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Your Top Ten Nonmedical Exemption Questions, Answered

by Sara Beaudrault and Stacy de Assis Matthews

As of March 1, 2014, Oregon parents must submit documentation that they’ve received education about vaccines in order to sign a nonmedical exemption for their child.

Since March 1, the Oregon Immunization Program has been collecting questions about this new requirement from healthcare providers, clinic staff, and school staff. It’s clear from the thoughtful questions we’ve received that these groups are committed to finding the best way to help families and their staff meet the new requirements.

Do you have questions about nonmedical exemptions? Keep reading for the Top Ten Questions we’ve received, answered.

Question 10: To whom does the new law apply?

Parents whose child falls into one of the categories below will need to show documentation that they’ve received education before signing a nonmedical exemption.

–          Children entering a child care, preschool, or Head Start program

–          Children starting school for the first time, such as kindergarten

–          Entering students who have never been in an Oregon school before

–          Students starting college

–          Children and students whose exemptions change

Religious exemptions signed before March 1st do not need to be signed again unless the child falls into one of the above categories.

Question 9: For how long is a nonmedical exemption valid?

The nonmedical exemption is valid while the child is at school or child care.

Documentation of nonmedical exemptions transfers between schools in Oregon.

Parents whose child moves from child care to school (typically at kindergarten), will need a new nonmedical exemption. 

Question 8: Before claiming an exemption, do parents need to watch the online module and get a signature from a healthcare practitioner?

Parents will meet the education requirement by talking to a healthcare practitioner or watching the online module.

If a parent talks to a healthcare practitioner to fulfill the vaccine education requirement, the practitioner will provide a Vaccine Education Certificate.

If a parent watches the online vaccine education module, the parent will print a Vaccine Education Certificate at the end of the module.

The parent will turn the Vaccine Education Certificate in at their child’s school, along with the completed Certificate of Immunization Status.

Question 7: Who is a “healthcare practitioner” that can sign the Vaccine Education Certificate?

A practitioner with the authority to order immunizations can sign the Vaccine Education Certificate. This includes medical doctors, osteopaths, naturopaths, nurse practitioners and physician assistants.

Registered nurses working under the direction of an MD, DO, ND, or NP can also sign the Vaccine Education Certificate.

Question 6: The healthcare practitioners at the clinic where I work are concerned about signing nonmedical exemptions. What should I tell them?

Great question! The form that practitioners sign – the Vaccine Education Certificate – simply documents that the practitioner has educated the parent about vaccine benefits and risks. It does not mean that the practitioner agrees with the parent’s decision to claim a nonmedical exemption. This law does not require practitioners to sign nonmedical exemptions.

The parent claims a nonmedical exemption by signing this section of the Certificate of Immunization Status that is maintained at their child’s school or child care.

Question 5: What information do healthcare practitioners have to cover to sign the Vaccine Education certificate?

Practitioners must discuss benefits and risks of immunization, using information that is consistent with what is published by CDC. Unlike the requirement to provide a Vaccine Information Statement when vaccines are administered, this nonmedical exemption law does not require the use of specific materials or resources. Practitioners can decide what materials to use, or to simply have a conversation with parents.

We encourage practitioners and clinic staff to view the online vaccine education module to learn what information is communicated through the online module. Practitioners can provide similar information before signing the Vaccine Education Certificate.

Question 4: Can my clinic create a customized Vaccine Education Certificate to give to parents after education is provided by their healthcare practitioner?

Short answer: Clinics must use the Vaccine Education Certificate available at www.healthoregon.org/vaccineexemption or an identical version.

Long answer: School and child care staff are required to review every immunization record, which includes confirming that there is a valid Vaccine Education Certificate for every nonmedical exemption signed after March 1, 2014. School and child care staff use caution when doing these reviews and keep their eyes open for anything that might be a forgery. If a parent submits a Vaccine Education Certificate that the school staff does not recognize, the parent will likely be required to do additional work to confirm that the certificate is valid. In a worst case scenario, a student may be kept out of school while this happens.

If your clinic feels that they have a valid reason to use a customized Vaccine Education Certificate (for example, you wish to create an identical certificate that preprints your clinic’s name), please contact Sara Beaudrault at sara.beaudrault@state.or.us prior to proceeding.

Question 3: Staff at my clinic want a refresher on communicating effectively about vaccines with parents who have concerns about vaccinating their child. What resources are available?

Excellent resources and materials have been developed in the past few years. Some cover the essential skills to use when talking to parents about vaccines. Others provide simple, accurate answers to the questions that parents ask most often.

Links to materials and materials are available at http://public.health.oregon.gov/PreventionWellness/VaccinesImmunization/VaccineSafety/Pages/Providers.aspx

We commend the staff at your clinic for taking this opportunity to enhance their vaccine communication skills. Healthcare providers are a trusted source of information for most parents, and parents will usually follow their recommendations.

Question 2: After thinking it through, my clinic has decided to refer parents to the online vaccine education module. Is there anything else we need to be thinking about?

Yes. This is the perfect time to think about what process your staff will follow when a parent calls to find out how to get a Vaccine Education Certificate. Some questions you might ask are:

–          Will you provide a customized letter with instructions for parents and a link to the online vaccine education module?

–          Do your front desk staff have the information they need to answer parents’ questions?

–          Will your staff document this in a patient’s medical record?

Looking for resources to share with parents? An information sheet for parents and a graphic of the process for claiming a nonmedical exemption are available at www.healthoregon.org/vaccineexemption

Question 1: Is the online module available in other languages?

Alternative formats will be available upon request. To request materials in an alternate format, contact the Oregon Immunization Program at (971) 673-0300.

We truly appreciate the thoughtfulness of questions that healthcare providers, clinic staff, and school staff are asking. It’s apparent that these groups are concerned about nonmedical exemption rates, and believe that the new nonmedical exemption process will help us decrease nonmedical exemption rates and increase immunization coverage in Oregon.

Additional information is available at www.healthoregon.org/vaccineexemption. Or, call the Oregon Immunization Program at (971) 673-0300.

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When it Comes to Exemptions, Let’s Not be Special

by Sara Beaudrault

In Oregon, we celebrate all the little things that make us special. We have more ghost towns than any other state in the country. We’re one of only two states where someone still pumps our gas for us. And we’re the only state in the nation that has an official state nut. (It’s the hazelnut, by the way).

But when we’re talking about our children’s health, there’s one fact about Oregon that makes us worry, not celebrate. In Oregon, more parents of kindergartners sign exemptions to school- and childcare-required vaccines than in any other state in the nation.

Exemption rates in Oregon have steadily crept up over the past decade, with greater than six percent of kindergartners having an exemption to at least one vaccine during the 2012-13 school year. Some counties have exemption rates as high as 15 percent! People in these communities are at risk, should a vaccine-preventable disease strike their area.

A new law went into effect on March 1, 2014. The hope is that it will slow this trend.

This new nonmedical exemption law changes the process for parents who choose to exempt their child from vaccines required for school and childcare attendance. Parents now must provide documentation that they have received information about vaccine risks and benefits before signing an exemption. Oregon is among the first states in the nation to strengthen existing exemption laws by requiring parents to review science-based immunization information before signing an exemption.    

“We want to make sure parents and guardians receive science-based information about the benefits and risks of vaccine,” said Stacy de Assis Matthews, school law coordinator for the Oregon Health Authority’s Public Health Division Immunization Program. “There is a lot of misinformation out there.”

The nonmedical exemption law gives parents two choices for receiving vaccine education. They can talk to a healthcare practitioner, who can sign a Vaccine Education Certificate. Or parents can view an online vaccine education module and print a vaccine Education Certificate at the end of the module. Whichever option they choose, parents must turn the Vaccine Education Certificate in at their child’s school or childcare, along with the Certificate of Immunization Status.

 “We hope this law serves to strengthen existing relationships between parents and their healthcare providers,” says Lydia Emer, Oregon Immunization Program manager. “Most parents trust their child’s healthcare provider, and will follow their recommendations. This law provides another opportunity for parents who have concerns about vaccines to talk to their provider.”

The online vaccine education module is a great option for parents who would prefer to receive their Vaccine Education Certificate online, or whose healthcare provider does not supply this Certificate. Although the online module has only been available since March 1, early feedback from parents and clinic staff has been overwhelmingly positive.

Oregon’s new nonmedical law affects so many in Oregon: parents, students, people who can’t be vaccinated, and babies too young to be vaccinated. If all of us who work in schools, healthcare settings, or more broadly in the field of immunizations pull together, Oregon’s nonmedical exemption law will effectively reduce our state’s exemption rates. Because when it comes to exemption rates, we don’t want to be so special.  

Want to learn more about the new nonmedical exemption process? Information and resources for parents, healthcare providers, and school and childcare staff are available at www.healthoregon.org/vaccineexemption. And stay tuned for next week’s ImmiNews article for the “Top 10 Questions About Nonmedical Exemptions, Answered.”


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