The COE form is used when a parent or guardian wants to exempt their child from one or more of the immunization requirements. The completed form must be turned into the school or child care.
The COE in several languages is available on the School and Child Care immunization webpage: www.doh.wa.gov/SCCI. A COE cannot be printed from the IIS.
It depends, if the COE exempts all of the required immunizations a CIS is not needed. If the COE only exempts some of the required immunizations then both a CIS and COE need to be on file.
No. The COE on file is valid for all exemptions other than personal/philosophical exemption for the measles, mumps and rubella immunization requirements. A new COE is not necessary for all other existing exemptions.
A revised COE is effective as soon as it is published on the DOH website. The date of publication is on the bottom of the form. Parents should use the most current COE to request any new exemption from the immunization requirements.
There are four different types of exemptions:
Medical Exemption: A health care practitioner may grant a medical exemption to a vaccine required by rule of the state board of health only if in his or her judgment, the vaccine is not advisable for the child. When it is determined that this particular vaccine is no longer contraindicated, the child will be required to have the vaccine.
Philosophical/Personal Exemption: To be used when the parent/guardian has a personal or philosophical objection to the immunization of the child. A philosophical/personal exemption may not be used to exempt a child from the measles, mumps or rubella vaccine requirements (effective July 28, 2019).
Religious Exemption: To be used when the parent/guardian has a religious belief that is contrary to the required immunization.
Religious Membership Exemption: To be used when the parent/guardian affirms membership in a church or religious body that does not allow them to take their child for medical treatment from a health care practitioner (MD, DO, NP, PA. ARNP). Because it is against their religious beliefs to get medical treatment from a health care practitioner this exemption does not require a health care practitioner signature.; RCW 28A.210.090.
There are three types of exemptions that can be claimed with a completed Certificate of Exemption for MMR:
- Medical Exemption - signed by both the parent and health care practitioner
- Religious Exemption - signed by both the parent and health care practitioner
- Religious Membership - signed by the parent. This exemption type is only used when the religious belief does not allow for medical treatment by a health care practitioner, therefore no health care practitioner signature is required.
Personal or philosophical exemptions are not allowed for MMR. RCW 28A.210.090
The law did not include a grandfathering or exclusion clause for students who had personal exemptions for the measles, mumps or rubella immunization requirements in place before the law changed. As of July 28, 2019 any existing personal exemptions to the MMR immunization requirements were voided.
Your child's healthcare provider will determine if they need to be temporarily or permanently exempted from receiving a vaccine for a medical reason. Medical contraindications and precautions to vaccination are outlined in the Advisory Committee on Immunization Practices' (ACIP) recommendations and guidelines published by the Centers for Disease Control and Prevention. Medical contraindications to vaccination are rare.
Yes, health care practitioners must put the date that the temporary exemption ends on the Certificate of Exemption. School, preschool, or child care staff should monitor temporary exemptions. When the temporary exemption ends the child can be in conditional status for up to 30 days in order to get the missing immunization or another exemption.
Religious Exemption: To be used when the parent/guardian has a religious belief that is contrary to the required immunization. This requires the signature of a health care practitioner that they have provided the parent with information about the benefits and risks of immunization for the child.
Religious Membership Exemption: To be used when the parent/guardian affirms membership in a church or religious body that does not allow them to take their child for medical treatment from a health care practitioner (MD, DO, NP, PA. ARNP). This exemption does not need a healthcare practitioner signature. If the parent or guardian has a religious objection to the vaccine but takes their child to see a health care practitioner for things like illness and injury care this is not the appropriate exemption. They should use the Religious Exemption area of the COE which must have a healthcare practitioner signature. RCW 28A.210.090.
It is not recommended that school or child care staff attempt to verify the religious beliefs of a parent/guardian requesting a religious or religious membership exemption. A completed Certificate of Exemption is all that is required. The role of the health care practitioner is to provide information to the parent/guardian. The health care practitioner's signature indicates that they have provided the information, not that they have assessed the parent's religious beliefs.
If the child receives medical treatment for things other than immunizations the religious membership exemption is not the appropriate type of exemption. Ask the parent if the child sees a health care provider for injury or illness care. If the parent or guardian says yes, then another exemption which requires a health care practitioner signature should be used instead.
It is not required to provide the reason for granting the medical exemption. This information is not requested on the Certificate of Exemption form.
In most cases, yes. Parents or guardians requesting a medical, philosophical, or religious exemption must have the signature of a health care practitioner (MD, DO, ND, ARNP, PA) licensed in Washington state confirming that they provided the parent with information about the benefits and risks of immunizations. A practitioner may also write and sign a letter containing the same information instead of signing the COE. This letter must be attached to the parent signed COE. If granting a medical exemption, the practitioner must complete the medical exemption section of the COE.
A health care practitioner does not need to sign the COE if the parent claims a Religious Membership exemption. This exemption states that the parent's religious beliefs do not allow medical treatment of their child by a health care practitioner. This exemption does not require a health care practitioner signature. Parents/guardians who have a religious objection to vaccination but whose children obtain care from health care practitioners need to use the religious exemption which requires a health care practitioner signature.
Only a health care practitioner can sign the COE. A healthcare practitioner is defined as a physician (M.D.), physician assistant (P.A.), osteopath (D.O.), naturopath (N.D.), or advanced registered nurse practitioner (A.R.N.P.) licensed in Washington state. For more details, see Revised Code of Washington (RCW) 28A.210.090.
A health care practitioner who, in good faith, signs the statement that they have provided the parent with information about the benefits and risks of immunization for the child, are immune from civil liability for providing the signature. For more details, see Revised Code of Washington (RCW) 28A.210.090.
A certificate from another state cannot be used to exempt a student from the WA state immunization requirements. The Washington state Certificate of Exemption form must be used and the health care practitioner (MD, DO, ND, and ARNP, PA) who signs it must be licensed in Washington state. For more information, see the Revised Code of Washington (RCW) 28A.210.090.
This is not addressed in state immunization law. A health care practitioner should speak with their professional organization or discuss with their own legal counsel. The role of the practitioner is to provide information and their signature indicates they have provided the information, not that they have assessed or agree with the parent's religious beliefs.
The role of the health care practitioner is to provide information to the parent about the benefits and risks of vaccination. Their signature indicates they have provided the information, not that they have assessed the validity of the person's religious beliefs. There is nothing requiring the provider to check for documentation. If a provider feels they want to incorporate this into their practice, they should discuss with their professional organization or their own legal counsel.
Only a physician, osteopath, naturopath, physician assistant, or advanced registered nurse practitioner licensed in Washington state may sign the WA COE. If the parent is one of the qualified health care practitioners listed in the law (RCW 28A.210.090), it is up to that practitioner's own best judgment, based on their individual legal, ethical, medical, and professional obligations.
No. Students must have a completed COE on file in their record only if they have an exemption to one or more of the immunization requirements.
If a parent turns in, or during record review you discover, a COE that has been improperly filled out, return it to the parent and let them know a properly completed COE is needed for the exemption to be valid. In this case, inform the parent that they may only have one type of exemption per disease immunization requirement.
The only type of COE with an expiration date is a COE with a temporary medical exemption. The COE does not need to be renewed annually. Once a COE is filled out, it can be used for the length of the student's Washington state school career, including school transfers. If parent's request changes to the COE a new form must be completed.
No, documentation of a refusal in the IIS means the parent or patient refused a vaccine offered to them during a provider visit. It does not mean that the parent or patient requested an exemption from the school or child care immunization requirements. It also does not document that a health care practitioner (MD, DO, ND, and ARNP, PA) discussed the benefits and risks of immunizations with the parent. The IIS does not have a place to document that information. Parents requesting an exemption from the immunization requirements must turn in a completed COE to the school or child care.
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