Medical Exemption Policy
To request a medical exemption from one or more required vaccinations, the MSDH Medical Exemption Request (Form 139) 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. Exemption from required immunizations for religious, philosophical, or conscientious reasons is not allowed under Mississippi law.
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.
Once the request is reviewed and accepted, a Certificate of Medical Exemption (Form 122) will be issued. Only the Certificate of Medical Exemption (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 exemption by MSDH. The original Certificate of Medical Exemption (Form 122) will be housed at MSDH with a copy mailed to the parent and the requesting physician.
Follow up and request for additional information will be conducted by the State Epidemiologist or Deputy State Epidemiologist for out-of-state medical exemption requests if needed. The parent and the requesting physician will be contacted in the event that the out-of-state medical exemption request is not accepted.
Requesting a Medical Exemption
Any requested medical exemption will be allowed if it meets the following guidelines and there is no local or statewide occurrence of disease such that the exemption would cause undue risk to the community.
- An MSDH Medical Exemption Request (Form 139) must be completed and signed by the child's pediatrician, family physician, or internist who is duly licensed in Mississippi.
- Medical exemption requests completed and signed by a tertiary care physician outside of the state will be reviewed on a case by case basis.
- The same pediatrician, family physician, internist, or tertiary care physician must indicate on Form 139 the medical condition of the child seeking exemption and indicate the exemption status for each of the listed vaccines.
- Form 139 must be submitted to the Mississippi State Department of Health Epidemiologist or Deputy State Epidemiologist.
- The State Epidemiologist or Deputy State Epidemiologist will mail a copy of the Certificate of Medical Exemption (Form 122) to the parent and the pediatrician, family practitioner, internist, or tertiary care physician who submitted the Medical Exemption Request. The original Certificate of Medical Exemption (Form 122) will be housed at MSDH.
- Data regarding medical exemptions will be maintained in the Immunization area of the MSDH website. See the report at the end of this page.
The exemption expiration date will be based on the circumstances for the exemption, and will be no less than one school year unless otherwise indicated on the request.
This policy will not amend the school law Section 41-23-37, Mississippi Code of 1972. Children with a Certificate of Medical Exemption who are not adequately immunized will be excluded from school if there is a threat of vaccine preventable diseases occurring in the community. The child will be excluded until the infectious disease is no longer present, or is no longer a threat to the safety and welfare of the child or other children in the school.
Exemption from required immunizations for religious, philosophical, or conscientious reasons is not allowed under Mississippi law.
Questions regarding the medical exemption process or the medical exemption request form should be directed to the Assessment Reports Coordinator at (601) 576-7725.
The medical exemption request form should be sent to the Mississippi State Department of Health central office in Jackson:
Mississippi State Department of Health
570 E. Woodrow Wilson, O-420
Attn: Assessment Reports Coordinator
Post Office Box 1700
Jackson, MS 39215-1700
Telephone: (601) 576-7725
Fax: (601) 576-7497
The State Epidemiologist or Deputy State Epidemiologist can also be reached at (601) 576-7725.
