Additional Information

Last updated November 16, 2022
Created December 11, 2021
Format application/pdf
Form Number
Form File Identifier 014-4895-64e
Name English - 014-4895-64e - Statement of Medical Exemption – Immunization of School Pupils Act
Form File Status Available

A physician or nurse practitioner must complete a Statement of Medical Exemption for children who require a medical exemption from vaccine requirements under the Immunization of School Pupils Act.

Language English
Functionality Fill, Print, and Save
Form File Content Type Form
Edition Date 2022-11