Exemption or Declination from UC's Immunization Requirements

Overview

Medical Exemptions may be considered for students with medical conditions which may be contraindications for the following required vaccines:

  • MMR
  • Varicella
  • Tetanus/Pertussis
  • Meningococcal ACWY

Declination Letters may be submitted for the following vaccines, without the need for a Medical Exemption request:

  • COVID-19
  • Influenza

Students seeking an Exemption or Declination must submit a request via the Student Health Patient Portal no later than their appropriate compliance deadline dates. Please follow the directions for completion and submission of a Medical Exemption or Declination below.

 

If you intend to submit a request, please click on the form below that corresponds to the specific exemption or declination that you are requesting. The submission of a request is completed online via the Student Health Patient Portal.

Overview of the process:

  1. Student downloads the fillable request form. Links to the forms appear below on this webpage and they are also available on the Student Health Patient Portal.
  2. Student completes and signs the applicable form. Note that the medical exemption-disability exception form must be completed and signed by your health care provider.
  3. Student uploads the completed form to the Student Health Patient Portal for inclusion in the student's electronic health record.

Review of Exemption/Declination Requests

  1. Medical Exemptions will be reviewed by the SHC Medical Director.
  2. Declinations will be AUTO-APPROVED if the DATE is entered in the portal correctly

Questions?

  • For questions regarding the exemptions process, please send a secure message on the Student Health Patient Portal to "Immunization Exemption/Deferral Request Inquiry". A SHC nurse will respond to your inquiry within 3-5 business days.

Medical Exemption

The form below is to be used to request a medical exemption.

  1. Download the form
  2. Present to your Personal Healthcare Provider to complete, Date and Sign
  3. Upload the form through the Student Health Portal
 

PLEASE NOTE: The Medical Board of California has stated that a physician who grants a vaccine MEDICAL EXEMPTION without conducting an appropriate prior exam and without a finding of a legitimate medical reason supporting such an exemption within the standard of care may be subjecting their license to disciplinary action.

The Medical Board of California encourages the public to REPORT such providers to the Board if they feel that a physician is granting exemptions inappropriately.

The form below is to be used to request a COVID-19 Declination.

  1. Download the form
  2. Complete, Date and Sign
  3. Upload the form through the Student Health Portal

The form below is to be used to request a Flu Vaccination Declination.

  1. Download the form
  2. Complete, Date and Sign
  3. Upload the form through the Student Health Portal

PDF iconUC Flu Vaccination Declination Letter