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Iowa State Exemption Page
VacLib.org & VaccineTruth.net Exemption Page |
Click for the desired information for your stateNew Born Issues: NewBornBirthingPlan&BirthExemptions | Waivers_CareInSigning | Letters_Forms_AffidavitsSchool-Daycare-Preschool Issues: Schools | DayCare | Preschool | K-12 | College | (options) OptOutRegistry | Adult Issues: Employment | TB_and/or_LeadTesting Statutes/Laws | Waivers_CareInSigning | Misc_Info, Sponsors, etc. |
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Statutes/Laws
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 "Submit a written statement signed by a parent that the parent is an adherent of a religious denomination whose teachings are opposed to immunizations" |
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PDF documents (.pdf) A PDF reader is required for PDF Files: Free Foxit Reader 12 MB file size. Or Free Download of Acrobat Reader: [Adobe. 43 MB file size] |
Click for the desired information for your stateNew Born Issues: NewBornBirthingPlan&BirthExemptions | Waivers_CareInSigning | Letters_Forms_AffidavitsSchool-Daycare-Preschool Issues: Schools | DayCare | Preschool | K-12 | College | (options) OptOutRegistry | Adult Issues: Employment | TB_and/or_LeadTesting Statutes/Laws | Waivers_CareInSigning | Misc_Info, Sponsors, etc. |
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NewBorn Birthing Plan and Birth Exemptions
BirthExemptions |
Birthing_Plans |
Vitamin_K |
Hepatitis_B |
Eyedrops |
Newborn_ScreeningBirth 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. PARENTAL REFUSAL OF NEWBORN HEARING SCREENING http://www.idph.state.ia.us/iaehdi/common/pdf/parent_refusal_birth_center.pdf Iowa Neonatal Metabolic Screening Program Waiver for Newborn Screening Refusal form Newborn Screening Waiver Form Forms are available through hospitals. Sample of form is here: http://www.shl.uiowa.edu/publications/archive/hotline/1998/1998_08/newborn.xml Steps:
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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... Information on the Dangers of Hospital Birth and the Benefits of Home Birth from gentlebirth.org Our best and most itemized birthplan: (.pdf) birthplan-itemized.pdf(HTML) BirthPlan-Itemized for reading on screen. Includes handy small dictionary of terms in the document. Model Birth Plan Letter for Hospital Births. This one is more detailed. 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)
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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. AFFIDAVIT in Microsoft Word If your Title and Paragraph number of your state law is not pasted above, click here for the link to your state law. |
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Vitamin K Injection... The prescribing information on Vitamin K shot states that fatalities are an adverse reaction according to the Merck pharmaceutical package insert. http://fdb.rxlist.com/drugs/drug-9003-Aqua-Mephyton+Inj.aspx?drugid=9003&drugname=Aqua-Mephyton+Inj "The injectable form of vitamin K can rarely cause severe (sometimes fatal) allergic reactions when given by injection into a muscle or vein. Therefore, vitamin K should be injected into a muscle or vein only when it cannot be given by injection under the skin or taken by mouth, or when your doctor has judged that the benefit is greater than the risk. Seek immediate medical attention if you experience symptoms of an allergic reaction such as rash, itching, swelling, dizziness, or trouble breathing."Potential exists for the newborn to experience hypersensitivity to any component of this medication. Each milliliter contains: Phytonadione ............. 2 mg or 10 mg Inactive ingredients: Polyoxyethylated fatty acid derivative ................... 70 mg Dextrose...................................................................... 37.5 mg Water for Injection, q.s. .................................................. 1 mL Added as preservative: Benzyl alcohol ...................... 0.9% Links to prescribing information for Vitamin K: http://vaclib.org/chapter/inserts.htm#vitK Archive: Year 2002 Merck Vitamin K Package Insert - Aquamephyton PI | posted on Scribd 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. |
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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. See Birth Plans for more information on avoiding Hep B Vaccination at birth |
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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 |
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Iowa New Born Screening PARENTAL REFUSAL OF NEWBORN HEARING SCREENING http://www.idph.state.ia.us/iaehdi/common/pdf/parent_refusal_birth_center.pdf Iowa Neonatal Metabolic Screening Program Waiver for Newborn Screening Refusal form Newborn Screening Waiver Form Forms are available through hospitals. Sample of form is here: http://www.shl.uiowa.edu/publications/archive/hotline/1998/1998_08/newborn.xml General USA Information - New Born Screening 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) ncsl.org/IssuesResearch/Health/NewbornGeneticandMetabolicScreeningLaws/tabid/14416/Default.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 |
Click for the desired information for your stateNew Born Issues: NewBornBirthingPlan&BirthExemptions | Waivers_CareInSigning | Letters_Forms_AffidavitsSchool-Daycare-Preschool Issues: Schools | DayCare | Preschool | K-12 | College | (options) OptOutRegistry | Adult Issues: Employment | TB_and/or_LeadTesting Statutes/Laws | Waivers_CareInSigning | Misc_Info, Sponsors, etc. |
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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! 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. 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 |
Click for the desired information for your stateNew Born Issues: NewBornBirthingPlan&BirthExemptions | Waivers_CareInSigning | Letters_Forms_AffidavitsSchool-Daycare-Preschool Issues: Schools | DayCare | Preschool | K-12 | College | (options) OptOutRegistry | Adult Issues: Employment | TB_and/or_LeadTesting Statutes/Laws | Waivers_CareInSigning | Misc_Info, Sponsors, etc. |
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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 Short Sample Vaccine Letter 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 the following manner. (Usually, you'll never find anybody in the hospital to sign this simple form): "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. 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 |
Click for the desired information for your stateNew Born Issues: NewBornBirthingPlan&BirthExemptions | Waivers_CareInSigning | Letters_Forms_AffidavitsSchool-Daycare-Preschool Issues: Schools | DayCare | Preschool | K-12 | College | (options) OptOutRegistry | Adult Issues: Employment | TB_and/or_LeadTesting Statutes/Laws | Waivers_CareInSigning | Misc_Info, Sponsors, etc. |
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DayCare - Preschool - Schools - Colleges
DayCare-Preschool-K-12-CollegesDayCare | Preschool | K thru 12 | Colleges
Preschool See Forms and Information - below
Kindergarten & Schools See Forms and Information - below Forms and information links for Daycare, Preschool and Schools
State Form Required: No. However, most schools require the Department of Public Health formForm This one prints out landscape on regular paper. Iowa Department of Public Health Certificate of Immunization Exemption (.pdf) http://www.idph.state.ia.us/adper/common/pdf/immunization/products/cert_of_immunization.pdfHome School and other information from: The Network of Iowa Christian Home Educators The exemption form reads: A religious exemption may be granted to an applicant if immunization conflicts with a genuine and sincere religious belief. A Certificate of Immunization Exemption for religious reasons shall be signed by the applicant or, if the applicant is a minor, by the parent or guardian or legally authorized representative and shall attest that the immunization conflicts with a genuine and sincere religious belief and that the belief is in fact religious, and not based merely on philosophical, scientific, moral, personal, or medical opposition to immunizations. The Certificate of Immunization Exemption for religious reasons is valid only when notarized. Religious exemptions shall become null and void during times of emergency as determined by the state board of health and declared by the director of public health. The current form no longer says applicant is a member or adherent of a recognized religious denomination or bona fide church. Iowa administrative code in pdf format (.pdf)
http://www.idph.state.ia.us/adper/common/pdf/immunization/iowas_imm_code_ch7_641.pdfFERPA - NOTIFICATION TO RESIDENT PUBLIC SCHOOL THAT DIRECTORY INFORMATION SHOULD NOT BE RELEASED (.pdf) http://www.the-niche.org/images/FERPA_Form.pdf
Colleges/Universities
641—7.5(139A) Required education. Each institution of higher education that has an on-campus residence hall or dormitory shall provide vaccination information on meningococcal disease to each postsecondary student enrolled in the institution of higher education. Meningococcal disease information shall be contained on student health forms. For purposes of this rule, student health form(s) means a document(s) prepared by an institution of higher education that contains, at a minimum, information on meningococcal disease, vaccination information and any recommendations issued by the national Centers for Disease Control and Prevention regarding meningococcal disease. The student health form(s) shall also include space for the postsecondary student to indicate whether or not the postsecondary student has received vaccination against meningococcal disease, including, at a minimum, the date of vaccination. The student health form(s) shall also include space for the postsecondary student to indicate whether or not the postsecondary student has received information on meningococcal disease and benefits of vaccine. If a traditional student health form is not utilized by the institution of higher education, any document(s) containing the above information is acceptable.Form This one prints out landscape on regular paper. Iowa Department of Public Health Certificate of Immunization Exemption (.pdf) http://www.idph.state.ia.us/adper/common/pdf/immunization/products/cert_of_immunization.pdfFor the colleges/universities that don't require the New state form, nor have their own, this AFFIDAVIT below is sufficient for a religious exemption statement from MMR and any other vaccines to post secondary institutions. Most colleges now have their mandatory waiver for meningitis. The required documentation informs the postsecondary school, and thus the state, that the student has either been vaccinated for meningococcal meningitis or has chosen to decline the vaccine.
Replace the 4th paragraph of the Affidavit below with this language:
"I, {First and Last name}, am exercising my rights under the First Amendment of the US Constitution and Iowa Code641—7.5(139A) to receive Religious Exemption from Vaccination & testing. Iowa Code641—7.5(139A) Re: Meningococcal Vaccine (Declined. See attached health forms.)" An Adult Affidavit, with Christian beliefs, is here. (MSDOC file) Feel free to modify as needed. |
Click for the desired information for your stateNew Born Issues: NewBornBirthingPlan&BirthExemptions | Waivers_CareInSigning | Letters_Forms_AffidavitsSchool-Daycare-Preschool Issues: Schools | DayCare | Preschool | K-12 | College | (options) OptOutRegistry | Adult Issues: Employment | TB_and/or_LeadTesting Statutes/Laws | Waivers_CareInSigning | Misc_Info, Sponsors, etc. |
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OptOutRegistry for Vaccines
Vaccine Registry Opt-Outs:and various other Opt-Outs KNOW YOUR RIGHTS Confidentiality of Your Child’s Vaccination Records FERPA: The Family Educational Rights and Privacy Act http://www.vaxchoicevt.com - - - - 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) http://www.militaryfreeschools.org/PDF/optout2.pdfUNDERGROUND ACTION ALLIANCE STUDENT OPT OUT FORM SAMPLE ENGLISH - BILINGUAL FORMS FOR OPTING OUT Act to Protect Your Privacy from Military Recruiters Information links and forms at AFSC site 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.catholiccitizens.org/content/img/f26422/opt%20out%20notice.pdfSTUDENT OPT-OUT NOTICE - Google Search |
Click for the desired information for your stateNew Born Issues: NewBornBirthingPlan&BirthExemptions | Waivers_CareInSigning | Letters_Forms_AffidavitsSchool-Daycare-Preschool Issues: Schools | DayCare | Preschool | K-12 | College | (options) OptOutRegistry | Adult Issues: Employment | TB_and/or_LeadTesting Statutes/Laws | Waivers_CareInSigning | Misc_Info, Sponsors, etc. |
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Employment
OSHAStandard 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 for more information. US Fish and Wildlife Service Form 3-2283 Hepatitis B Immunization Consent/Refusal Form (.pdf)
http://www.fws.gov/forms/3-2283.pdfClick here for an Affidavit for Adult (college & employment religious exemption) ... Edit as needed... |
Click for the desired information for your stateNew Born Issues: NewBornBirthingPlan&BirthExemptions | Waivers_CareInSigning | Letters_Forms_AffidavitsSchool-Daycare-Preschool Issues: Schools | DayCare | Preschool | K-12 | College | (options) OptOutRegistry | Adult Issues: Employment | TB_and/or_LeadTesting Statutes/Laws | Waivers_CareInSigning | Misc_Info, Sponsors, etc. |
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. See QXCI-BioMeridian Providers, etc below |
Click for the desired information for your stateNew Born Issues: NewBornBirthingPlan&BirthExemptions | Waivers_CareInSigning | Letters_Forms_AffidavitsSchool-Daycare-Preschool Issues: Schools | DayCare | Preschool | K-12 | College | (options) OptOutRegistry | Adult Issues: Employment | TB_and/or_LeadTesting Statutes/Laws | Waivers_CareInSigning | Misc_Info, Sponsors, etc. |
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Misc Info - Sponsors - Etc.
Here are some of the practitioners for IowaIowa BEST BioMeridian Practitioners: Please call contact below to find additional BioMeridian practitioners in your area or closeby. Oksana Gorodetsky Marketing/Administrative Coordinator BioMeridian International 12411 South 265 West, Suite F Draper, UT 84020 T 801-501-7517 F 801-501-7518 Toll Free 888-224-2337 ogorodetsky@biomeridian.com QXCI Practitioners: http://theqxci.com/practitioners.php For information on purchase or lease of the new Quantum Life BioFeedback L.I.F.E. System, please email Donna at Exemptions Contact Page and leave your name, mailing address, phone number and email. If you're inquiring for another interested individual or practitioner, please leave their information. The company will then send information and contact the interested parties. Or you may call 1-407-672-6144. The L.I.F.E. System is also registered with the FDA for safety issues as a Class 2 Biofeedback Device ![]() ![]() |