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Indiana State Exemption Page
VacLib.org & VaccineTruth.net Exemption Page
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Statutes/Laws
StateLaw  |   Exemptions  |   PDF-Reader


Note: Be advised that websites and links change constantly. It would be wise to go through this page and save ALL the exemption forms and letters, in case a website goes down. Please share with others who also want to refrain from medical experimentation.

Link to state law.
National Vaccine Information Center:
Link to state law.


For additional help with exemptions, birth plan,etc questions:
Non_Vaccinating_Physicians

Check our Vaccination Liberation State Chapter and other resource organizations page for help in your state.

If your state specific help is not available, Contact us.


Available Exemptions
Medical  &  Religious


A school child may not be required to undergo any immunization when the child's parent objects on religious grounds. A religious objection must be:
(1) Made in writing;
(2) Signed by the child's parent; and
(3) Delivered to the child's teacher or to the individual who might order an immunization.


PDF-file PDF documents (.pdf)

A special reader, Acrobat Reader software for Windows(TM), Macintosh(TM), MS-DOS(TM), SGI(TM), and Sun(TM) is required for .PDF files and is available free from Adobe.

Free Download of Acrobat Reader:Get-Acrobat-Reader


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NewBorn Birthing Plan and Birth Exemptions
BirthExemptions  |   Birthing_Plans  |   Vitamin_K  |   Hepatitis_B  |   Eyedrops  |   Newborn_Screening

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.

Steps:
  • Create the Birthplan. Or modify one of our ours to fit your state laws and any other personal circumstances. (see below)

  • Sign the birthplan in front of a Notary.

  • Submit the birth plan to your hospital or midwife. Keep a couple extra copies in case plans change.

  • Make sure affected parties (doctors, nurses, etc) understand your requirements and wishes.
  • .
  • Plan on having one or two trusted persons stay with the mother and child to watch the child at all times while in the hospital, so no unwanted injections are given the baby.

  • The birth plan arrangements and letter should be turned in before delievery date.

  • The "Refusal to Permit Medical Treatment" form below is optional.

Birth Plans (To be used with hospitals and/or midwives)
(Links to model birth plan letters)

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...

Our best and most itemized birthplan:
Word-Document (.doc) birthplan-itemized.doc  |   PDF-Document (.pdf) birthplan-itemized.pdf

(HTML) BirthPlan-Itemized for reading on screen. Includes handy small dictionary of terms in the document.

Word-Document (.doc) Model Letter for Hospital Births (Model11425.doc)

Model Birth Plan Letter for Hospital Births. This one is more detailed.

Word-Document (.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)
Word-Document (.doc) VaccineTruth.net/letters/Model letter for hospital births for adoptions.doc


The birth plan arrangements and letter should be turned in before delievery date.
This "Refusal to Permit Medical Treatment" form below is optional.

"Refusal to Permit Medical Treatment" form
A generic form.
PDF-file (.pdf) letters/refusal_treatment.pdf

It would be good idea to use the AFFIDAVIT below AND a model birth plan letter from above above.
Affidavit - Birth Exemptions
HTML (simple text) Affidavit to modify.
Word-Document AFFIDAVIT in Microsoft Word (.doc) format. (may be modified)

If your Title and Paragraph number of your state law is not pasted above, click here for the link to your state law.


Vitamin K Injection...

The prescribing information on Vitamin K shot states that fatalities are an adverse reaction according to the Merck pharmaceutical package insert.
"WARNING - INTRAVENOUS USE Severe reactions, including fatalities, have occurred during and immediately after the parenteral administration of AquaMEPHYTON® (Phytonadione)."
fatalities=death
Links to prescribing information for Vitamin K:
http://vaclib.org/chapter/inserts.htm#vitK

Merck Vitamin K Package Insert - Aquamephyton PI | Scribd

The package insert should be printed out and used along with the birth plan letter, 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 to 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 safe alternative that your chiropractor or naturopath can order for you. Or order directly from Amazon.com

Biotics Research, Bio-K Mulsion - 1 fl oz

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.


Hepatitis B Vaccine
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 by asking hospital personal to sign the following waiver. Usually, you'll never find anybody in the hospital to sign this simple form, but you well get relief from demands to vaccinate your child.

"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.

Hepatitis B Vaccine Refusal from Dr. Sherri Tenpenny's webpage:
(.pdf) http://drtenpenny.com/wp-content/uploads/2012/06/Hep_B_in_the_hospital_1_.pdf
This form is generic. It can be used in other states.

See Birth Plans for more information on avoiding Hep B Vaccination at birth
Eyedrops
Some states require Prophylaxis against Gonococcal OPHTHALMIA NEONATORUM.

A discussion of medical and legal issues regarding Silver Nitrate in the eyes of the newborn is here:
PDF file: Statutory Law USA: Requiring Silver Nitrate in Eyes of Newborns at: http://www.rbs2.com/SilvNitr.pdf
Written by Dr. Ronald B. Standler, attorney in Massachusetts and consultant

Blog type discussion of pros and cons of eyedrops for newborn is here: http://answers.google.com/answers/threadview/id/20050.html


New Born Screening
Religious Exemption from newborn screening allowed.
Large PDF: 1127 pages
Ind. Code 16-41-17-2(d)
IC 16-41-17-2
Examinations; religious exemption

Sec. 2. (a) Subject to subsection (d), every infant shall be given examinations at the earliest feasible time for the detection of the following disorders:
(1) Phenylketonuria.
(2) Hypothyroidism.
(3) Hemoglobinopathies, including sickle cell anemia.
(4) Galactosemia.
(5) Maple Syrup urine disease.
(6) Homocystinuria.
(7) Inborn errors of metabolism that result in mental retardation and that are designated by the state department.
(8) Congenital adrenal hyperplasia.
(9) Biotinidase deficiency.
(10) Disorders detected by tandem mass spectrometry or other technologies with the same or greater detection capabilities as tandem mass spectrometry, if the state department determines that the technology is available for use by a designated laboratory under section 7 of this chapter.
(b) Subject to subsection (d), every infant shall be given a physiologic hearing screening examination at the earliest feasible time for the detection of hearing impairments.
(c) Beginning January 1, 2012, and subject to subsection (d), every infant shall be given a pulse oximetry screening examination at the earliest feasible time for the detection of low oxygen levels. Section 10(a)(2) of this chapter does not apply to this subsection.
(d) If a parent of an infant objects in writing, for reasons pertaining to religious beliefs only, the infant is exempt from the examinations required by this chapter.
As added by P.L.2-1993, SEC.24. Amended by P.L.91-1999, SEC.2; P.L.149-2001, SEC.3; P.L.229-2011, SEC.165.

Indiana Code: https://iga.in.gov/legislative/laws/2014/ic/

Newborn Screening home page http://www.in.gov/isdh/20215.htm


In accordance with Ind. Code 16-41-17-2, subsection (d), I certify that the newborn screening to my child, ________________________, is contrary to ________________________ my personal religious beliefs, held either individually or jointly with others, and I therefore request that my child be exempt from the newborn screening and examinations of IC 16-41-17-2.

Signature: __________________________________ Date: ________________________

Signature: __________________________________ Date: ________________________


Hearing Screening...

17. What should we do if a family signs the religious waiver just to avoid the screen?
The only accepted reason to waive a screening is due to true religious beliefs and the parents have the right to sign the religious waiver form without question from hospital personnel. When this occurs; however, hospitals are responsible to educate the family on the importance of the hearing screen and assure them of the screening procedure. This will often lead to compliance for the screening if the refusal is not truly due to religious beliefs. If the family still refuses the screening, record the infant in the Reason Codes section of the Monthly Summary Report and send a copy of the signed religious waiver to ISDH with the MSR. IC 16-41-17-2

INDIANA

Statute: Sec. 2. (c) If a parent of an infant objects in writing, for reasons pertaining to religious beliefs only, the infant is exempt from the examinations required by the chapter. [Source: HB 1410, 1999]

In accordance with Ind. Statute: Sec. 2. (c) I certify that the hearing screening to my child, ________________________, is contrary to ________________________ my personal religious beliefs, held either individually or jointly with others, and I therefore request that my child be exempt from the hearing screening and examinations of Ind. Statute: Sec.2. (b).


Signature: __________________________________ Date: ________________________

Signature: __________________________________ Date: ________________________


General Info:
U.S. states now require screening of newborn babies for specific diseases.

Conditions and legal status of "requirement" of newborn to be screened for each state:
National Newborn Screening Status Report - http://genes-r-us.uthscsa.edu/sites/genes-r-us/files/nbsdisorders.pdf

Newborn Genetic Screening Privacy Laws
(includes links to laws for various states)
Archived Copy: http://web.archive.org/web/20130603035608/http://www.ncsl.org/issues-research/health/newborn-genetic-and-metabolic-screening-laws.aspx

Newborn screening From Wikipedia, the free encyclopedia
http://en.wikipedia.org/wiki/Newborn_screening

Federal NewBorn Screening Law (from Families of Spinal Muscular Atrophy)
http://www.fsma.org


Statutes/Laws  |   NewBornBirthingPlan&BirthExemptions  |   Waivers_CareInSigning  |   Letters_Forms_Affidavits  |   DayCare_Schools_Colleges  |   Employment  |   TB_and/or_LeadTesting  |   OptOutRegistry  |   Misc_Info

Waivers - Take Care In Signing
If you take your new baby to an MD as opposed to a naturopath and/or chiropractor, please be aware of and careful of any forms you sign.

Our WARNING below is about signing (some) state approved and AAP created forms. See this letter from our director, Ingri Cassel, before you consider signing waiver forms.

WARNING!

Dear VacLib Members and Friends -

Wanted to give you all a heads up on state issued exemption forms. I haven't had to deal with this personally for several years, and I always crossed out sentences or clauses, and often adding some of my own, before signing their exemption of medical release type of forms. When Donna Carrillo began to diligently search out existing exemption forms and posting them, I read over a couple of them and encouraged people to make up their own whenever possible. After having a "closer encounter" with such a form - a form provided to the state of Idaho by the American Academy of Pediatrics and the Centers for Disease Control and Prevention and used by licensed Idaho daycares, I was shocked into the VERY REAL danger of signing these forms without changing them significantly.

Any form one affixes their initials to, dates and affixes their signature to at the end is a LEGAL document. All statements prior to your signature you must agree to fully OR restrict your signature to say that you are signing under TDC - threat, duress, and coercion. The form that my daughter was told she needed to fill out for this daycare is posted here: ChildCareExemptForm.pdf On this form, she crossed out all the "nots" and in her personal statement she further clarified that she understands fully the risks of vaccinating her child.

I have since found out that most public schools and daycares in other states also use a similar form. Basically, by initialing and signing this form as is, you are admitting to understanding that "vaccine preventable" diseases are extremely deadly and ALSO admitting to negligence for willfully denying your son/daughter the life saving protection that vaccines offer. These forms are MEANT to not only be intimidating but to catch the legally ignorant off guard. This is very serious to me since all states have adopted the federally funded Child Abuse Prevention and Treatment Act which gives states the right to literally steal your children for up to 48 hours -- the time they have to prove child neglect OR abuse.

If it were ME, I would insist that they accept a form that I provide them since it satisfies the law. If there are any problems or they insist on me using their form, I would cite the law and ask the school or daycare provider where it actually says in state statute that this particular form is the only form that will satisfy the law. Since your parental rights are at stake here, it is best to be vigilant and err on the side of being overly cautious.


A modified AAP form is posted here that you may wish to use with your doctor: AAPmodified.htm

AAPmodified.doc MSWord .DOC file  |  AAPmodified.pdf PDF file, best for printing.

You may also use one or both of these to give to your doctor:
(.doc) http://www.vaclib.org/letters/Letter-to-doctor.doc
(.pdf) Vaccine Refusal & Exemption Forms
http://drtenpenny.com/forms/

Not all State employees are aware of the law and many exhibit the Hitler Complex. Take a firm stand. Some individuals have had difficulty getting the required forms. Such arrogance on the part of State employees should be reported to the Director of your state Department of Health.

See:   AnaiRhoads.org Why Signing a Waiver to Avoid Vaccines Can Be Considered Abuse
She is referring to the Refusal To Vaccinate From developed by The American Academy of Pediatrics, not a regular religious or conscientious exemption letter or form.


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Letters Forms Affidavits
Links to Model birth plan letters (above).

Link to Refusal to Permit Medical Treatment form

Links to Affidavit - Birth

An Adult Affidavit, with Christian beliefs, is here. (MSDOC file) Feel free to modify as needed.


Dr. Tenpenny has the following forms on her web site. The forms are generic and may be used in any state.

Affidavit for Parents Participating in International Adoption (Word) (pdf)
Hep B vaccine in hospital for newborn refusal, sample (pdf)
OSHA Declination Statement Form (also, pdf)
Religious exemption letter that was approved in Florida (Word) (pdf)
School Vaccine Exemption Form, sample (Word) (pdf)
TB testing refusal, sample (pdf)
Childcare and School Immunization Requirements

http://drtenpenny.com/forms/

Sample Vaccine Letters. from www.vaccines.bizland.com/letters.htm archived on VacLib.org/letters/doctor.htm

The ACCEPTANCE OF RESPONSIBILITY is imperative in exercising your rights for legal exemptions from forced medical experimentation and legalized bioterrorism. DO be prepared to fight for your baby's rights!
An index page to various Acceptance of Responsibility) forms is here:
. http://www.vaclib.org/legal/accept.htm

Religious exemption forms will be listed below under Daycare Schools Colleges

Did not find your state exemption form on our site?
Then try this link to forms for all 50 states and D. of Columbia.
http://experimentalvaccines.org/vaccine-exemption-forms/


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DayCare - Schools - Colleges
DayCare-K-12-Colleges
DayCare  |   K thru 12  |   Colleges

State Form Required: No. A religious objection must be made in writing, signed & delivered to teacher or individual who ordered immunizations.
DayCare & Preschools
see IC 12-17.2-3.5-11.1
Large PDF: 1225 pages
Immunizations
Here: page 771 https://iga.in.gov/static-documents/0/1/9/8/019844fb/TITLE12_title12.pdf

Sample Letter that you may modify: Exemption VacLib-Indiana.doc
(.doc) VaccineTruth.net/letters/ExemptionVacLib-Indiana.doc

Kindergarten & Schools
Sample Letter that you may modify: Exemption VacLib-Indiana.doc
(.doc) VaccineTruth.net/letters/ExemptionVacLib-Indiana.doc


Colleges/Universities
IC 21-40-5-6
Religious objections

Sec. 6. (a) Except as otherwise provided, a student may not be required to undergo testing, examination, immunization, or treatment required under this chapter when the student objects on religious grounds.

(b) A religious objection does not exempt a student from testing, examination, immunization, or treatment required under this chapter unless the request for an exemption is:

(1) made in writing;
(2) signed by the student; and
(3) delivered to the individual who might order a test, an examination, an immunization, or a treatment absent the religious objection.

This university has its own exemption form online:
DePauw University
Student Health Services
300 East Seminary Street
Greencastle, IN 46135
DePauw University Student Health Services REQUEST FOR EXEMPTION
(.pdf) https://www.depauw.edu/files/resources/immunizationwaiverform.pdf


An Adult Affidavit, with Christian beliefs, is here. (MSDOC file) Feel free to modify as needed.

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Employment
OSHA
Standard Interpretations
09/23/1997 - The Bloodborne Pathogen Standard and the Enforcement Procedures for TB.
"Finally, be aware that participation in the employer's skin testing program is voluntary on the part of the employee. OSHA does not require that employees participate in TB skin testing, only that the employer make such skin testing available to employees."
See TB Testing below for more information.

US Fish and Wildlife Service Form 3-2283
Hepatitis B Immunization Consent/Refusal Form
PDF-file (.pdf) http://www.fws.gov/forms/3-2283.pdf


Statutes/Laws  |   NewBornBirthingPlan&BirthExemptions  |   Waivers_CareInSigning  |   Letters_Forms_Affidavits  |   DayCare_Schools_Colleges  |   Employment  |   TB_and/or_LeadTesting  |   OptOutRegistry  |   Misc_Info

TB and/or Lead Testing

TB-Links/Exemptions

Generic letter for Exemption to TB Testing:
HTML (text): Exemption-tb-test.html

MS Doc file: Exemption-tb-test.doc

OSHA
Standard Interpretations
09/23/1997 - The Bloodborne Pathogen Standard and the Enforcement Procedures for TB.
"Finally, be aware that participation in the employer's skin testing program is voluntary on the part of the employee. OSHA does not require that employees participate in TB skin testing, only that the employer make such skin testing available to employees."
TB and Lead Testing Links:
F L Y E R    LETTER    Exemption_Letters    OSHA_and_TB_test    Tubersol    Treatment    TB_Screening    Alternatives/QuantiFERON_TB_Gold_testimony

The above TB and Lead exemption letters are courtesy of Deirdre DeVane of Wash DC. Thank you Deirdre!
The adult TB letters were edited by Sherri Tenpenny. Thank you Sherri!

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 Indiana

Indiana BEST™ BioMeridian Practitioners:

Indiana QXCI Practitioners:
Margaret Rausch, CAT
Certified Athletic Trainer
QXCI Practitioner
Service Areas: Kentucky, Southern Indiana, USA
Specialties: Musculoskeletal injuries, Weight Loss, Chronic Pain
Fees: $100.00 per session; Neuromuscular bodywork, $65 per hour
Contact: Phone:(502) 254-1846 Cell: (502) 777-1833

Kim L. Dexter, CNHP
Certified Biofeedback Specialist
QXCI Practitioner
Service Areas: Elkhart, Mishawaka, South Bend, INDIANA, USA
Specialties: Nutrition, Pain Management, Addictions, Anxiety, Depression, Energy
Fees:
$125 for the first session.
$75 for follow-up sessions are possible.
Pre-payment discounts are also offered.
Contact:
Phone: 574-596-4226 or 574-262-8109
Email: KDexter101@aol.com
Comments: I have had excellent results with chronic pain. 90% of my clients with pain issues are completely pain free after the first few sessions. Most clients leave their therapy session with a renewed sense of vitality and an overall balancing, especially mood and energy issues.,

Richard S. Montieth
QXCI Practitioner
Service Areas: Central Indiana, USA
Specialties: nutrition, pain, emotional stress
Fees:
$75 for initial session (1.5 to 2 hours)
$60 per hour for follow up visits
Contact:
Phone: 317-293-9525
Email: rick@georgetownmarket.com
Comments: My name is Rick Montieth and I am happy to offer QXCI sessions to anyone in the central Indiana area. Please email me with your contact information so that we can arrange an appointment and I can answer any questions you might have.



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OptOutRegistry for Vaccines
and various other Opt-Outs
Vaccine Registry Opt-Outs:

Info about Indiana vaccine registry and Opt-Out for same.
http://miracletome.blogspot.com/2008/07/opting-out-of-vaccine-registry.html

     - - - - Other Opt-Outs - - - -:

Birth Certificate and Marriage License Opt-Out:

Did you know that you can REFUSE to sign the hospital birth certificates and that there is no law that requires you to do so?
See: Marriage Licenses, Birth Certificates & #SSNs

Military Recruiters:

STUDENT OPT OUT FORM regarding the
RELEASE OF NAME, ADDRESS, AND TELEPHONE NUMBER TO MILITARY RECRUITERS
(.pdf) Archived letter from www.militaryfreeschools.org

UNDERGROUND ACTION ALLIANCE STUDENT OPT OUT FORM
(.pdf) http://www.militaryfreezone.org/opt_out.pdf

SAMPLE ENGLISH - BINGUAL FORMS FOR OPTING OUT
Act to Protect Your Privacy from Military Recruiters
(.pdf) Bi-lingual Recruitment Opt-Out Form

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.armenianchurchlibrary.com/files/national_opt-out.pdf

STUDENT OPT-OUT NOTICE - Google Search


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Misc Info - Sponsors - Etc.

Vaccination Liberation - Indiana