Iowa Immunization Forms

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Iowa Documentation of Immunization Exemption

Fill out and attach this document if you are filing a Form A (i.e., homeschooling a child under Choice 3, 4 or 5) and you desire your child to be exempted from immunizations for medical or religious reasons. This is necessary only the first time the child is placed in competent private instruction. If you dual enroll your student, or otherwise participate in a public school activity, the public school may also require you to submit a certificate of immunization exemption on a form prepared by the Iowa Department of Health.

RESOURCE

Iowa IDPH 2012 Immunization Exemption Form: Religious or Medical

This form can use used to establish an exemption from immunization requirements based on religious objections (notary seal required) or medical contraindication (requires the signature of a physician, physician assistant, or nurse practitioner). A medical exemption may contain an expiration date if the medical signatory specifies. When filing a CPI form for the first time for a child, if you include a copy of the exemption, the requirement to submit immunization information will be satisfied.