English - 014-4895-64e - Statement of Medical...
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.
Additional Information
| Last updated | November 16, 2022 |
|---|---|
| Created | December 11, 2021 |
| Format | application/pdf |
| Form Number | https://forms.mgcs.gov.on.ca/dataset/f9bf0c92-049a-4412-bf72-6bdcf09f873a/resource/6ead97cd-4f9a-471b-9bc9-360c17a1b253/download/4895-64e.pdf |
| Form File Identifier | 014-4895-64e |
| Name | English - 014-4895-64e - Statement of Medical Exemption – Immunization of School Pupils Act |
| Form File Status | Available |
| Description | 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 |
| Remark | |
| Edition Date | 2022-11 |