Pella Regional Health Center

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INFLUENZA IMMUNIZATION

POLICY

Pella Regional Health Center requires all employees, physicians, contracted staff and active volunteers to receive an annual seasonal influenza immunization during the flu season. An exemption may be requested to this requirement on the basis of: (1) influenza immunization is medically, contraindicated, or (2) a sincerely held religious belief or creed that prohibits immunization. An exemption does not exempt the employee from the annual influenza prevention program but rather is an alternative method of compliance in place of the influenza immunization.

In order to be considered for an exemption to receiving the immunization, you need to complete and submit Exemption Request Form along with the required supporting documentation to Occupational Health. Occupational Health will review each request on a case-by-case basis. Supporting medical documentation must include information that supports the rationale for granting the exemption (i.e., results of an allergy test, etc.). You may be asked to sign a Release of Information form for the appropriate healthcare provider if your documentation does not supply the above criteria.

MEDICAL EXEMPTION:

You may request an exemption to the influenza immunization if the immunization is medically contraindicated due to a medical condition. To request an exemption, please submit a completed Exemption Request Form, along with a signed statement from your physician, nurse practitioner or physicians assistant that describes the nature, duration, and severity of your medical condition, and an explanation as to why this condition prevents you from receiving the influenza vaccine. This information will be confidentially maintained in your Occupational Health record.

RELGIOUS BELIEF OR CREED EXCEPTION:

You may request an exemption on the basis of a sincerely held religious belief or practice that prohibits you from obtaining the influenza immunization. Please submit the completed Exception Request Form along with a personal statement that describes the religious belief or practice that prevents you from receiving the flu vaccine.

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