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Exemption FAQs

Medical Exemptions

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Frequently Asked Questions

1. What were the main changes to the medical exemption process that came into effect under Senate Bills (SB) 276 and SB 714 (Pan, 2019)?

Beginning January 1, 2021 all new medical exemptions for school and child care entry must be issued through CAIR-ME. Medical exemptions can only be issued by MDs or DOs licensed in California and must meet applicable Centers for Disease Control and Prevention (CDC), Advisory Committee on Immunization Practices (ACIP), and American Academy of Pediatrics (AAP) criteria.

2. Are medical exemptions filed for children in attendance at a California child care facility or school before 2021 valid in later years?

A medical exemption filed at a pre-kindergarten facility or school remains valid until the earliest of:

  • When the child enrolls in the next grade span (TK/K-6th grade, 7th-12th grade)
  • The expiration date specified in a temporary medical exemption
  • Revocation of the exemption (PDF) because the issuing physician has been subject to disciplinary action from the physician’s licensing entity.

3.  A doctor has told a child’s parents that their child needs a medical exemption from a required immunization. How do parents get a medical exemption for their child?

Starting January 1, 2021, all new medical exemptions for school and child care entry must be issued through CAIR-ME.  Parents can create an account in CAIR-ME and apply for an exemption. They will receive an exemption application number to give to their child’s physician. The physician can register for an account in CAIR-ME and log in to issue the ME.  Once the ME is issued, the physician prints the form and provides a copy to the parents to give to their child’s school or child care facility.

Spanish:

Un médico les ha dicho a los padres de un niño que su hijo(a) necesita una exención médica de las vacunas requeridas. ¿Cómo obtienen los padres una exención médica para su hijo(a)?

A partir del 1 de enero del 2021, todas las nuevas exenciones médicas para el ingreso a la escuela y al cuidado infantil deben emitirse a través de CAIR-ME. Los padres y médicos pueden registrarse y crear una cuenta en CAIR-ME en cualquier momento. Una vez registrados, los padres pueden iniciar una sesión en CAIR-ME para solicitar una exención médica. Los padres llevan el número de solicitud de exención al médico de su hijo(a), quien puede iniciar una sesión en CAIR-ME para emitir la exención. Una vez que se emite la exención, el médico imprime el formulario  y les proporciona una copia a los padres para que la entreguen en la escuela o el centro de cuidado infantil de su hijo(a).

4. When should schools and child care facilities sign up to use CAIR-ME?

Schools and child care facilities should email medicalexemptions@cdph.ca.gov to request access to the CAIR-ME website after they receive a medical exemption issued through CAIR-ME for one of their enrollees.  After registering and creating an account, schools and child care facilities will be able to see medical exemptions that have been issued in CAIR-ME for children that attend their school or child care facility and to receive notifications about these medical exemptions.

5. How early may a physician issue a medical exemption in CAIR-ME before a child first enters a grade span starting in 2021?

A medical exemption may be issued in CAIR-ME no more than 12 months before a child first enters a grade span (grade spans are birth-preschool, TK/K-6th, and 7th-12th). 

6. Which medical exemptions in CAIR-ME will the State of California Department of Public Health (CDPH) review?

Starting January 1, 2021, new medical exemptions must be issued using the medical exemption website CAIR-ME.  By law, CDPH is required to review exemptions in CAIR-ME when:

  •  A school's or child care facility’s immunization rate falls below 95% or
  •  A school or child care facility fails to provide reports of vaccination rates to CDPH
    or
  • A doctor writes 5 or more medical exemptions per year beginning January 1, 2020.

CDPH may also review a medical exemption if CDPH determines it is necessary to protect public health. 

7. Who at CDPH will review my child's medical exemption in CAIR-ME?

Medical exemptions reviewed based on the criteria specified by law will be reviewed by clinical staff at CDPH with expertise in immunization. Only the State Public Health Officer, or a physician they designate from the CDPH's immunization program, can revoke a medical exemption. 

8. Does a child with an existing medical exemption in CAIR-ME need a new medical exemption if the child enrolls in a new school or child care facility within the same grade span?

No, a parent can present the medical exemption issued previously in CAIR-ME to the new school or childcare, but the school or child care facility information must be updated in CAIR-ME.  Parents must log in to CAIR-ME, update the school or child care facility information, and show proof of the change to the new school or child care facility.  Parents will be able to print a copy of the changes to show the school or child care facility.  The new school or child care facility can also log in to CAIR-ME to confirm that the medical exemption is listed for their school or child care facility. 

9. What happens if my child's medical exemption in CAIR-ME is revoked? May I appeal?

The law provides an appeal process for parents if CDPH revokes a medical exemption because the exemption did not meet applicable Centers for Disease Control and Prevention (CDC), Advisory Committee on Immunization Practices (ACIP), and American Academy of Pediatrics (AAP) criteria or the standard of medical care.  Parents will receive information about their options if their child's medical exemption is revoked.  Parents will have 30 days to appeal.

Appeals will be reviewed by an independent expert panel appointed by the California Health and Human Services Agency (CHHS). The panel's decision shall be adopted by CHHS and is final. 

10. Who can access the medical exemption website CAIR-ME? 

CAIR-ME is available to parents/guardians seeking a medical exemption, California-licensed physicians, schools and child care facilities, local health departments, the Medical Board of California, the Osteopathic Medical Board of California, the California Department of Public Health, and the California Health and Human Services Agency.  Access to information in CAIR-ME is restricted based on the type of user and in compliance with state and federal confidentiality and privacy laws.

11. To meet the chickenpox immunization requirement for TK/K-12 admission or for advancement into 7th grade, what documentation may a school accept? 

A school may accept either an immunization record indicating the child has received two doses of chickenpox vaccine or a medical exemption from varicella vaccine. Starting in 2021, new medical exemptions must be issued using CAIR-ME.

12. When do medical exemptions issued in CAIR-ME expire?​

Medical exemptions issued in CAIR-ME expire at the earliest of:

  • When the child enrolls in the next grade span (TK/K-6th grade, 7th-12th grade)
  • The expiration date specified in a temporary medical exemption
  • Permanent revocation of the exemption.​

13. Effective January 1, 2021 do changes in the law prevent a licensed physician from issuing a medical exemption?

Yes, under certain circumstances. Licensed physicians will not be able to issue new medical exemptions if they are:

  • on probation for immunization-related practices,
  • have a pending accusation for immunization-related practices, or
  • CDPH determines they are a public health risk.  In this case, the physician may be barred from submitting an exemption for no less than two years.

​14. Does the law limit doctors from issuing more than 5 medical exemptions a year? 

No, physicians are not limited to issuing 5 medical exemptions a year. By law, CDPH will review medical exemptions when a doctor issues 5 or more exemptions in a year to ensure that the exemptions are consistent with the standard of medical care for a particular medical condition and align with CDC, ACIP, and AAP guidelines.

15. Do medical exemptions issued prior to 2021 need to be uploaded into CAIR-ME?

No. Existing MEs issued for children in attendance before 2021 will remain on file at schools and child care facilities and do not need to be uploaded into CAIR-ME.

16. As a school or child care user, I already have a login for the California Immunization Registry (CAIR2).  Do I need a different account to log in to CAIR-ME to view exemptions issued through CAIR-ME for my enrollees?

Yes, school and child care staff will need to register separately to access CAIR-ME.  To register for a CAIR-ME account, you will need to have an exemption issued through CAIR-ME for one of your enrollees.  Once you receive the exemption from the parent, email the medical exemption number and school/childcare ID from the form to medicalexemptions@cdph.ca.gov to receive a code to allow you to register.

Medical Exemptions Prior to 2021

17.  Are medical exemptions issued before January 1, 2020 by physicians who have been disciplined by their medical licensing board valid?

No, these medical exemptions are no longer valid.

To find out if a physician has been disciplined by the Medical Board or Osteopathic Medical Board, please look up an issuing physician’s name or medical license number on the list of disciplined physicians (PDF)(updated August 2022), or the most up-to-date information can be found on the Department of Consumer Affairs license search website.  Additional details are in the letter (PDF) to child care facilities and schools. A parent may appeal within 30 days (PDF)| (Spanish)(PDF) of being notified of the revocation. 

18. Did children with a prior medical exemption who were admitted into the next grade span (e.g., starting transitional kindergarten/kindergarten or 7th grade) in 2020 need to obtain a new medical exemption document in 2020 or could they have re-used a document dated before 2020?

The parent or guardian would have needed to submit a new medical exemption from a physician licensed in California to the school or child care facility.

19. For admissions on or after July 1, 2019, through December 31, 2020, what was required for a medical exemption to a required immunization?

​​Starting July 1, 2019, a parent or guardian must submit a signed, written statement from a physician (MD or DO) licensed in California which states:

  • The specific nature of the physical condition or medical circumstance of the child for which a licensed physician does not recommend immunization.
  • Each specific required vaccine that is being exempted.
  • Whether the medical exemption is permanent or temporary.
  • If the exemption is temporary, an expiration date no more than 12 calendar months from the date of signing. ​

20. For admissions prior to July 1, 2019, what was required for a medical exemption to a required immunization?

A parent or guardian must submit a written statement from a licensed physician (MD or DO) which states:

  • That the physical condition or medical circumstances of the child are such that the required immunization(s) is not indicated
  • Which vaccines are being exempted
  • Whether the medical exemption is permanent or temporary
  • The expiration date, if the exemption is temporary.

Personal Beliefs Exemptions

21. What were the main changes Senate Bill (SB) 277 (Pan, 2015) made to the immunization requirements for children entering child care or school?

Since January 1, 2016:

  • Parents or guardians of students in any school or child-care facility, whether public or private, are no longer allowed to submit a personal beliefs exemption to a currently-required vaccine.
  • Students are no longer required to have immunizations for entry if they attend:​
  • Students who have an individualized education program (IEP) should continue to receive all necessary services identified in their IEP regardless of their vaccination status.
    • Schools are still required to request, maintain, and report records of immunizations that have been received for these students.

Additional Personal Beliefs Exemptions FAQs ​(PDF)

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