This is for the protection of the exempted child and the protection of others. Daycare/School Exemption Form or College Exemption Form. 4815 West Markham Mail Slot 48 Please certify below the medical reason that your patient should not be vaccinated for COVID-19 by . All Rights Reserved. Please Click here to download the list of International Travel Physicians who provide immunizations for travelers. By getting shots on time, you can protect your child and yourself from disease and protect others at home, daycare, school, or work. Most reports are sent in by vaccine manufacturers and health care providers, but vaccine recipients, parents/guardians, and others may also submit reports. A physician statement outlining medical reasons for an exemption of a specific immunization is to be submitted to the Medical Director of the Immunization Section with the exemption form. The Arkansas Department of Health is authorized by Act 999 of 2003 to grant individual exemptions from the immunization requirements. Answer:Get your flu shot each year beginning in early Fall. If you believe there are COVID-19 vaccinations missing from your COVID-19 SMART Health Card, you may reach out to the site where you received the vaccination to have it added to the WebIZ system. Vaccine clinics and events may also be available in your area through hospitals, health care providers, or your worksite. 75.119.198.104 x[mo)aOvVU4IjzM~ 6p7yx;]6a8=-BG If youre still having trouble, If you right-click and are still having trouble, you may need to. Incomplete forms will be returned for completion. If you received COVID-19 vaccinations in another state, you may provide your vaccination information to your health care provider for a local health unit and the information will be added to your Arkansas WebIZ record. NOTE: You MUST have access to a printer before you start the online application process. HIB All Rights Reserved. The COVID-19 SMART Health Care QR Code is not connected to the WebIZ. Non-employeesare defined as non-UAMS workers, contractors, visiting students, visiting faculty, pharmaceutical representatives, traveling nurses, locum tenens physicians, custodians, and employees of businesses who work on a UAMS campus. A lawsuit has been filed against Conway Regional Health System over religious exemptions and the hospital's COVID-19 vaccine mandate. Complete and mail, fax or email to: Immunization doesnt just protect the person getting the shot; it protects the entire community. Though the development of a COVID-19 vaccine has followed an accelerated timeline,safety has been the top priority. 2022-2023 Childcare-School Immunization Exemption Application, DTap Click to reveal Office of Performance Management Quality Improvement and Evaluation, 2023-2024 Childcare-School Immunization Exemption Application, 2022-2023 Childcare-School Immunization Exemption Application, 2023-2024 College Immunization Exemption Application, 2022-2023 College Immunization Exemption Application, Immunizations Required for AR Daycares & Schools, NH Immunization Reporting Form for NH's 22-23, Recommended Immunizations for Children (Birth through 6 Years), Recommended Immunizations for Preteens and Teens (7-18 Years), Recommended Immunizations for Adults (19 Years and Older) by Age and Medical Condition, Recommended Immunization Schedule for Children and Adolescents aged 18 Years or Younger, Recommended Immunization Schedule for Adults, Early Hearing Detection and Intervention Performance, Hospital Reporting Form-Lay Midwife Patient Transfer. If you do happen to. In Conway, Ark., Matt Troup, CEO of Conway Regional Health System, has granted 45 religious exemptions to employees who refused to get a COVID-19 vaccine. download the latest version for free right now to be sure, install the most recent version of Adobe Reader software, Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Georgia, Hawaii, Illinois, Indiana, Iowa, Kansas, Louisiana, Michigan, Mississippi, Missouri, Montana, Nebraska, New Hampshire, North Carolina, North Dakota, Ohio, Oklahoma, Oregon, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, West Virginia, Wisconsin, Wyoming, California, Colorado, Idaho, Kentucky, Maine, Massachusetts, Minnesota, Nevada, New Jersey, New Mexico, New York, Pennsylvania, Rhode Island, Vermont, Washington, Chrome and Firefox users: Choose "Save Link As", Microsoft Edge users: Choose "Save Target As", Safari users: Choose "Download Linked File as". If you do happen to qualify for a medical exemption, it will likely be in the form of a doctor's note, said Dr. Schaffner. The Arkansas Board of Health requirement that all children attending childcare facilities and public button private schools in the State of Arkansas be immunized against vaccine-preventable diseases and also requires that all students attending colleges and campuses in . Click here for a list of clinics. Office of Performance Management Quality Improvement and Evaluation, Vaccine plan in response to COVID-19 pandemic, CDC Frequently Asked Questions about COVID-19 Vaccination, Health Equity Strike Team Vaccination Clinics, Johnson & Johnson COVID-19 Vaccine EUA Fact Sheet for Patients, Pfizer-BioNTech COVID-19 Vaccine EUA Fact Sheet for Patients, Moderna COVID-19 Vaccine EUAFact Sheet for Patients, Pfizer-BioNTech Pediatric COVID-19 Vaccine Distribution Plan, CDC COVID-19 Vaccination Program Provider Agreement, COVID-19 Vaccine Program Enrollment Instructions, Johnson & Johnson COVID-19 Vaccine EUA Fact Sheet for Healthcare Providers, Pfizer-BioNTech COVID-19 Vaccine EUA Fact Sheet for Healthcare Providers, Moderna COVID-19 Vaccine EUAFact Sheet for Healthcare Providers, COVID-19 Information for Healthcare Providers, Arkansas Alzheimers Disease & Related Dementias (AADRD), Blood Pressure (Hypertension) Resources for Patients and the Public, Blood Pressure (Hypertension) Resources for Professionals, Arkansas Heart Attack Registry Participating Hospitals, Arkansas Acute Stroke Care Task Force (ASCTF), Provisionally Designated as Arkansas Stroke Ready Hospitals. If you believe there are COVID-19 vaccinations missing from your COVID-19 SMART Health Card, you may reach out to the site where you received the vaccination to have it added to the WebIZ system.
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