• To claim an exclusion for medical reasons, The child or student must present a statement signed by the child's physician (M.D.or D.O.), duly registered and licensed to practice medicine in the United States who has examined the child,in which it is stated that, in the physician's opinion, the vaccine required is medically contraindicated or poses a significant risk to the health and well-being of the child or any member of the child's household.
• Unless it is written in the statement that a lifelong condition exists, the exemption statement is valid for only one year from the date signed by the physician.

To claim an exclusion for Reasons of Conscience, including Religious Belief, a signed Texas Department of Health signed affidavit must be presented by the child's parent or guardian, stating that the child's parent or guardian declines vaccinations for reasons of conscience, including because of the person's religious beliefs. The affidavit will be valid for a two-year period. The child, who has not received the required immunizations for reasons of conscience, including religious beliefs, may be excluded from school in times of emergency or epidemic declared by the commissioner of public health.

1. A person claiming exclusion for reasons of conscience, including a religious belief, from a required immunization may only obtain the affidavit form by submitting a written request to the Department of Health. The request must include the following:
   • Full name of child;
   • Child's date of birth (month/day/year);
2. Written requests must be submitted through the United States Postal Service (or other commercial carrier), by facsimile, or by hand delivery to:

Bureau of Immunization and Pharmacy Support
1100 West 49th Street
Austin, Texas 78756

3. Upon request, one affidavit form for each child will be mailed unless otherwise specified (shall not exceed a maximum of five forms per child).
4. The parent must provide a copy of the letter sent to the Texas Department of Health to the school. The student may attend school for 30 days from the day the parent mailed the request to provide time for the parent to receive the affidavit from the Texas Department of Health.
5. The parent must have the Texas Department of Health form notarized and provide the original affidavit to the school.
6. The parent will receive a copy of the affidavit for their records.

• If a student is in series and it is too soon to have another immunization, they are not considered delinquent.
• The immunizing clinic will sometimes write a return date on the far right side of the immunization card.
• If the return date is not written on the card, utilize the attached "Summary of Rules for Childhood Immunization" to identify when the next dose is due.

• Serologic confirmations of immunity to measles, rubella, mumps, hepatitis A, hepatitis B, or varicella, are acceptable.
• Evidence of measles, rubella, mumps, hepatitis A, hepatitis B, or varicella illnesses must consist of a laboratory report that indicates either confirmation of immunity or infection.
• A parent or physician validated history (written statement) of varicella disease (chickenpox) is acceptable in lieu of vaccine.

• When the student returns to school with the "Vaccine Unavailability Form":
  • The RN will note the anticipated date of vaccine availability
  • The RN will place a copy of this form in the tickler file according to the anticipated month that the vaccine will be available.

Provisional Enrollment Chart

The law requires that students be fully vaccinated against the specified diseases. A student may be enrolled provisionally if the student has an immunization record that indicates the student has received at least one dose of each specified age-appropriate vaccine required by this rule. To remain enrolled, the student must complete the required subsequent doses in each vaccine series on schedule and as rapidly as is medically feasible and provide acceptable evidence of vaccination to the school. A school nurse or school administrator shall review the immunization status of a provisionally enrolled student every 30 days to ensure continued compliance in completing the required doses of vaccination. If, at the end of the 30-day period, a student has not received a subsequent dose of vaccine, the student is not in compliance and the school shall exclude the student from school attendance until the required dose is administered.

A student who is homeless, as defined by §103 of the McKinney Act, 42 USC §11302, shall be admitted temporarily for 30 days if acceptable evidence of vaccination is not available. The school shall promptly refer the student to appropriate public health programs to obtain the required vaccinations.

A student can be enrolled provisionally for no more than 30 days if he/she transfers from one Texas school to another, and is awaiting the transfer of the immunization record.

A dependent of a person who is on active duty with the armed forces of the United States can be enrolled provisionally for no more than 30 days if he/she transfers from one school to another and is awaiting the transfer of the immunization record.

Source: The provisions of this Texas Administrative Code, Chapter 97, Title 25 Health Services, adopted to be effective April 1, 2004, 29 TexReg 3188