Q) What is the COE form?

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A) The COE form is used when a parent or guardian wants to exempt their child from one or more of the immunization requirements. The completed form must be turned into the school or child care.

 

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Q) Where can I get a copy of the COE? How can we get copies of the COE in other languages?

 

A) The COE in English and 7 languages can be downloaded from: www.doh.wa.gov/SCCI

 

 

Q) Does a student with an exemption need to submit both a CIS and a COE?

 

A) Yes, the Washington Administrative Code requires a CIS to be on file for all students. If a student requests an exemption to required immunizations, both a CIS and COE need to be on file.

 

 

Q) What is different about the new COE dated June 2019?

 

A) The revised COE removed the option for a personal/philosophical exemption to the measles, mumps and rubella (MMR) immunization requirement. As of July 28, 2019 these exemption are no longer valid. All other exemptions are unchanged.

 

 

Q) Now that there is a new COE, does a current student with a COE already on file need to submit the new COE?

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A) No. The COE on file is valid for everything except a personal/philosophical exemption to the MMR vaccine. A new COE is not necessary.

 

 

Q) When is the new COE effective? When should I start using it?

 

A) It is effective as soon as it is published on the DOH website. Schools and child care centers should start using the new COE for all newly enrolling children and students who are requesting an exemption to the immunization requirements.

 

 

Q) What kinds of exemptions are available for parents who want to exempt their child from the school or child care immunization requirements?

 

A) There are four different types of exemptions:

 

Medical Exemption: A health care practitioner may grant a medical exemption to a vaccine required by rule of the state board of health only if in his or her judgment, the vaccine is not advisable for the child. When it is determined that this particular vaccine is no longer contraindicated, the child will be required to have the vaccine.

 

Philosophical/Personal Exemption: To be used when the parent/guardian has a personal or philosophical objection to the immunization of the child. A philosophical/personal exemption may not be used to exempt a child from the measles, mumps or rubella vaccine requirements (effective July 28, 2019).

 

Religious Exemption: To be used when the parent/guardian has a religious belief that is contrary to the required immunization.

 

Religious Membership Exemption: To be used when the parent/guardian affirms membership in a church or religious body that does not allow medical treatment of the child.

 

 

Q) What kinds of exemptions are available for parents who want to exempt their child from the measles, mumps and rubella (MMR) school or child care immunization requirements?

 

A) There are three types of exemption that can be claimed with a completed COE for MMR after July 28, 2019:

 

Medical Exemption - signed by both the parent and health care practitioner

Religious Exemption - signed by both the parent and health care practitioner

Religious Membership - signed by the parent. This exemption type is only used when the religious belief does not allow for medical treatment by a health care practitioner, therefore no health care practitioner signature is required.

 

 

Q) What is the difference between a temporary and a permanent medical exemption?

 

A) Medical exemptions may be permanent or temporary.

 

Permanent medical exemption: To be used when a health care practitioner determines that the vaccine is not advisable for the child on a permanent basis.

 

Temporary medical exemption: To be used when a health care practitioner determines that the vaccine is not advisable for the child on a temporary basis. Healthcare practitioners must put the date that the temporary exemption ends on the COE. School, preschool, or child care staff should monitor temporary exemptions. When the temporary exemption ends the child can be in conditional status for up to 30 days in order to get the missing immunization or another exemption.

 

 

Q) What is the difference between a religious and a religious membership exemption?

 

A) Religious Exemption: To be used when the parent/guardian has a religious belief that is contrary to the required immunization. This requires the signature of a health care practitioner that they have provided the parent with information about the benefits and risks of immunization for the child.

 

Religious Membership Exemption: To be used when the parent/guardian affirms membership in a church or religious body that does not allow medical treatment from a health care practitioner. Therefore it is against their religious beliefs to get information about the benefits and risks of immunizations from a health care practitioner. This exemption does not require a health care practitioner signature.; RCW 28A.210.090.

 

 

Q) How to I determine if a religious or religious membership exemption is based on actual religious beliefs?

 

A) It is not recommended that school or child care staff attempt to verify the religious beliefs of a parent/guardian requesting a religious or religious membership exemption. A completed COE is all that is required.

 

 

Q) What if I know the religion listed in the religious membership section of the form does allow medical treatment? What if I know a parent asking for a religious membership exemption does take the child in for medical treatment?

 

A) If you suspect that the named religion does not prohibit medical treatment of the child do not investigate the named religion. However, if the child receives medical treatment for things other than immunizations the religious membership exemption cannot be used. Ask the parent if the child sees a health care provider for well-child or injury, illness care. If yes then another exemption which requires a health care practitioner signature must be used instead.

 

 

Q) Does a healthcare provider need to sign the COE?

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A) In most cases, yes. Parents or guardians requesting a medical, philosophical, or religious exemption must have the signature of a health care practitioner (MD, DO, ND, ARNP, PA) licensed in WA State confirming that they received information about the benefits and risks of immunizations. A practitioner may also write and sign a letter with the same information, instead of signing the COE. The letter must be kept with the parent signed COE.

 

A health care practitioner does not need to sign the COE if the parent claims a Religious Membership exemption. This exemption states that the parent's religious beliefs do not allow medical treatment by a health care practitioner. Therefore it would be against their religious beliefs to meet with the healthcare practitioner to learn about the benefits and risks of vaccination. Parents/guardians who have a religious objection to vaccination but whose children do obtain care, such as well-child, illness and injury care, from medical professionals need to use the Religious Exemption which requires a healthcare practitioner signature.

 

 

Q) Which providers are allowed to sign the COE?

 

A) Only a health care practitioner can sign the COE. A healthcare practitioner is defined as a physician (MD), physician assistant (PA), osteopath (DO), naturopath (ND), or advanced registered nurse practitioner (ARNP) licensed in Washington State. RCW 28A.210.090

 

 

Q) Do health care practitioners face any liability for signing the COE?

 

A) A health care practitioner who, in good faith, signs the statement that they have provided the parent with information about the benefits and risks of immunization for the child immune from civil liability for providing the signature. RCW 28A.210.090

 

 

Q) Can a parent who is a health care practitioner licensed in WA sign the health care practitioner declaration for their own child?

 

A) Only a Washington licensed medical doctor, osteopath, naturopath, physician assistant, or advanced registered nurse practitioner may sign a certificate of exemption in Washington state. Whether or not a parent who is one of the qualified health care practitioners listed in the law (RCW 28A.210.090) may sign the healthcare practitioner declaration on the certificate of exemption for their own child is up to that providers own best judgment, based on their individual legal, ethical, medical, and professional obligations.

 

 

Q) Does a student without any exemptions need a copy of a COE in her or his file?

 

A) No. Students must have the COE completed and filed in their record only if requesting an exemption.

 

 

Q) What should I do if a COE has both personal and medical exemptions listed for the same vaccines?

 

A) If a parent turns in, or during record review you discover a Certificate of Exemption (COE) that has been improperly filled out return it to the parent with information and guidance and let them know a properly completed COE is needed for the exemption to be valid.

 

 

Q) Can I get the COE through the IIS?

 

A) No. The IIS doesn't include the COE. You can get a copy of the COE at: www.doh.wa.gov/SCCI

 

 

Q) Does a COE expire? Does a COE need to be renewed annually?

 

A) The only type of COE with an expiration date is a COE with a temporary medical exemption. The COE does not need to be renewed annually. Once a COE is filled out, it can be used for the length of the student's WA State school career, including school transfers. If parents request changes to the COE a new form must be completed.

 

 

Q) I see that a healthcare provider entered a contraindication of "Parent or Patient Refusal, Personal or Religious" in the IIS for a patient. Can I use this information to document a personal or religious exemption for a student rather than have the provider sign the COE?

 

A) No, documentation of a refusal in the IIS means that on that date the provider offered the vaccine and the parent or patient refused. It does not mean that the parent or patient requested an exemption from the school or child care immunization requirements. It also does not document that a health care practitioner (MD, DO, ND, ARNP, PA) discussed the benefits and risks of immunizations with the parent. Parents still need to turn in a completed COE to the school or child care.

 

 

Q) If a family has an out-of-state exemption on file signed by a MD, then do they still need to file a WA DOH COE?

 

A) Yes. A certificate form another state cannot be used to exempt a student from the WA state immunization requirements. The WA Certificate of Exemption form must be used and the health care practitioner (MD, DO, ND, ARNP, PA) who signs it needs to be licensed in WA. RCW 28A.210.090

 

 

Q) I have a lot of questions about the exemption law and how to fill out the COE. Where can I get more information?

 

A) For more information please email: OICPSchools@doh.wa.gov

 

 

Q) Can I accept a WA COE signed by a health care provider in another state or country?

 

A) Only a COE signed by a health care practitioners (MD, DO, NP, PA or ARNP) who is also licensed in WA State is acceptable. RCW 28A.210.090

 

 

Q) When completing the Certificate of Exemption form does a health care practitioner granting a medical exemption need to identify the reason why the vaccine is not advisable for the child?

 

A) It is not required to provide the reason for granting the medical exemption. This information is not requested on the Certificate of Exemption form.

 

 

Q) Can a private school set immunization policies that are stricter than the state’s requirements?

 

A) If the administration of a private school would like to set immunization policies stricter than the state’s requirements, they should consult with their legal counsel. The Department of Health cannot give legal advice. Find state immunization laws at RCW 28A.210.060, 28A.210.080, and 28A.210.090.

 

 

Q) Can a private child care set immunization policies that are stricter than the state’s requirements?

 

A) Please send questions about this to Jennifer Health of the Department of Children, Youth, and Families at Jennifer.Helseth@dcyf.wa.gov.