OREGON - IMMUNIZATION EXEMPTIONS by State (includes current statutes, letters & forms)IMMUNIZATION EXEMPTIONS by State (includes current statutes, letters & forms)Oregon Current Statutes & Laws: http://www.909shot.com/state-site/Oregon.htm Medical & Religious Submit a statement signed by the parent that the child has not been immunized as required because the child is being reared as an adherent to a religion the teachings of which are opposed to such immunization.
Exemption Letters & Forms... Birth Exemptions: For those who are planning a hospital birth but want to evade invasive routine post natal procedures such as a Hep B shot, vitamin K injection, newborn screening, or the application of silver nitrate in the newborn's eyes, a very specific birthing plan must be submitted to the hospital in advance of the birth. Hospital staff must be informed, in advance, of your needs, wants and desires where your baby and birthing experience are concerned. The same applies to midwives. IMPORTANT! Please download this if you're expecting a child or know someone who is! Northwest Regional Newborn Screening Program Oregon Practitioners's Manual A religious exemption can be claimed from the requirement for the newborn screening tests. In this event, the person otherwise responsible for submitting the specimen for testing is responsible for submitting a copy of the Informed Dissent form to the State Laboratory signed by the infants parent; see page 48. Parental Refusal In the event a parent refuses the testing, the program strongly urges practitioners to obtain an "Informed Dissent" signed by the parent and placed in the infants medical record. Suggested wording is provided below: Parental refusal (Informed Dissent form) page 48 of the pdf file. (.pdf) http://www.oregon.gov/DHS/ph/nbs/nbspract/manual.pdf
This proves to the hospital that religious exemption is allowed for refusing newborn screening in Oregon. Should use with the Model Birth Plan letters. OREGON Sub Chapter: NEWBORN HEARING SCREENING TEST Statute: ORS 433.321 Title: Hearing screening tests for newborns; disclosure of information; exemptions (7) A hospital or birthing center directed to provide newborn hearing screening tests under this section is exempt from providing such services if the parent or guardian of the newborn child objects to the testing procedure on the grounds that the procedure conflicts with the religious tenets and practices of the parent or guardian. The parent or guardian must sign a statement that the newborn infant is being so reared. [Source: HB3246, 1999] Rule: 333-020-0130 (1) (c) No newborn child may be refused the Newborn Hearing Screening Testing because of an inability of the parent or guardian to pay for the testing. 333-020-0165(1) A hospital or birthing center directed to provide Newborn Hearing Screening Tests under these Administrative Rules is exempt from providing such services if the parent or guardian of the newborn child objects to the testing procedure on the grounds that the procedure conflicts with the religious tenets and practices of the parent or guardian. (2) The parent or guardian must sign a statement that the newborn child is being so reared, using the following language:
The undersigned parent (or guardian) of states that this child is exempt from testing for detection of hearing loss in that the child is being reared as an adherent to a religion the teachings of which are opposed to such testing. [ Source: Administrative Rule, Division 20, as of Stat. Auth.: 1999 Oregon Laws, Ch. 958Stat. Implemented: 1999 Oregon Laws, Ch. 958] This proves to the hospital that religious exemption is allowed for hearing screening refusal in Oregon. ORS 433.321 - Oregon Revised Statutes Vitamin K prophylaxis... ORS 433.306 - Oregon Revised Statutes (Vitamin K prophylaxis)... Sub Chapter: VITAMIN K FOR NEWBORNS Statute: ORS 433.306 Title: Duty to administer vitamin; religious objection; effect of inability to pay Text: (1) A physician licensed under ORS chapters 677, 684 and 685 or the midwife attending the mother at the birth of the child shall be responsible for insuring that the newborn infant shall receive vitamin K within 24 hours after birth by the most appropriate means, either by injection or orally. (2) The procedure described in subsection (1) of this section does not apply to any infant whose parents object to the procedure on the grounds that the procedure conflicts with the religious tenets and practices of the parents. The parents must sign a statement saying the infant is being so reared. (3) No infant shall be refused the procedure described in subsection (1) of this section because of the parents inability to pay. This proves to the hospital that religious exemption is allowed for Vitamin K refusal in Oregon. ORS 433.306 - Oregon Revised Statutes You may state your objection and use this generic (.pdf)
Refusal to Permit Medical Treatment form and a religious exemption AFFIDAVIT for newborns.The forms and AFFIDAVIT should be used along with the Model Birth plan letters below. Vitamin K package insert... (.pdf) http://www.fda.gov/medwatch/SAFETY/2003/03Feb_PI/AquaMEPHYTON_PI.pdfPlease read the above insert and read the warning... WARNING - INTRAVENOUS USE Severe reactions, including fatalities, have occurred during and immediately after the parenteral administration of AquaMEPHYTON® (Phytonadione). fatalities=death The package insert should be printed out and used along with the model birth plan letter, the Informed Dissent Form on page 48 of the manual (above...), and your exemption letter or AFFIDAVIT. This shows the hospital or birthing center that you are aware of the risks of Vitamin K injection, and that they should be too. Alternatives for Vitamin K Prophylaxis... Although oral vitamin K is not licensed for use as a drug by the FDA, drops for oral administration are available. Typically, one drop contains 2 mg. of vitamin K. Contact a midwife in your area, or a birthing supply company (such as birthwithlove.com), or Scientific Botanicals (206 527-5521) where your health care provider can order liquid vitamin K directly. Here's another much safer alternative that your chiropractor or naturopath can order for you. http://www.bioticsresearch.com/Products/BioK.htm A good organic whole food diet along with lots of leafy green vegetables is all that is necessary to prevent vitamin K deficiency in newborns. Sample Vaccine Letters From this website... http://www.vaccines.bizland.com/letters.htm Most states now require the Hepatitis B vaccine for newborns. Many parents are also cornered by emergency room personnel during accident visits. Hospitals nationally are under pressure to utilize every opportunity to score a "hit." If your pediatrician understands your views, get him involved with the hospital. As a last resort, protect your right to receive quality care in the following manner. (Usually, you'll never find anybody in the hospital to sign this simple form): "I certify that the (Name of Vaccine)________ vaccine being administered to (Name of Child)_________ is free from all known and yet unknown zoonotic or human viruses or viral fragments and will not cause acute or chronic illness in the recipient due to viral contamination or as a reaction to the components of this vaccine. (Signature of Physician and Date)_________." If you do get a signature, hold on to the form. (Links to model birth plan letter and acceptance of responsibility) Acceptance of Responsibility. http://www.vaclib.org/legal/accept1.htm Model Birth Plan Letter for Hospital Births. You can attach an exemption from immunizations. In some states, there are religious exemptions from newborn screening tests such as PKU, etc... (.doc) Model Letter for Hospital Births (Model11425.doc) Model Birth Plan Letter for Hospital Births. This one is more detailed. You can attach an exemption from immunizations. In some states, there are religious exemptions from newborn screening tests such as PKU, etc... (.doc)
Model letter for hospital births 2.doc (11426)Model Birth Plan Letter for Hospital Births for an adopted child... Model letter for hospital births for adoptions -- Dear Doctor and Medical Staff.doc (11427) (.doc) VaccineTruth.net/letters/Model letter for hospital births for adoptions.doc
The above documents can also be made available in WordPerfect
Hepatitis B Vaccine Refusal from Dr. Sherri Tenpenny's webpage: AFFIDAVIT I/We, _________________________, Sui Juris, Free, Natural Flesh and Blood Human Being(s), state Citizen(s) of the Oregon Republic affirm: Be it known to all courts, governments, and other parties that: Being (a person/people) of Strong Christian Morals, it is against (my/our) Deep, Sincerely Held, Religious Convictions to accept the injection of any foreign substance into (my Body/our Bodies) or the Body of (my/our) Child. This includes, but is not limited to, any and all, Vaccinations, Shots, Tests for Diseases, Oral Vaccines, Epidermal Patches and in any other way that Live or Killed Bacterium, Viruses, Pathogens, Germs, or any other Microorganisms, may be introduced into or upon (my/our) newborn's body. This written statement to exempt (my/our) newborn from any immunizations, newborn screening, and the Vitamin K shot, because (Iwe) hold genuine and sincere personal religious beliefs which are inconsistent with these medical procedures & experimentation. The practice of vaccination and the injection or application of any foreign substance is contrary to (my/our) conscientiously held religious beliefs and practices, and violates the free exercise of (my/our) religious principles. The Hepatitis-B vaccine supposedly protects against a disease that is only transmitted through multiple sexual partners or street IV drug users and therefore usurps (my/our) parental authority to condemn such activity in (my/our) child. The acceptance of this vaccine promotes sexual promiscuity and immoral behavior in direct contradiction to the teachings of (my/our) faith. The prescribing information on Vitamin K shot states that fatalities are an adverse reaction according to the Merck pharmaceutical package insert. http://www.fda.gov/medwatch/SAFETY/2003/03Feb_PI/AquaMEPHYTON_PI.pdf "WARNING - INTRAVENOUS USE Severe reactions, including fatalities, have occurred during and immediately after the parenteral administration of AquaMEPHYTON® (Phytonadione)."A conflict arises because (my/our) religious convictions are predicated on the belief that all life is sacred. God's commandment "Thou Shall Not Kill" applies to the practice of injection of carcinogenic substances that can kill. (We / I) {First and Last name(s)}, as the {(parent (s) / guardian(s)} of ______________________(name of newborn child) are exercising (our/my) rights under the First Amendment of the US Constitution, Oregon Revised Statutes 333-020-0165 (1), and 433.306 (2) to receive Religious Exemption from Vaccination, ALL injections, & testing. Furthermore the Oregon Revised Statutes under Disease and Condition Control 433.267; Immunization of school children; exceptions; effect of failure to comply, (c) says that a statement signed by the parent that the child has not been immunized because the child is being reared as an adherent to a religion the teachings of which are opposed to such immunization is exempt from such immunization. The Oregon State Constitution, Article I, Bill of Rights, Section 2: "Freedom of worship. All men shall be secure in the Natural right, to worship Almighty God according to the dictates of their own consciences. Section 3: Freedom of religious opinion. No law shall in any case whatever control the free exercise, and enjoyment of religious (sic) opinions, or interfere with the rights of conscience." Applicable law has been interpreted to mean that a religious belief is subject to protection even though no religious group espouses such beliefs or the fact that the religious group to which the individual professes to belong may not advocate or require such belief. Title VII of the Civil Rights Act of 1964 as amended Nov. 1, 1980; Part 1605.1-Guidelines on Discrimination Because of Religion. Our legal rights are guaranteed by the free exercise clause of the First Amendment to the U.S. Constitution. Recent court decisions have upheld the rights of individuals seeking exemptions from immunizations based upon personal and religious reasons. On the U.S. Supreme Court level in Frazee V. Illinois Dept. of Security, 489 U.S. 829, it was found that a state may not deny an exemption simply because a person is not a member of a formal religious organization. The Lord Jesus Christ and Our Creator are the only source of protection of my body and that of my family that I can accept. (I/We) affirm that vaccination & injections of any foreign substances and proteins conflict with (my/our) religious beliefs as stated above. Therefore, (I/we) would request that you accommodate (my/our) religious beliefs and practices by exempting (my/our) newborn child from any vaccinations, injections and testing of any kind. Rest assured that (my family and I/our family) do practice a form of immunization that keeps our immune systems strong and is in keeping with Biblical principles. Further Affiant Saith Not The use of notary below is for identification only, and such use does NOT grant any jurisdiction to anyone. Subscribed and sworn, without prejudice, and with all rights reserved, (Print Name Below) _______________________________________________________________, Principal, by Special Appearance, in Propria Persona, proceeding Sui Juris. _______________________________ Signature of Affiant ACKNOWLEDGMENT state of Oregon county of _________________: On this _______ day of ______________, 200___, before me personally appeared __________________________________, to me known to be the person described in and who executed the foregoing instrument and acknowledged that he executed the same as his free act and deed, for the purposes therein set forth. _______________________________________ (Notary Public) My Commission Expires ______________________________, 200___ Above AFFIDAVIT now available in both Microsoft Word Postnatal - 2 months (first "well baby" visit): If you do take your new baby to an MD as opposed to a naturopath and/or chiropractor, please be aware and careful of any forms you sign. We're referring to those "Refusal To Vaccinate" forms put out by the American Academy of Pediatrics. Go to this page below and find out why signing this form is very dangerous. We all know about these forms and how they can be used to undermine parental rights... http://www.vaclib.org/legal/donotsign.htm Generic Vaccine Refusal Form from Dr. Sherri Tenpenny's webpage. (.pdf) http://www.nmaseminars.com/files/Vaccine_Refusal_Form.pdfState Form Required: Oregon's CIS form is preferred. Daycare & Preschools: Information about Oregon's Religious Exemption (.pdf) http://www.oregon.gov/DHS/ph/imm/docs/SchExempt.pdf Relgious Exemption Brochure (.pdf) http://oregon.gov/DHS/ph/imm/docs/Relexempbrch.pdf The Oregon CIS Form is picked up at the health department or schools. Schools: Information about Oregon's Religious Exemption (.pdf) http://www.oregon.gov/DHS/ph/imm/docs/SchExempt.pdf Relgious Exemption Brochure (.pdf) http://oregon.gov/DHS/ph/imm/docs/Relexempbrch.pdf The Oregon CIS Form is picked up at the health department or schools. These following religious exemption letters may be accepted in some schools or preschools. Oregon (School Children Religious exemption) (.doc) VaccineTruth.net/letters/Immunizations OR child (5186).doc
OREGON SEVENTH-DAY ADVENTIST EXEMPTION BECAUSE OF RELIGION FROM IMMUNIZATIONS http://www.nwreligiousliberty.org/sample%20letters/sda_or_immuniz.htm If you want a great letter written by a lawyer to an Oregon School Board Letter_Oregon_School_District.htm This letter was originally found at: http://www.childscreen.org/Letter%20to%20the%20Oregon%20School%20District.htm, but is no longer posted on this site so it has been moved to http://www.vaclib.org/pdf/letters/Letter_Oregon_School_District.htm Opt-Outs: Military Recruiters: STUDENT OPT OUT FORM regarding the RELEASE OF NAME, ADDRESS, AND TELEPHONE NUMBER TO MILITARY RECRUITERS (.pdf) http://www.militaryfreeschools.org/PDF/optout2.pdfUNDERGROUND ACTION ALLIANCE STUDENT OPT OUT FORM (.pdf) http://www.militaryfreezone.org/opt_out.pdf (.doc) http://veterans4peace.org/opt_out.docSAMPLE ENGLISH - BINGUAL FORMS FOR OPTING OUT Act to Protect Your Privacy from Military Recruiters (.pdf) http://www.afsc.org/pacificsw/documents/Opt-Out-Form.pdf STUDENT OPT-OUT - Google Search STUDENT OPT-OUT NOTICE regarding the instruction of sexuality to children: STUDENT OPT-OUT NOTICE Valid in all 50 states (.pdf) http://www.ccv.org/images/StudentOptOutNotice.PDF (.pdf) http://www.catholiccitizens.org/content/img/f26422/opt%20out%20notice.pdfEntire packet... STUDENT OPT-OUT NOTICE - Google Search Colleges & Universities: http://oregon.gov/DHS/ph/imm/law/college/index.shtml Southern Oregon University (.pdf) http://www.sou.edu/health/pdfs/immunization_form.pdfExemption Section 1 Section I ______Please check this line if you were born before January 1, 1957. ______Please check this line if you had rubeola (hard measles). Complete Section III on reverse side. ______Please check this line if your religious beliefs prohibit your being vaccinated. Please note: In ______the event of a measles outbreak you may be denied access to the campus for your protection as well as that of others. ______Please check this line if it would be medically unsafe for you to receive a measles vaccination (e.g., pregnancy, anaphylactic reaction to eggs, immunocompromised state, etc.). Complete Section III on reverse side. (There may also be a place to check off exemptions on the health history form) Oregon Health & Science University School of Nursing Office of Student Affairs Hepatitis B Vaccine Waiver (.pdf) http://www.ohsu.edu/son/student/forms/hepBwaiver.pdf
Portland State University The Center for Student Health & Counseling (SHAC) Check Religious Exemption on page 2 (.pdf) http://www.shac.pdx.edu/forms/mmrform.pdf
2. Students who choose may also ask for a religious exemption by signing the appropriate section on the pink measles requirement form and turning it in to the registrar's window. Portland State University Portland State University's Intensive English Language Program (IELP) Measles (Rubeola) Vaccine Requirement (.pdf) http://www.ielp.pdx.edu/pdf/MeaslesForm.pdf
Check off number 7 on page 2 _____ 7. Religious Exemption: I have read and understand the above information. I practice a religion that opposes immunizations; and therefore request to be exempted from Measles immunization requirement.Portland State University Department Of Chemistry Check Religious Exemption on page 2 (.pdf) http://chem.pdx.edu/grads/measles.pdf
NORTHWEST CHRISTIAN COLLEGE Eugene, Oregon 97401 Certificate of Measles Immunization or EXEMPTION (.pdf) http://www.nwcc.edu/admissions/housing/measles.pdfNewer Form (.pdf) http://www.nwcc.edu/studentdev/residence/measles.pdfUniversity of Oregon Health Center, Eugene, OR 97403-1232 (541) 346-2770 Have a physician fill out the appropriate part of the medical exemption form, or fill out the religious exemption form and return to the Health Center. http://healthcenter.uoregon.edu/immunization/measlescertificate.html http://healthcenter.uoregon.edu/business/measlescertificate.htm http://healthcenter.uoregon.edu/measlesform.html Linfield College McMinnville, Oregon 97128 (Check the part that looks like this...) _____My religious beliefs prohibit my use of the immunization. I request that I will be allowed exemption from immunization requirements. Student Signature: _________________Date: ______/___ /____ . The exemption is on page 2. (.pdf) http://www.linfield.edu/accounting/pdf/Immunization.pdf Oregon Health & Science University School of Nursing Hep B vaccine waiver (.pdf) http://www.ohsu.edu/son/student/forms/hepBwaiver.pdf Portland State University (religious exemption at the bottom of page 2) (.pdf)
http://www.shac.pdx.edu/forms/mmrform.pdfGEORGE FOX UNIVERSITY 414 N. MERIDIAN ST. #6265 NEWBERG, OR 97132-2697 Measles Record Form 2004-05 (check exemption at the bottom of form) (.pdf) http://www.georgefox.edu/offices/hea_cou/measles_04-05.pdf EASTERN OREGON UNIVERSITY CERTIFICATE OF IMMUNIZATION At the bottom of the page is where you check off your exemption. I meet the following exemption(s) and thus do not need the measles immunization: (.pdf) http://www3.eou.edu/health/documents/mmrcertificateform.pdf (.pdf) http://www3.eou.edu/health/documents/MMRClearanceForm.pdfThese Google searches are mostly the college and school exemptions. There are always new forms coming online. Keep a regular check on these to look for newly added forms. Some are for daycare too. The links are the actual keywords that are used. Immunization Exemption Form Vaccine Exemption Form Immunization Waiver Employment: US Fish and Wildlife Service Form 3-2283 Hepatitis B Immunization Consent/Refusal Form (.pdf)
http://www.fws.gov/forms/3-2283.pdfOregon (Adult Religious Exemption for employment) Most of these are the Hepatitis B vaccine declination forms, such as the OSHA form. There are hundreds of these forms. Rather than linking to each one, here are the Google Search results for these keywords. There are other vaccines that one can decline that are worded like the OSHA forms. Vaccine Declination Form or Hep B vaccine waiver TB Test: Oregon State University - Only required for students from other countries NORTHWEST CHRISTIAN COLLEGE (targeted TB testing) TB Testing Exemption Letter: Sample Exemption Letter for TB testing. May be modified to your use. http://www.vaclib.org/letters/TBwaiverGen.htm Sample Exemption Letter for TB testing. May be modified to your use. http://www.vaclib.org/letters/TBwaiverGen.doc TB Testing Exemption Letter for Adults: Sample Exemption Letter for TB testing. May be modified to your use. http://www.vaclib.org/letters/TBTestingWaiverAdult.doc Sample Exemption Letter for TB testing. May be modified to your use. http://www.vaclib.org/letters/TBTestingWaiverAdult.wpd Sample Exemption Letter for TB testing. http://www.vaclib.org/letters/TBTestingWaiverAdult.pdf Extra link from Dr. Sheri Tenpenny's webpage: (.pdf) http://www.nmaseminars.com/files/Exemption_for_TB_testing_1_.pdfLead Testing Exemption Letter: Sample Exemption Letter for Lead testing. May be modified to your use. http://www.vaclib.org/letters/Lead_testing_waiverGen.htm Sample Exemption Letter for Lead testing. May be modified to your use. http://www.vaclib.org/letters/Lead_testing_waiverGen.doc The above TB and Lead exemption letters courtesy of Deirdre DeVane of Wash DC. Thank you Deirdre! The adult TB letters were edited by Sherri Tenpenny. Thank you Sherri! TB Testing Alternatives... TB can be detected by biofeedback machines that are hooked up to a computer, such as the QXCI, Best BioMeridian MSAS (Meridian Stress Assessment) or Electro Dermal Screening, Quantum Life System, and the F-Scan. You will need to ask specifically for a pathogen scan, especially TB. You will also need to request a printout with the results. Here are some of the practitioners for Oregon Oregon BEST BioMeridian Practitioners (Meridian Stress Assessment) World Wellness Dr. Christian Mathisen, D.C. Meridian Stress Assessment BIOMERIDIAN MSAS System 349 E. Main St. #3 Ashland, OR 97520 Phone: 541-552-1782 Fax: 541-552-1782 http://www.worldwellness.org beachavenue@jeffnet.org Meridian Stress Assessment provides a comprehensive, non-invasive method for evaluating a person’s energetic balance and vital functions. Using ancient meridians and 21st Century computer technology, the MSAS allows a wide range of possibilities to help regain energetic balance. Dr. Christian Mathisen, D.C. uses the BIOMERIDIAN MSAS System. Liberty Massage and Wellness Center 795 Liberty St SE Salem OR 97301 Phone: (503) 371-7655 Fax: (503) 371-9070 Meridian Stress Assessment (MSA) http://www.libertymassage.com/page14.html http://www.libertymassage.com info@libertymassage.com Meridian Stress Assessment (MSA) 1 hour . . . . . . . . . . . . . . . . . . . . . . . $125 Holland Chiropractic and Rehabilitation Therapy 929 NW Grant Ave, Corvallis, OR 97330 Phone: 541.754.1023 | Fax: 541.758.0558 http://www.hollandchiroandrehab.com info@hollandchiroandrehab.com Meridian Stress Assessment Immune Function & Pathogenic Factors: This includes an in-depth analysis of the major areas of immune function, such as spleen, thymus, tonsillar tissues, and the lymphatic system. We also scan for signatures of viruses, bacteria, fungi, and parasites. Once we find the offending pathology, we create a program to clear this from the body. Cannon Beach Center for Natural Medicine Dr. Timothy Krupa, DC, Chiropractic Physician 183 N. Hemlock, Cannon Beach, Oregon 97110 Toll-free 1.888.577.8772 --or-- 503.436.8772 http://www.cbnaturalmedicine.com/allergies.html http://www.cbnaturalmedicine.com cbspa@pacifier.com The BEST Test, Biomeridian Electronic Stimulate Test Oregon QXCI Practitioners: Victoria Schnieder Certified Biofeedback, Bicom Certified, Loomis Enzyme Nutritionist Degree, EPFX / QXCI Practitioner Digestive Health Fees: $50.00 per hour 1st session (usually lasts 1 1/2 hours) Eugene, OR 541-343-7046 victoriacare@earthlink.net Susan Tyler Certified Biofeedback Therapist, Reiki Second Degree, SCIO Practitioner with specialties in Fibromyalgia, Detoxification, Anti-Aging and Immune Wellness Fees: $75 per session (lasts 90 minutes to 2 hours), $30 per hour of my time after that if needed All distance phone work …..no change there Oregon and USA for distance sessions, in person in Roseburg, OR area Distance Phone Sessions 541-496-2233 http://advancedbiofeedback.com www.orenda.iact1.com/11239 susan@advancedbiofeedback.com http://www.theqxci.com/practitioners.php#NorthWest Main page of practitioners: http://www.theqxci.com/information.php For information on purchase or lease of the new Quantum Life BioFeedback L.I.F.E. System, please email Donna and leave your name, mailing address, phone number and email. If you're inquiring for another interested individual or practitioner, please leave their information. The company will then send information and contact the interested parties. Or you may call 1-888-249-1421. Immunization Registry Opt-Out: IX. Voluntary Opt-Out In any circumstance in which a parent or guardian specifically request that information on their child be removed from ALERT, the child's record will be flagged so the parent or guardian will not receive reminders or recalls. However, under Oregon law, ALERT cannot remove the record or other information on any children from the registry. Such request from a parent or guardian must be in writing. |
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