Illinois parents seeking a religious exemption from school immunizations or health, dental or eye exams must use this IDPH certificate, required since October 16, 2015 under Public Act 99-0249. The parent states the religious grounds for each exemption, and the child's health care provider signs to confirm the family was informed about the requirements, immunization benefits and disease risks.
The parent or legal guardian completes the student details, exemptions requested and religious statement on page 2. The health care provider responsible for the child's health examination (physician, advanced practice nurse or physician assistant) completes and signs the provider section.
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Certificate of Religious Exemption to Required Immunizations and/or Examinations
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No. The provider statement says the signature only reflects that you gave the parent or guardian information about the required examinations, the benefits of immunization, and the health risks to the student and community. It expressly does not affirm the family's religious beliefs about any examination or vaccine.
The health care provider responsible for performing the child's health examination: a physician licensed to practice medicine in all its branches, an advanced practice nurse or a physician assistant. The provider's signature must be dated within one year before school entry.
The completed certificate goes to the local school authority on or before October 15 of the school year, or by an earlier enrollment date if the district sets one. The school informs the family of exclusion procedures that apply during an outbreak.