Form 139-M must be submitted to the Mississippi State Department of Health Epidemiologist or Deputy State Epidemiologist.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.Medical exemption requests completed and signed by a tertiary care physician outside of the state will be reviewed on a case by case basis.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.Requesting a Medical ExemptionĪny requested medical exemption will be allowed if it meets the following guidelines

The parent and the requesting physician will be contacted in the event that the out-of-state medical exemption request is not accepted. 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.įollow 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. 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. Once the request is reviewed and accepted, a Certificate of Medical/Religious Exemption (Form 122) will be issued. Review of all medical exemption requests will be conducted at the Mississippi State Department of Health by the State Epidemiologist or Deputy State Epidemiologist. Medical exemption requests completed and signed by a tertiary care physician outside of the state will be reviewed on a case by case basis. Children receiving specialized or tertiary care outside of the state may have medical exemption requests completed and signed by their tertiary care physician.Īll exemptions submitted by a Mississippi licensed pediatrician, family physician, or internist will be accepted based on the Medical Exemption guidelines below. 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. Board of Health statement on religious exemptions.Questions and answers about religious exemptions.

Vaccine religious exemption letter