For example, one such situation recognized by the CDC as a contraindication to getting a Johnson & Johnson booster vaccine is for those who experience thrombosis with thrombocytopenia syndrome (TTS) after their first J&J shot. Each request for exemption, regardless of the reason, is evaluated individually by Student and Employee Health Services, and if needed, the Office of Human Resources. What Are Side Effects of COVID-19 Vaccines? To request a medical exception or delay from the COVID-19 vaccination requirement using this form: You must complete Part 1 of this form. Outdated or alternate forms are not allowed. For information, inquiries, feedback and comments contact us. When youre ready to fill out the exemption application: Youll need to have a recent version of Adobe Reader software installed on your computer to open the exemption application. Here's a list of the Comirnaty/Pfizer-BioNTech vaccine ingredients: While we're at it, here's a list of the ingredients in the Moderna COVID-19 vaccine: And the ingredients for the Johnson & Johnson COVID-19 vaccine: For each vaccine, the contraindication is the same: You shouldn't get it if you have had a severe allergic reaction to one of the ingredients in the vaccine. A physician statement outlining medical reasons for an exemption of a specific immunization is to be submitted to the Medical Director of the Immunization Section with the exemption form. Complete and mail to: Arkansas Department of Health 4815 West Markham - Mail slot 48 Little Rock, AR 72205. An attestation form from Conway (Ark.) Provider Annual Profile and Order Form If you dont have the right software installed, youll be sent to a page telling you to download it. The application may be completed by parents or guardians of students or by students who are 18 years of age or older. x=ks33"zi'u6q9sf^{~tqK |I$vZ" A $'GYrQ6iQ&EV%Y,)xdx$E.WEm%7xSyIwJ i 9]YI\% T6hyt6wN&w1i,O[r?zKg1Q(KXi[%uH>\a_?>~B44}`H:7?|]rv2O28*X In the near future, the federal Occupational Safety and Health Administration (OSHA) and the North Carolina Division of Occupational Safety and Health (NC OSH) are likely to require most larger employers to adopt a vaccine mandate (see here).Vaccine mandates are lawful, subject only to . Code Ann. Each time you receive an additional dose of COVID-19 vaccine, you will need to obtain a new COVID-19 SMART Health Card to ensure all vaccinations are included on your card and in your QR code. All Rights Reserved. Arkansas Immunization Exemption Application For information, inquiries, feedback and comments contact us. To fill out a health coverage exemption application, youll need to download it onto your computer first. If you believe there are COVID-19 vaccinations missing from your COVID-19 SMART Health Card, you may reach out to the site where you received the vaccination to have it added to the WebIZ system. Please include what you were doing when this page came up and the Cloudflare Ray ID found at the bottom of this page. PDF The following information on Exemptions is from the Arkansas Department "Getting vaccinated is important," said Dr. Schaffner.

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