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Oregon Medical Exemption Form for School Vaccines

Oregon children with a valid contraindication or precaution to a required vaccine can be medically exempted from school and child care immunization rules, but only after local public health review. In Section A the physician documents the condition, the vaccines affected and whether it is permanent or temporary; the local health department then approves or denies the exemption in Section B.

Who completes it

A physician completes and signs Section A with license number and state; under ORS 433.235 that means a physician licensed by the Oregon Medical Board or Board of Naturopathic Medicine, or similarly licensed elsewhere. A local health department representative completes Section B.

Submitting and payment

How to submit it
The physician returns the form to the parent and keeps a copy. The parent brings it to the school or child care, which submits it to the local health department for review and keeps the reviewed copy in the child's record.

Good to know

  • The condition must be a contraindication or precaution recognized by CDC or the American Academy of Pediatrics, as required by OAR 333-050-0270.
  • A temporary exemption needs the date the condition is expected to resolve; when it expires, the child must be vaccinated or the physician must request an extension for re-review.
  • Vaccines on the form: diphtheria/tetanus/pertussis, hepatitis A, hepatitis B, polio, MMR, varicella and Hib. The current edition is dated July 2026.
  • Immunity is not an exemption: for hepatitis A, hepatitis B, Hib, MMR and varicella, Oregon accepts a physician letter or lab result showing disease history or a positive titer instead.

Get the official form

Download the current version from the source each time; forms change without notice.

Oregon Medical Exemption form

Official pagePDF

Fill it with Vero

If your copy of the form is a fillable PDF, upload it once and Vero Documents fills it from the visit note and the chart, ready for you to review and sign. Download, print, or email the finished form, with the patient’s consent.

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How this list is checked

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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Frequently asked questions

Who approves an Oregon medical exemption?

A representative of the local public health authority. After the physician completes Section A, the school or child care sends the form to the local health department, which checks completeness and whether the condition is a contraindication or precaution, then marks it approved as permanent or temporary, or denied, with a reason.

Can a nurse practitioner sign the Oregon medical exemption form?

Section A must be completed by a physician as defined in ORS 433.235: licensed by the Oregon Medical Board or the Oregon Board of Naturopathic Medicine, similarly licensed in another state or country, or a commissioned medical officer of the Armed Forces or Public Health Service. A local health department representative may also complete it.