Back to School! Vaccines! And Exemption Forms

Maria Huang, MD, FAAP, WCAAP Vaccine Committee Co-Chair

As much as we would love all WA kids to be fully immunized, we know there remains a sizable vaccine hesitant population. WA State Law allows parents or guardians to exempt their child from the school or childcare immunization requirements by claiming personal/philosophical, religious or medical reasons. (MMR may not be exempted for personal/philosophical reasons). So to save the time and sanity of our hardworking school nurses, when we are asked to sign Certificate of Exemption (COE) forms, let’s do it correctly.  Read on to learn answers to the most common FAQs

What is the COE form and who is allowed to sign?

The COE form is used when a parent or guardian wants to exempt their child from one or more of the immunization requirements.  Required vaccines in WA: varicella, Haemophilus influenzae type b (Hib)*, pneumococcal disease*, hepatitis B, measles, mumps, rubella, polio, diphtheria, tetanus, and pertussis (*required only until 5 years of age).  The completed form must be turned into the school or child care for the child to attend.  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.  (Note: This list does not include parents, school nurses, or religious leaders). 

If I sign the form, does it mean I agree with or have assessed their religious or personal/philosophical beliefs? 

No – It is not recommended that health care practitioners, school, or child care staff attempt to verify or assess the beliefs of the parent/guardian. A completed Certificate of Exemption is all that is required. The role of the practitioner is to provide information about the benefits and risks of immunization and their signature indicates they have provided the information, not that they have assessed or agree with the parent/guardian’s religious, personal, or philosophical beliefs.  Health care practitioners who, in good faith, sign the statement that they have provided the parent with this information, are immune from civil liability for providing their signature. 

What are the 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 (MMR) 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.

More resources: