|Classification / Identification:|
| ||Form Number:||014-4895-64E||Edition date: ||2013/08 |
| ||Title:||Statement of Medical Exemption – Immunization of School Pupils Act|
| ||Ministry:||Health|| || |
| ||Branch/ABC:||Public Health|| || |
| ||Program:||Public Health|| || |
| ||Purpose of Form:||A physician or nurse practitioner must complete a Statement of Medical Exemption for children who require a medical exemption from vaccine requirements under the Immunization of School Pupils Act.|| || |
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