Oklahoma law and Human Services policy require families applying for or receiving TANF to show each child's immunizations are current or request an exemption. For children who do not attend school or child care, this two-page form records the exemption; a licensed physician completes the medical contraindication section, naming the vaccines and the endangering condition.
The child's licensed physician completes and signs the Medical Contraindication section, with printed name and phone number. The parent or caretaker relative signs the exemption request; religious and personal objections are signed by a religious leader or the parent instead.
Download the current version from the source each time; forms change without notice.
Immunization Certificate of Exemption
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.
Vero is not affiliated with, or endorsed by, the agencies and insurers listed here. Read our editorial policy.
When the child does not attend school or a child care facility. Children in school, child care or Head Start use the Oklahoma State Department of Health Form 216-A, Certificate of Exemption. 08TA017E covers TANF families whose children are not enrolled in those settings.
The physician certifies that the listed immunizations are medically contraindicated for the named child, lists those immunizations, and states the condition that would endanger the child's life or health, then prints their name, adds a phone number, and signs and dates the section.
No. The personal objection section of the form states that lost records are not grounds for an exemption. A medical exemption requires a physician's certification that specific immunizations are contraindicated for the child.