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

PDF documents (.pdf)

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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.
Note:   Newborn testing is mandatory in Nebraska. No exemptions are allowed at this time. It's possible that newborn testing via biofeedback may be accepted. See the bottom of this page for the list of Biomerdian and QXCI practitioners in your area.

Vitamin K Injection...

The prescribing information on Vitamin K shot states that fatalities are an adverse reaction according to the Merck pharmaceutical package insert.
(.pdf)

"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.

Or you can do your own model birth plan letter online...
Hospital Birth Preference Plan ~ Birth Naturally, LLC
http://www.birthnaturally.org/GentleBirth/hospitalplan.htm
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

You may write a religious exemption letter or statement refusing the Vitamin K injection and Hepatitis B vaccine. At this time, there is no exemption for refusal of newborn testing. However, you could try the biofeedback practitioners at the bottom of the page to test for newborn disorders. There is no guarantee, that they would accept it in lieu of the heel pricking, but it's worth a try. The law in Nebraska must be repealed, for parents to have a choice in what they feel is best for their newborn, not the state.
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!

State Form Required: No

Daycare & Preschools:

Use the school forms below.

Schools:

Each school in Nebraska is required to keep on file the immunization history of the students enrolled. Parents or guardians must present one of three documents to the school to verify immunization status:

Refusal of Immunization for Medical Reasons (pdf)
(.pdf) http://www.hhs.state.ne.us/imm/2_dose_HepB_REFUSAL_OF_IMMUNIZATION_medical.pdf

Refusal of Immunization for Medical Reasons (MS Word)
(.doc) http://www.hhs.state.ne.us/imm/2_dose_HepB_REFUSAL_OF_IMMUNIZATION_medical.doc

Refusal of Immunization of Student for Religious Reasons (pdf)
(.pdf) http://www.hhs.state.ne.us/imm/Religious_AFFIDAVIT.pdf

Refusal of Immunization of Student for Religious Reasons (MS Word)
(.doc) http://www.hhs.state.ne.us/imm/Religious_AFFIDAVIT.doc

Omaha Public Schools
(.pdf) http://www.ops.org/scs/hs/Public/Immunization.Waiver.pdf

Colleges & Universities:

Refusal of Immunization for Medical Reasons (pdf)
(.pdf) http://www.hhs.state.ne.us/imm/2_dose_HepB_REFUSAL_OF_IMMUNIZATION_medical.pdf

Refusal of Immunization for Medical Reasons (MS Word)
(.doc) http://www.hhs.state.ne.us/imm/2_dose_HepB_REFUSAL_OF_IMMUNIZATION_medical.doc

Refusal of Immunization of Student for Religious Reasons (pdf)
(.pdf) http://www.hhs.state.ne.us/imm/Religious_AFFIDAVIT.pdf

Refusal of Immunization of Student for Religious Reasons (MS Word)
(.doc) http://www.hhs.state.ne.us/imm/Religious_AFFIDAVIT.doc

University of Nebraska Medical Center
Smallpox Vaccine waiver
(.pdf) http://www.unmc.edu/ibc/forms/Vaccinia_Waiver_Form.pdf
(.doc) http://www.unmc.edu/ibc/forms/Vaccinia_Waiver_Form.doc

NEBRASKA METHODIST COLLEGE
HEPATITIS B VACCINATION DENIAL OF CONSENT
HTML (.html) http://www.methodistcollege.edu/academicprograms/WaiverForHepatitisB.htm
PDF (.pdf) http://www.methodistcollege.edu/Students/studenthealth/hepatitiswaiver.pdf

Concordia University Nebraska
On medical history form
Request for Waiver of Immunizations, bottom of page. 2
Religious exemption: I request exemption based on religious beliefs, understanding that in the event of an outbreak I will be barred from campus for the duration of the outbreak which could last several weeks.
Signature __________________________________________ Date _____________
(.pdf) http://www.cune.edu/help/health/medhistoryform.pdf
(.pdf) http://www.cune.edu/resources/docs/Health/Med_History_form.pdf

Meningitis Information Acknowledgment
(.pdf) http://www.cune.edu/resources/docs/Health/Meningitis_Acknowledgment.pdf
__ We do not want our child to receive the vaccine at this time.

These 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:

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:

TB Testing Exemption Letter:
HTML
Sample Exemption Letter for TB testing. May be modified to your use. http://www.vaclib.org/letters/TBwaiverGen.htm
Microsoft Word Document (.doc)
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:
Microsoft Word Document (.doc)
Sample Exemption Letter for TB testing. May be modified to your use. http://www.vaclib.org/letters/TBTestingWaiverAdult.doc
WordPerfect Document (.wpd)
Sample Exemption Letter for TB testing. May be modified to your use. http://www.vaclib.org/letters/TBTestingWaiverAdult.wpd
PDF document (.pdf)
Sample Exemption Letter for TB testing. http://www.vaclib.org/letters/TBTestingWaiverAdult.pdf

Lead Testing Exemption Letter:
HTML
Sample Exemption Letter for Lead testing. May be modified to your use. http://www.vaclib.org/letters/Lead_testing_waiverGen.htm
Microsoft Word Document (.doc)
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!

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