Montana students are not required to receive vaccines for which they are medically contraindicated. This one-page statement documents which school-required vaccines are affected, a brief description of the contraindication or precaution for each, and how long the exemption lasts. It is filed at the student's school together with the student's most current immunization record.
A qualifying health care provider completes and signs the whole statement: someone licensed in any US state or Canada, authorized to give the vaccine in question, who has treated the student or gave a vaccine that caused a reaction.
Download the current version from the source each time; forms change without notice.
Medical Exemption Statement
A form is listed only after its name and number were confirmed on the issuing agency’s or insurer’s own website, or in the form itself. Each entry links to that source. The list was last checked in October 2026. Forms and their requirements change without notice, so check the official page for the current version before you complete one.
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A qualifying health care provider under HB 334: a person licensed, certified or authorized to provide health care in any US state or Canada, authorized within their scope to administer the vaccine being exempted, and who has previously treated the student or administered a vaccine to which the student had an adverse reaction.
Yes. The form states that a written and signed statement from a qualifying health care provider is accepted in lieu of HES 101A under the conditions in ARM 37.114.715. Either way, it is filed at the school with the student's current immunization record.