KANSAS - IMMUNIZATION EXEMPTIONS by State (includes current statutes, letters & forms)

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Most states have specific laws regarding newborn screening. In Kansas you may refuse for religious reasons. If you do so, you may be asked to sign a refusal form. This form relieves your doctor of liability for damages that result from a disorder that could have been detected by screening.

"WARNING - INTRAVENOUS USE Severe reactions, including fatalities, have occurred during and immediately after the parenteral administration of AquaMEPHYTON® (Phytonadione)."
fatalities=death

The above documents can also be made available in WordPerfect (.wpd) format.
Please Contact us if you want the model birth plan letters in WordPerfect.

Hepatitis B Vaccine Refusal from Dr. Sherri Tenpenny's webpage:
(.pdf) http://www.nmaseminars.com/files/Hep_B_in_the_hospital_1_.pdf
This form is generic. It can be used in other states.

Sample Birth Plan from The Center of Unhindered Living

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

This "Refusal to Permit Medical Treatment" form is optional to use.

"Refusal to Permit Medical Treatment" form
Refusal to Permit Medical Treatment. A generic form.
(.pdf) http://www.scpie.com/riskmgmt/forms/refusal_treatment.pdf

It would be good idea to use with the AFFIDAVIT below AND model birth plan letter. I hope someone uses this affidavit, model birth plan letter and refusal form, and that it succeeds. We want to hear about it if someone does succeed with this. 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!

Birth plan religious AFFIDAVIT text below. Use with model birth plan letter and/or refusal forms, and edit as needed...
AFFIDAVIT is available in Microsoft Word (.doc) and WordPerfect (.wpd) format. Contact us.

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"By endorsing this particular waiver, parents would essentially be signing an admittance of neglect and or "abuse" for refusing vaccines. The language contained in this waiver could put parents and caregivers in jeopardy down-the-line if they should ever find themselves in the courts due to their child's health problems, when confronted with child protective services, divorce, or just about any matter pertaining to that child that could be used against the parent(s).

Please read any waiver provided by your child's doctor carefully before signing. Instead, offer a formally written and signed letter that simply says that you do not wish to vaccinate your child. If you are unsure of the language in the waiver, buy some time by telling your doctor that you need to consult with a lawyer before signing it. "

Anai Rhoads Ford
Human Rights Journalist
Why Signing a Waiver to Avoid Vaccines Can Be Considered Abuse by Anai Rhoads Ford, released 15 November 2005.
http://www.anairhoads.org/

Media Contact (703) 491-1903

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Daycare & Preschools:

(.pdf)

http://www.usd259.com/district/admissions.html#Immunization Requirements
Kansas requirements, religious exemption allowed:
Immunization information and KCI forms are available at schools, at most health care providers and at the Wichita-Sedgwick County Department of Community Health, 1900 E. 9th, Wichita, KS 67214, or call 268-8441.

Kansas Certificate of Immunization (KCI Form)
(.pdf) http://www.kdhe.state.ks.us/bcclr/forms/CCL.007 Exemption from Immunization 8-2002.pdf

Kansas Certificate of Immunization (KCI Form) Form B Medical Exemption
(.pdf) http://www.kdhe.state.ks.us/immunize/download/kci_form_b.pdf

Schools:

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Subj: Exemption from Immunization Form
Date: 9/10/2004 7:14:17 AM Pacific Daylight Time
From: MSiemsen@kdhe.state.ks.us
To: Services4Health@...
CC: SWatson@Kdhe.state.ks.us
Sent from the Internet (Details)

Your request for information regarding a school exemption from immunization form was referred to me.

Kansas law KSA 72-5209 (b) says as an alternative to the certification required (tests and/or inoculations) (1) An annual written statement signed by a licensed physician stating the physical condition of the child to be such that the test or inoculations would seriously endanger the life or health of the child, or (2) A written statement signed by one parent or guardian that the child is an adherent of a religious denomination whose religious teachings are opposed to such tests or inoculations.

At this time, Kansas state law provides for only medical or religious exemptions.

There is a medical exemption state form B that must be signed yearly by a physician, either an MD or DO. The religious exemption may be signed by the parent/legal guardian on the Kansas Certificate of Immunization (KCI)

You may download a KCI at the following address:
(.pdf) http://www.kdhe.state.ks.us/immunize/imm_manual_pdf/kci_form.pdf

The Medical Exemption Form B can be found at:
(.pdf) http://www.kdhe.state.ks.us/immunize/download/kci_form_b.pdf

If I can be of further assistance, please do not hesitate to contact me.



Great things are possible when people persevere

Martha Siemsen, RN, ARNP
Kansas Immunization Program Assistant Director
1000 SW Jackson, Suite 210
Topeka, KS 66612-1274
Phone 785-296-2774
Fax 785-296-6510
e-mail msiemsen@kdhe.state.ks.us
www.kdhe.state.ks.us/immunize

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PARENT/GUARDIAN CONSENT/REFUSAL FOR SCREENING

A parent or guardian has the right to refuse screening on children under his/her legal custody. A written, signed statement from the parent/guardian indicating refusal is recommended for school screenings.

The Vision Screening Task Force recommends that school districts inform parents of the vision screening process prior to its occurrence in the school. This information can be provided through the school newsletter, local newspaper or other media, and/or a letter to each student’s family. Providing information about an upcoming school-screening program prior to its occurrence gives parents the opportunity to decide whether or not to allow the test to be performed on their children. A form denying permission for vision screening should be included with the letter of explanation of the procedure. If the form is not returned with the parent’s or guardian’s signature to the school by a designated time, stating the child should not be screened, the child will automatically be screened.

Written, signed parental consent is required for Infant-Toddler Part C screenings. [K.A.R. 28-4-551 (e)]

In the case of provision of EPSDT and well child clinics, vision screening is a portion of the required screening services; thus, the waiver of screening does not apply.

Colleges:

Kansas Recommendations for Immunization of College/University Students
(.pdf)

Religious/Philosophical Exemption to Immunization Requirement
I ____________________________________________or

______________________________________________ object to the immunization of (circle) myself/the above named student to measles, rubella, mumps, diptheria/tetanus, polio. It is understood that exposure to these communicable diseases may cause disabilities and complications; and that in the event of a measles or rubella outbreak on campus, the above named student will be excluded from campus.
_____________________________________________
Signature of Student                         Date
(Parent/Guardian if student is under 18)

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