Inoculation Exemptions

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.

 

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.

 

A review of all religious exemption requests for completeness will be conducted at the Mississippi State Department of Health. Complete Religious exemption requests submitted per MSDH policy will be accepted and signed 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 Form 122 signed and dated by the State Epidemiologist or Deputy State Epidemiologist provides official, documented proof that a child has been issued a medical/religious exemption by MSDH. The original Form 122 will be housed at MSDH with a copy mailed to the parent and the daycare or school indicated on the Religious Exemption Request Form.