name Below)
_______________________________________________________________,
Principal, by Special Appearance, in Propria Persona, proceeding Sui Juris.
_______________________________
Signature of Affiant
ACKNOWLEDGMENT
state of Michigan
county of _________________:
On this _______ day of ______________, 200__, before me
personally appeared __________________________________, to me known to be the person described in and who executed the foregoing instrument and acknowledged that he executed the same as his free act and deed, for the purposes therein set forth.
_______________________________________
(Notary Public)
My Commission Expires ______________________________, 200___
The above AFFIDAVIT is available in Microsoft Word
(.doc) and WordPerfect (.wpd)
format.Click here to Contact Donna.
These Google searches are mostly the college and school exemptions. There are always new forms coming online. Keep a regular check on these to look for newly added forms. Some are for daycare too. The links are the actual keywords that are used.
Immunization Exemption Form
Vaccine Exemption Form
Immunization Waiver
Employment:
Use the AFFIDAVIT for Michigan Adult above.
For Hep B vaccine in the workplace, your employer should give you a Hepatitis B Declination Form with this across the top...
OSHA Regulations (Standards - 29 CFR) Hepatitis B Vaccine Declination (Mandatory) - 1910.1030 App A
Most of these are the Hepatitis B vaccine declination forms, such as the OSHA form. There are hundreds of these forms. Rather than linking to each one, here are the Google Search results for these keywords. There are other vaccines that one can decline that are worded like the OSHA forms.
Vaccine Declination Form
or
Hep B vaccine waiver
TB Test:
TB Testing Exemption Letter:
HTML
Sample
Exemption Letter for TB testing. May be modified to your use.
http://www.vaclib.org/letters/TBwaiverGen.htm
Microsoft Word Document (.doc)
Sample Exemption
Letter for TB testing. May be modified to your use.
http://www.vaclib.org/letters/TBwaiverGen.doc
TB Testing
Exemption Letter for Adults:
Microsoft Word Document (.doc)
Sample
Exemption Letter for TB testing. May be modified to your use.
http://www.vaclib.org/letters/TBTestingWaiverAdult.doc
WordPerfect Document (.wpd)
Sample
Exemption Letter for TB testing. May be modified to your use.
http://www.vaclib.org/letters/TBTestingWaiverAdult.wpd
PDF
document (.pdf)
Sample
Exemption Letter for TB testing.
http://www.vaclib.org/letters/TBTestingWaiverAdult.pdf
Lead
Testing Exemption Letter:
HTML
Sample
Exemption Letter for Lead testing. May be modified to your use.
http://www.vaclib.org/letters/Lead_testing_waiverGen.htm
Microsoft Word Document (.doc)
Sample
Exemption Letter for Lead testing. May be modified to your use.
http://www.vaclib.org/letters/Lead_testing_waiverGen.doc
The
above TB and Lead exemption letters courtesy of Deirdre DeVane of Wash DC.
Thank you Deirdre!
The adult TB letters were edited by Sherri Tenpenny.
Thank you Sherri!
TB Testing Alternatives...
TB can be detected by biofeedback machines that are hooked up to a computer, such as the QXCI, Best BioMeridian MSAS (Meridian Stress Assessment) or Electro Dermal Screening, Quantum Life System, and the F-Scan. You will need to ask specifically for a pathogen scan, especially TB. You will also need to request a printout with the results.
Here are some of the practitioners for Michigan
Michigan BEST™ BioMeridian Practitioners:
Integrated Health of Mid Michigan
Hubbs, Renee L.Ac. (CA)
4111 Okemos Road, Suite 102
Okemos, MI 48864
Phone: 517-349-5219
Fax: 517-349-5259
http://www.integratedhealth.meta-ehealth.com/
E-Mail: Ren2hubbs@earthlink.net
Acupuncture, NAET, Meridian Stress Assessment
Karen Hoezee
Hudsonville, MI 49426
Tel: 616-669-1575
Email: being updated
Flower Essence Practitioner, MSA Meridian Stress Assessment Technician
Salubrity Vida Health Spa
115 Clover #100, Holland, MI 49423
Conveniently located off US 31 and Business 96 between 8th Street and Chicago Drive.
616-392-1899
http://www.salubrityvida.com/
MERIDIAN STRESS ASSESSMENT TESTING NOW AVAILABLE AT SALUBRITY VIDA.
Please call contact below to find additional BioMeridian practitioners in your area or closeby.
Oksana Gorodetsky
Marketing/Administrative Coordinator
BioMeridian International
12411 South 265 West, Suite F
Draper, UT 84020
T 801-501-7517
F 801-501-7518
Toll Free 888-224-2337
ogorodetsky@biomeridian.com
Michigan QXCI Practitioners:
http://www.theqxci.com/information.php
CHIROPRACTIC HEALTH CLINIC
Maegan Davis, DC, Owner
2549 Jolly Road, Suite 360
Okemos, MI 48864
(517) 347-2222 * Fax. (517) 347-2233
http://www.chiropractichealthclinic.com/
Email: maegandc@voyager.net
We offer gentle, effective chiropractic care and massage therapy for the entire family, including QXCI health scan and nutritional guidance. Knowing all healing comes from within, our mission is to inspire, educated and support clients in attaining their personal best when the body, soul and spirit are balanced.
For information on purchase or lease of the new Quantum Life BioFeedback L.I.F.E. System, please email Donna and leave your name, mailing address, phone number and email. If you're inquiring for another interested individual or practitioner, please leave their information. The company will then send information and contact the interested parties.
Or you may call 1-888-249-1421.
Immunization Registry Opt Out: Forms - Opt Out of MCIR
Parents or guardians have the right to request in writing that their
children's immunization information not be included in the MCIR database.
New Link!
Download 'MCIR Participation in the MCIR
Reporting' Form (DOC Format) (.doc)
http://www.mcir.org/region-6/documents/OptOutForm.doc
Download
'MCIR Participation in the MCIR Reporting' Form (PDF Format) (.pdf) http://web.archive.org/web/20041016005150/http://www.semha.org/se-mcir/forms/opt-out.pdf
Download 'MCIR Participation in the MCIR Reporting' Form (DOC
Format) (.doc)
http://web.archive.org/web/20041016012214/http://www.semha.org/se-mcir/forms/opt-out.doc
Information on this page is provided and sponsored by:
Referred by Roberto AC (you may have to click YES)