Q: How do I get a copy of my shot record, the shot record of my child, or a child under my guardianship? Fax Completed Form to: UAMS Employee Health . *Ark. If you're allergic to something in one of the vaccines, you might be able to get another one of the vaccine brands available, since some of the ingredients are different in each one. Thank you for using our online Immunization Exemption Application module. A medical exemption is due to a patient having a contraindication to the vaccine, meaning getting it could be bad for their health. Your SMART Health Card will only contain COVID-19 vaccinations that have been entered into the Arkansas immunization information system, WebIZ. Answer:The Arkansas Department of Health does not provide immunizations for travelers. It establishes an immunization goal of 95% of each school's student population and requires . Daycare/School Exemption Form or College Exemption Form. If youre still having trouble, If you right-click and are still having trouble, you may need to. When approved, exemptions will be effective for the start of the Fall session in 2022 and go through the . An application with a notarized signature of the parent/guardian, or the studentover 18 years of age, must be submitted each school year to the Department of Health. Nine of the 146 veterans home employees have requested covid-19 vaccine exemptions, and all nine were still being processed Friday, Harper said. If your application is not complete, we will send you a checklist showing the reason(s) we were unable to process your application. <> Here's Who Should (and Shouldn't) Get It, Why the FDA Restricted Use of Johnson & Johnson's COVID-19 Vaccine, FDA Grants Emergency Use Authorization for Novavax's COVID-19 Vaccine. Office of Performance Management Quality Improvement and Evaluation, Vaccine plan in response to COVID-19 pandemic, CDC Frequently Asked Questions about COVID-19 Vaccination, Health Equity Strike Team Vaccination Clinics, Johnson & Johnson COVID-19 Vaccine EUA Fact Sheet for Patients, Pfizer-BioNTech COVID-19 Vaccine EUA Fact Sheet for Patients, Moderna COVID-19 Vaccine EUAFact Sheet for Patients, Pfizer-BioNTech Pediatric COVID-19 Vaccine Distribution Plan, CDC COVID-19 Vaccination Program Provider Agreement, COVID-19 Vaccine Program Enrollment Instructions, Johnson & Johnson COVID-19 Vaccine EUA Fact Sheet for Healthcare Providers, Pfizer-BioNTech COVID-19 Vaccine EUA Fact Sheet for Healthcare Providers, Moderna COVID-19 Vaccine EUAFact Sheet for Healthcare Providers, COVID-19 Information for Healthcare Providers, Arkansas Alzheimers Disease & Related Dementias (AADRD), Blood Pressure (Hypertension) Resources for Patients and the Public, Blood Pressure (Hypertension) Resources for Professionals, Arkansas Heart Attack Registry Participating Hospitals, Arkansas Acute Stroke Care Task Force (ASCTF), Provisionally Designated as Arkansas Stroke Ready Hospitals. 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. Q: Is there a medical exemption regarding flu vaccinations for nursing home workers? This is a rare but severe condition that causes blood clots. 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. All Rights Reserved. For information, inquiries, feedback and comments contact us. This is for the protection of the exempted child and the protection of others. UAMS Form for Medical Exemption from Covid-19 Vaccination . Click on the document to open it. By getting shots on time, you can protect your child and yourself from disease and protect others at home, daycare, school, or work. To request a medical exception or delay from the COVID-19 vaccination requirement using this form: You must complete Part 1 of this form. 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. Vaccine exemption laws vary from state to state. Complete and mail to: Arkansas Department of Health 4815 West Markham - Mail slot 48 Little Rock, AR 72205. Performance & security by Cloudflare. 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. [xR_8qp/-[je{reIs% x[mo)aOvVU4IjzM~ 6p7yx;]6a8=-BG endobj This website is using a security service to protect itself from online attacks. Non-employeesare defined as non-UAMS workers, contractors, visiting students, visiting faculty, pharmaceutical representatives, traveling nurses, locum tenens physicians, custodians, and employees of businesses who work on a UAMS campus. If you verified you right-clicked and your Adobe is up-to-date, Check if you qualify for a Special Enrollment Period. %PDF-1.7 This form must also be signed by a Notary . The Arkansas Department of Health is authorized by Act 999 of 2003 to grant individual exemptions from the immunization requirements. Vaccine clinics and events may also be available in your area through hospitals, health care providers, or your worksite. Those seeking a medical exemption will need to fill out this form and have it signed by a medical provider certifying that they should not receive the COVID-19 vaccine. Answer: Here. Tdap (Tetanus, Diptheria, Pertussis) After the video, you will have access to the application form. Conway Regional Hospital is requiring its staff to get the COVID-19 vaccine. Pneumococcal Conjugate (PCV13) Call 1-800-803-7847 for assistance finding a vaccine in your area or to sign up for an ADH clinic. 2023-2024 Childcare-School Immunization Exemption Application There may be at least one other situation where a doctor will write a medical exemption with legitimate intentions, Dr. Schaffner explained: If someone developed a serious health issue soon after getting their first dose of an mRNA vaccine. 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, Early Hearing Detection and Intervention Performance, Hospital Reporting Form-Lay Midwife Patient Transfer. "There are some people who have received one dose of the vaccine and had a subsequent medical event close in time to the vaccine," said Dr. Schaffner. %PDF-1.5 COVID-19 Mu Variant Named a 'Variant of Interest'Here's What You Need to Know, What To Do if You Have an Allergy to a COVID-19 Vaccine, Pfizer-BioNTech's COVID-19 Vaccine Ingredient List, Booster Recommendations After J&J's Janssen COVID-19 Vaccine. <>/Font<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/Annots[ 16 0 R 19 0 R 20 0 R 21 0 R 22 0 R] /MediaBox[ 0 0 612 792] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> Or E-mail us to request the exemption form. Release of information will be provided only to the custodial parent/guardian or student over 18 years of age who completes this application and according to the notarized signature. The University of Arkansas for Medical Sciences mandates influenza, MMR, Tdap, Covid-19, Varicella. 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".
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