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Michigan State Exemption Page
VacLib.org & VaccineTruth.net Exemption Page |
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Topical Page Navigation Links
New Born Issues:Click for the desired information for your state Statues/Laws | NewBornBirthingPlan&BirthExemptions | Waivers_CareInSigning | Letters_Forms_Affidavits School-Daycare-Preschool Issues: Schools [all] | DayCare | Preschool | K-12 | College | (options)_OptOutRegistry | Adult Issues: Employment | TB_and/or_LeadTesting | Statues/Laws | Waivers_CareInSigning | Misc_Info, QXCI providers, Sponsors, etc. |
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Statues/Laws
Link to state law.National Vaccine Information Center: Link to state law. For additional help with exemptions, birth plan,etc questions: Check our Vaccination Liberation State Chapter and other resource organizations page for help in your state. If your state specific help is not available, Contact us. Available Exemptions Medical & Religious |
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PDF documents (.pdf) A PDF reader is required for PDF Files: Free Foxit Reader 12 MB file size. Or Free Download of Acrobat Reader: [Adobe. 43 MB file size] |
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NewBorn Birthing Plan and Birth Exemptions
BirthExemptions |
Birthing_Plans |
Vitamin_K |
Hepatitis_B |
Eyedrops |
Newborn_ScreeningBirth Exemptions: For those who are planning a hospital birth but want to evade invasive routine post natal procedures such as a Hep B shot, vitamin K injection, newborn screening, or the application of silver nitrate in the newborn's eyes, a very specific birthing plan must be submitted to the hospital in advance of the birth. Hospital staff must be informed, in advance, of your needs, wants and desires where your baby and birthing experience are concerned. The same applies to midwives. Steps:
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Birth Plans (To be used with hospitals and/or midwives) (Links to model birth plan letters) Model Birth Plan Letter for Hospital Births. You can attach an exemption from immunizations. In some states, there are religious exemptions from newborn screening tests such as PKU, etc... Information on the Dangers of Hospital Birth and the Benefits of Home Birth from gentlebirth.org Our best and most itemized birthplan: (.pdf) birthplan-itemized.pdf(HTML) BirthPlan-Itemized for reading on screen. Includes handy small dictionary of terms in the document. Model Birth Plan Letter for Hospital Births. This one is more detailed. Model Birth Plan Letter for Hospital Births for an adopted child... Model letter for hospital births for adoptions -- Dear Doctor and Medical Staff.doc (11427)
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It would be good idea to use the AFFIDAVIT below AND a model birth plan letter from above above.
Affidavit - Birth Exemptions
HTML (simple text) Affidavit to modify. AFFIDAVIT in Microsoft Word Replace the paragraph (near bottom of page 1) of the generic AFFIDAVIT above with your state law as follows: [Make sure you replace with your name, status, and name of child.] If your Title and Paragraph number of your state law is not pasted above, click here for the link to your state law. |
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Vitamin K Injection... The prescribing information on Vitamin K shot states that fatalities are an adverse reaction according to the Merck pharmaceutical package insert. http://fdb.rxlist.com/drugs/drug-9003-Aqua-Mephyton+Inj.aspx?drugid=9003&drugname=Aqua-Mephyton+Inj "The injectable form of vitamin K can rarely cause severe (sometimes fatal) allergic reactions when given by injection into a muscle or vein. Therefore, vitamin K should be injected into a muscle or vein only when it cannot be given by injection under the skin or taken by mouth, or when your doctor has judged that the benefit is greater than the risk. Seek immediate medical attention if you experience symptoms of an allergic reaction such as rash, itching, swelling, dizziness, or trouble breathing."Potential exists for the newborn to experience hypersensitivity to any component of this medication. Each milliliter contains: Phytonadione ............. 2 mg or 10 mg Inactive ingredients: Polyoxyethylated fatty acid derivative ................... 70 mg Dextrose...................................................................... 37.5 mg Water for Injection, q.s. .................................................. 1 mL Added as preservative: Benzyl alcohol ...................... 0.9% Links to prescribing information for Vitamin K: http://vaclib.org/chapter/inserts.htm#vitK Archive: Year 2002 Merck Vitamin K Package Insert - Aquamephyton PI | posted on Scribd Alternatives to Vitamin K Prophylaxis... Although oral vitamin K is not licensed for use as a drug by the FDA, drops for oral administration are available. Typically, one drop contains 2 mg. of vitamin K. Contact a midwife in your area, or a birthing supply company (such as birthwithlove.com), or Scientific Botanicals (206 527-5521) where your health care provider can order liquid vitamin K directly. Here's another much safer alternative that your chiropractor or naturopath can order for you. http://www.bioticsresearch.com/Products/BioK.htm A good organic whole food diet along with lots of leafy green vegetables is all that is necessary to prevent vitamin K deficiency in newborns. |
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Hepatitis B Vaccine Most states now require the Hepatitis B vaccine for newborns. Many parents are also cornered by emergency room personnel during accident visits. Hospitals nationally are under pressure to utilize every opportunity to score a "hit." If your pediatrician understands your views, get him involved with the hospital. As a last resort, protect your right to receive quality care in by asking hospital personal to sign the following waiver. Usually, you'll never find anybody in the hospital to sign this simple form, but you well get relief from demands to vaccinate your child. "I certify that the (Name of Vaccine)________ vaccine being administered to (Name of Child)_________ is free from all known and yet unknown zoonotic or human viruses or viral fragments and will not cause acute or chronic illness in the recipient due to viral contamination or as a reaction to the components of this vaccine. (Signature of Physician and Date)_________." If you do get a signature, hold on to the form. See Birth Plans for more information on avoiding Hep B Vaccination at birth |
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Eyedrops Some states require Prophylaxis against Gonococcal OPHTHALMIA NEONATORUM. A discussion of medical and legal issues regarding Silver Nitrate in the eyes of the newborn is here: PDF file: Statutory Law USA: Requiring Silver Nitrate in Eyes of Newborns at: http://www.rbs2.com/SilvNitr.pdf Written by Dr. Ronald B. Standler, attorney in Massachusetts and consultant Blog type discussion of pros and cons of eyedrops for newborn is here: http://answers.google.com/answers/threadview/id/20050.html |
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New Born Screening U.S. states now require screening of newborn babies for specific diseases. Conditions and legal status of "requirement" of newborn to be screened for each state: National Newborn Screening Status Report - http://genes-r-us.uthscsa.edu/nbsdisorders.pdf Newborn Genetic Screening Privacy Laws (includes links to laws for various states) ncsl.org/IssuesResearch/Health/NewbornGeneticandMetabolicScreeningLaws/tabid/14416/Default.aspx Newborn screening From Wikipedia, the free encyclopedia http://en.wikipedia.org/wiki/Newborn_screening Federal NewBorn Screening Law (from Families of Spinal Muscular Atrophy) http://www.fsma.org |
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Waivers - Take Care In Signing
If you take your new baby to an MD as opposed to a naturopath and/or
chiropractor, please be aware of and careful of any forms you sign.Our WARNING below is about signing (some) state approved and AAP created forms. See this letter from our director, Ingri Cassel, before you consider signing waiver forms. WARNING! A modified AAP form is posted here that you may wish to use with your doctor: AAPmodified.htm AAPmodified.doc MSWord .DOC file | AAPmodified.pdf PDF file, best for printing. Not all State employees are aware of the law and many exhibit the Hitler Complex. Take a firm stand. Some individuals have had difficulty getting the required forms. Such arrogance on the part of State employees should be reported to the Director of your state Department of Health.
See:
AnaiRhoads.org Why Signing a Waiver to Avoid Vaccines Can Be Considered Abuse |
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Letters Forms Affidavits
Links to Model birth plan letters (above).Link to Refusal to Permit Medical Treatment form Links to Affidavit - Birth An Adult Affidavit, with Christian beliefs, is here. (MSDOC file) Feel free to modify as needed. Dr. Tenpenny has the following forms on her web site. The forms are generic and may be used in any state. Affidavit for Parents Participating in International Adoption (Word) (pdf) Hep B vaccine in hospital for newborn refusal, sample (pdf) OSHA Declination Statement Form (also, pdf) Religious exemption letter that was approved in Florida (Word) (pdf) School Vaccine Exemption Form, sample (Word) (pdf) TB testing refusal, sample (pdf) Childcare and School Immunization Requirements http://drtenpenny.com/vac_refusal_forms.aspx Sample Vaccine Letters. from www.vaccines.bizland.com/letters.htm archived on VacLib.org/letters/doctor.htm Short Sample Vaccine Letter Most states now require the Hepatitis B vaccine for newborns. Many parents are also cornered by emergency room personnel during accident visits. Hospitals nationally are under pressure to utilize every opportunity to score a "hit." If your pediatrician understands your views, get him involved with the hospital. As a last resort, protect your right to receive quality care in the following manner. (Usually, you'll never find anybody in the hospital to sign this simple form): "I certify that the (Name of Vaccine)________ vaccine being administered to (Name of Child)_________ is free from all known and yet unknown zoonotic or human viruses or viral fragments and will not cause acute or chronic illness in the recipient due to viral contamination or as a reaction to the components of this vaccine. (Signature of Physician and Date)_________." If you do get a signature, hold on to the form. The ACCEPTANCE OF RESPONSIBILITY is imperative in exercising your rights for legal exemptions from forced medical experimentation and legalized bioterrorism. DO be prepared to fight for your baby's rights! An index page to various Acceptance of Responsibility) forms is here: . http://www.vaclib.org/legal/accept.htm Religious exemption forms will be listed below under Daycare Schools Colleges |
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DayCare - Preschool - Schools - Colleges
DayCare-Preschool-K-12-CollegesDayCare | Preschool | K thru 12 | Colleges
DayCare Medical, Religious and Philosophical exemption allowed. See School Forms below. Opt_In/Opt_Out ofMichigan Care Improvement Registry (MCIR) http://www.mcir.org/forms/OptOut%20Form%20Jan07.pdf
Kindergarten & Schools Medical, Religious and Philosophical exemption allowed. See School Forms below.
School Forms Michigan Opposing Mandatory Vaccines M.O.M. Form (.pdf)
http://momvaccines.org/forms/vaccination-exemption.pdf The State of Michigan Immunization Waiver Form (.pdf)
http://www.momvaccines.org/forms/SS_Imm_Waiver_2010-11.pdf Warning: The M.O.M form is preferred over the state offered form (DCH-0716), mainly due to the next sentence included in the Department of Community Health Form: By signing this waiver, you acknowledge that you are placing your child and others at risk of serious illness should he or she contract a disease that could have been prevented through proper vaccination. I would cross out this statement if the DCH form is used. Advertencia: "La forma de M.O.M. es preferible a la forma del estado que ofrece (DCH-0716), debido principalmente a la siguiente frase incluida en el Departamento de Salud Comunitaria de la forma:" Al Firmar esta Exoneración, Usted reconoce que esta poniendo a su niňo(a) y o muchos ostros en riesgo de sufrir serias enfermedades si es que el o ella se contágian de la enfermedad que pudo ser prevenida con vacunación apropiada. Yo tacharia esta declaración si en el formulario DCH se utiliza. Note: Some of the Immunization Waiver 5320 F3 and Medical Contraindication 5320 F2 forms are generic, meaning the forms are courtesy of the Michigan Department of Health. If your school is not listed, then download one of the generic forms marked (Generic Form) The forms not marked (Generic Form) means it's specific for that school and the school's name is mentioned on form. The Generic forms may also be used for daycare and preschools. For the form, 5320 F3, see the Warning above Neola Forms for some Michigan public school districts... Eastern Upper Peninsula Intermediate School District Immunization Waiver 5320 F3 (Generic Form) Easternupisd-mi fm5320F3 (.pdf) http://www.neola.com/Easternupisd-mi/search/forms/fm5320F3.pdf The following schools can also use the above fm5320F3 Note: Some schools may ask for an additional statement. If that's the case, use the M.O.M. form above. Warren Consolidated IOSCO ISD Dickinson-Iron Intermediate School District Clarkston Community Schools Ubly Community Schools Fruitport Community Schools Hillsdale Community Schools Reed City Area Public School Wexford-Missaukee Intermediate School District Union City Community Schools Carson City-Crystal Area Schools Menominee Intermediate School District Johannesburg-Lewiston Schools Sturgis Public Schools Benzie County Central School District Traverse Bay Area Intermediate School District Mt. Pleasant Public Schools Columbia School District Otsego Public Schools Marquette Area Public Schools Lawton Community Schools Reading Community School District Cheboygan-Otsego-Presque Isle ISD All the above schools can use the Neola Medical exemption waiver form: (Generic) (.pdf) http://www.neola.com/whitmorelake-mi/search/forms/fm5320F2.pdf Bangor Public Schools Immunization Waiver 5320 F3 (Generic Form) (.pdf) http://www.neola.com/bangor-mi/search/forms/fm5320F3.pdf
Medical Contraindication 5320 F2 (Generic Form) (.pdf) http://www.neola.com/bangor-mi/search/forms/fm5320F2.pdf
Rogers City Area Schools Immunization Waiver 5320 F3 (Generic Form) (.pdf) http://www.neola.com/rogers-mi/search/forms/fm5320F3.pdf
Medical Contraindication 5320 F2 (Generic Form) (.pdf) http://www.neola.com/rogers-mi/search/forms/fm5320F2.pdfTraverse Bay Area Intermediate School District Immunization Waiver 5320 F3 (Generic Form) (.pdf) http://www.neola.com/traversebayarea-mi/search/forms/fm5320F3.pdf
Medical Contraindication 5320 F2 (Generic Form) (.pdf) http://www.neola.com/traversebayarea-mi/search/forms/fm5320F2.pdfLakeview Community Schools Immunization Waiver 5320 F3 (Generic Form) (.pdf) http://www.neola.com/lakeviewcommunity-mi/search/forms/fm5320F3.pdf Medical Contraindication 5320 F2 (Generic Form) (.pdf) http://www.neola.com/lakeviewcommunity-mi/search/forms/fm5320F2.pdfCLARKSTON COMMUNITY SCHOOLS Immunization Waiver 5320 F2 (Spanish) Vea la advertencia arriba. FORMULARIO PARA EXONERACIÓN DE IMMUNIZACIÓN (.pdf) http://www.neola.com/clarkston-mi/search/forms/fm5320F2.pdf
Medical Contraindication 5320 F2 (Spanish) FORMULARIO PARA EXONERACIÓN POR CONTRAINDICACIÓN MÉDICA (.pdf) http://www.neola.com/clarkston-mi/search/forms/fm5320F1.pdf
(For an English Form use the Generic forms above or below) Whitmore Lake Public Schools Immunization Waiver 5320 F3 (Generic Form) (.pdf) http://www.neola.com/whitmorelake-mi/search/forms/fm5320F3.pdfMedical Contraindication 5320 F2 (Generic Form) (.pdf) http://www.neola.com/whitmorelake-mi/search/forms/fm5320F2.pdfCalhoun Intermediate School District Immunization Waiver 5320 F3 (Generic Form) (.pdf) http://www.neola.com/calhounisd-mi/search/forms/fm5320F3.pdfMedical Contraindication 5320 F2 (Generic Form) (.pdf) http://www.neola.com/calhounisd-mi/search/forms/fm5320F2.pdfWarren Consolidated Immunization Waiver 5320 F3 (Generic Form) (.pdf) http://www.neola.com/warrenconsolidated-mi/search/forms/fm5320F3.pdfMedical Contraindication 5320 F2 (Generic Form) (.pdf) http://www.neola.com/warrenconsolidated-mi/search/forms/fm5320F2.pdfIosco Regional Educational Service Agency Immunization Waiver 5320 F3 (Generic Form) (.pdf) http://www.neola.com/iosco-mi/search/forms/fm5320F3.pdfMedical Contraindication 5320 F2 (Generic Form) (.pdf) http://www.neola.com/iosco-mi/search/forms/fm5320F2.pdfKingsley Area Schools Immunization Waiver 5320 F3 (Generic Form) (.pdf) http://www.neola.com/kingsleyarea-mi/search/forms/fm5320F3.pdfMedical Contraindication 5320 F2 (Generic Form) (.pdf) http://www.neola.com/kingsleyarea-mi/search/forms/fm5320F2.pdfEastern Upper Peninsula Intermediate School District Immunization Waiver 5320 F3 (Generic Form) (.pdf) http://www.neola.com/Easternupisd-mi/search/forms/fm5320F3.pdf
Medical Contraindication 5320 F2 (Generic Form) (.pdf) http://www.neola.com/Easternupisd-mi/search/forms/fm5320F2.pdfBad Axe Public Schools Immunization Waiver 5320 F3 (Generic Form) (.pdf) http://www.neola.com/badaxe-mi/search/forms/fm5320F3.pdfMedical Contraindication 5320 F2 (Generic Form) (.pdf) http://www.neola.com/badaxe-mi/search/forms/fm5320F2.pdfWexford-Missaukee Intermediate School District Immunization Waiver 5320 F3 (Generic Form) (.pdf) http://www.neola.com/wexfordmissaukee-mi/search/forms/fm5320F3.pdfMedical Contraindication 5320 F2 (Generic Form) (.pdf) http://www.neola.com/wexfordmissaukee-mi/search/forms/fm5320F2.pdfMt. Pleasant Public Schools Immunization Waiver 5320 F3 (Generic Form) (.pdf) http://www.neola.com/mtpleasant-mi/search/forms/fm5320F3.pdfMedical Contraindication 5320 F2 (Generic Form) (.pdf) http://www.neola.com/mtpleasant-mi/search/forms/fm5320F2.pdfQuincy Community Schools Immunization Waiver 5320 F3 (Generic Form) (.pdf) http://www.neola.com/quincy-mi/search/forms/fm5320F3.pdfMedical Contraindication 5320 F2 (Generic Form) (.pdf) http://www.neola.com/quincy-mi/search/forms/fm5320F2.pdf
Colleges/Universities
See MCL § 333.9205a (2007) Risks associated with meningococcal disease; materials; notice; availability; "institution of higher education" defined. Michigan Law Links MCL § 333.9205a (2007) authorizes the "department" to advise schools and "institutions of higher education" about meningococcal disease. Note the Affidavit below. You may need to download and modify for your use in some circumstance.
An Adult Affidavit, with Christian beliefs, is here. (MSDOC file)
Feel free to modify as needed.
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OptOutRegistry for Vaccines
Vaccine Registry Opt-Outs:and various other Opt-Outs Immunization Registry Opt Out: Forms - Opt Out of MCIR Parents or guardians have the right to request in writing that their
children's immunization information not be included in the MCIR database. |
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Employment
You may use the AFFIDAVIT for Michigan Adult above.For Hep B vaccine in the workplace, your employer should give you a Hepatitis B Declination Form with this across the top... OSHA Regulations (Standards - 29 CFR) Hepatitis B Vaccine Declination (Mandatory) - 1910.1030 App A OSHA Standard Interpretations 09/23/1997 - The Bloodborne Pathogen Standard and the Enforcement Procedures for TB. "Finally, be aware that participation in the employer's skin testing program is voluntary on the part of the employee. OSHA does not require that employees participate in TB skin testing, only that the employer make such skin testing available to employees."See TB Testing for more information. US Fish and Wildlife Service Form 3-2283 Hepatitis B Immunization Consent/Refusal Form (.pdf)
http://www.fws.gov/forms/3-2283.pdfClick here for an Affidavit for Adult (college & employment religious exemption) ... Edit as needed... |
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TB and/or Lead Testing TB-Links/Exemptions Generic letter for Exemption to TB Testing: HTML (text): Exemption-tb-test.html MS Doc file: Exemption-tb-test.doc OSHA Standard Interpretations 09/23/1997 - The Bloodborne Pathogen Standard and the Enforcement Procedures for TB. "Finally, be aware that participation in the employer's skin testing program is voluntary on the part of the employee. OSHA does not require that employees participate in TB skin testing, only that the employer make such skin testing available to employees." TB and Lead Testing Links: F L Y E R LETTER Exemption_Letters OSHA_and_TB_test Tubersol Treatment TB_Screening Alternatives/Additional_Information The above TB and Lead exemption letters are courtesy of Deirdre DeVane of Wash DC. Thank you Deirdre! The adult TB letters were edited by Sherri Tenpenny. Thank you Sherri! TB can be detected by biofeedback machines that are hooked up to a computer, such as the QXCI, Best BioMeridian MSAS (Meridian Stress Assessment) or Electro Dermal Screening, Quantum Life System, and the F-Scan. You will need to ask specifically for a pathogen scan, especially TB. You will also need to request a printout with the results. See QXCI-BioMeridian Providers, etc below |
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Misc Info - QXCI providers - Sponsors - Etc.
Here are some of the practitioners for MichiganMichigan BEST BioMeridian Practitioners: Integrated Health of Mid Michigan Hubbs, Renee L.Ac. (CA) 4111 Okemos Road, Suite 102 Okemos, MI 48864 Phone: 517-349-5219 Fax: 517-349-5259 http://www.integratedhealth.meta-ehealth.com E-Mail: Ren2hubbs@earthlink.net Acupuncture, NAET, Meridian Stress Assessment Karen Hoezee Hudsonville, MI 49426 Tel: 616-669-1575 Email: being updated Flower Essence Practitioner, MSA Meridian Stress Assessment Technician Salubrity Vida Health Spa 115 Clover #100, Holland, MI 49423 Conveniently located off US 31 and Business 96 between 8th Street and Chicago Drive. 616-392-1899 http://www.salubrityvida.com/ MERIDIAN STRESS ASSESSMENT TESTING NOW AVAILABLE AT SALUBRITY VIDA. Please call contact below to find additional BioMeridian practitioners in your area or closeby. Oksana Gorodetsky Marketing/Administrative Coordinator BioMeridian International 12411 South 265 West, Suite F Draper, UT 84020 T 801-501-7517 F 801-501-7518 Toll Free 888-224-2337 ogorodetsky@biomeridian.com Michigan QXCI Practitioners: http://www.theqxci.com/information.php CHIROPRACTIC HEALTH CLINIC Maegan Davis, DC, Owner 2549 Jolly Road, Suite 360 Okemos, MI 48864 (517) 347-2222 * Fax. (517) 347-2233 http://www.chiropractichealthclinic.com Email: maegandc@voyager.net We offer gentle, effective chiropractic care and massage therapy for the entire family, including QXCI health scan and nutritional guidance. Knowing all healing comes from within, our mission is to inspire, educated and support clients in attaining their personal best when the body, soul and spirit are balanced. For information on purchase or lease of the new Quantum Life BioFeedback L.I.F.E. System, please email Donna and leave your name, mailing address, phone number and email. If you're inquiring for another interested individual or practitioner, please leave their information. The company will then send information and contact the interested parties. Or you may call 1-888-249-1421. Information on this page is provided and sponsored by: ![]() Referred by Roberto AC (you may have to click YES) |