Documenting Parental Refusal to Vaccinate
This document outlines the procedure for parents who refuse vaccinations for their children. It provides important information from the American Academy of Pediatrics about vaccine safety and effectiveness. Upon reading, parents can make informed decisions regarding their child's vaccinations.
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How do I fill this out?
To fill out this form, gather the necessary information regarding your child's vaccination history. Carefully read through the sections to ensure a clear understanding of the vaccines being declined. Once completed, submit the form as indicated.
How to fill out the Documenting Parental Refusal to Vaccinate?
1
Read the Vaccine Information Statement carefully.
2
Fill in your child's detailed information.
3
Indicate which vaccines are being declined.
4
Sign the document to acknowledge understanding.
5
Submit the form to your child's healthcare provider.
Who needs the Documenting Parental Refusal to Vaccinate?
1
Parents wanting to refuse vaccines for their children.
2
Pediatricians needing documentation of vaccine refusals.
3
Schools requiring vaccination records for attendance.
4
Healthcare providers to ensure proper patient records.
5
Guardians needing to communicate vaccination decisions.
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What are the instructions for submitting this form?
To submit this form, please ensure it is filled out completely and accurately. You may fax it to your child's doctor at 847-434-8000 or email it to kidsdocs@aap.org. For physical submissions, print the form and mail it to the American Academy of Pediatrics at 141 Northwest Point Blvd, Elk Grove Village, IL 60007.
What are the important dates for this form in 2024 and 2025?
Important dates related to this document include annual vaccination deadlines for schools, typically occurring in July for the upcoming school year. Additionally, check for any new updates or guidelines from the American Academy of Pediatrics that may affect vaccination schedules.
What is the purpose of this form?
The purpose of this form is to document the refusal of vaccines for children, ensuring that all healthcare providers are informed of the parents' decision. This form serves to protect the health of both the child and the community by outlining the risks associated with non-vaccination. Through proper documentation, it allows families and providers to have clear communication regarding immunization status.
Tell me about this form and its components and fields line-by-line.
- 1. Child's Name: The full name of the child refusing the vaccine.
- 2. Parent's/Guardian's Name: The full name of the parent or guardian filling out the form.
- 3. Vaccines Declined: A checklist of vaccines the parent has chosen to decline.
- 4. Acknowledgment Statement: A section for the parent to acknowledge they understand the risks of refusing vaccination.
- 5. Signature: Area for the parent/guardian to sign confirming their decision.
What happens if I fail to submit this form?
If the form is not submitted, the healthcare provider may continue to recommend vaccinations without understanding the parent's decision. This could lead to unnecessary confusion and potential health risks for the child and the wider community. Ensuring submission helps maintain proper communication between the family and the healthcare providers regarding vaccination choices.
- Health Risks: Failure to document refusal can result in uninformed decisions about the child's health.
- Miscommunication: Without the form, misunderstandings may arise between parents and healthcare providers.
- Legal Concerns: Proper documentation is essential for legal protection when refusing vaccinations.
How do I know when to use this form?
- 1. Pre-Vaccination Discussions: Use this form during discussions with providers before vaccinations.
- 2. Educational Settings: Required for school enrollment where vaccination proof is mandated.
- 3. Healthcare Records: To document any refusals in the child's medical records.
Frequently Asked Questions
What is this document for?
This document is used to formally refuse vaccinations for children, providing necessary information to healthcare providers.
How do I fill out the form?
Carefully read the Vaccine Information Statements provided and fill in the required fields regarding your child's information.
Can I edit this document?
Yes, you can edit the document using the PrintFriendly PDF editor before submission.
Is a signature required?
Yes, a signature from the parent/guardian is necessary to validate the refusal.
How can I share this document?
You can easily share the document via email or social media directly from the PrintFriendly platform.
What happens if I decline vaccinations?
By declining vaccinations, it is important to understand the associated risks for your child and others.
When should I revisit this decision?
You can discuss your vaccination decisions at any time with your healthcare provider.
Who should keep a copy of this document?
Both the parent/guardian and the healthcare provider should keep a copy for their records.
What information is included in the document?
The document includes details about vaccines, reasons for refusal, and potential health risks.
Can I change my mind later?
Yes, you can decide to vaccinate your child at any time in the future.
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