West Virginia Medical Exemption Request (Vaccines)

West Virginia allows medical exemptions from compulsory school and child care immunization only with approval from the State Immunization Officer. The child's physician files this request naming each vaccine, the contraindication or precaution relied on, whether the exemption is permanent or temporary, and medical evidence showing it is necessary. The Officer approves or denies it based on current ACIP guidance.

Who completes it

A physician licensed to practice medicine who has treated or examined the child completes and files the whole request, and must tell the parent or guardian how to obtain an exemption and where the request stands.

Submitting and payment

How to submit it
Send the form and supporting medical evidence to the Immunization Services Division by mail, email or fax, or submit it through WVSIIS. The Officer decides within 20 days of a complete request.

Good to know

  • Temporary exemptions may not exceed 24 months from the request and must include a future date or time for reevaluation.
  • A request still incomplete after 45 days is denied, and the Officer may ask for more evidence before deciding.
  • Written notice goes by mail to both the physician and the parent. Parents can ask the State Health Officer to review an unfavorable decision within 30 days.
  • The posted PDF is a scanned image without fillable fields, so it is printed and completed by hand.

Get the official form

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

Request for Medical Exemption from Compulsory Immunization

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.

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

How long does a West Virginia temporary medical exemption last?

No more than 24 months from the time of the request. The physician must give a future date or time for reevaluation on the request. The OEPS page sets no time limit for permanent exemptions, which still need medical evidence showing the exemption is necessary.

Can a parent appeal a denied West Virginia medical exemption?

Yes. The parent or guardian files a written request with the State Health Officer within 30 days of the notice, adding reasons and any new evidence. The review decision is binding unless a hearing is requested within 45 days under 64 CSR 1.