Medical exemptions for the Covid-19 vaccination

Q. An allergist called recently regarding an angry patient who is demanding a medical exemption for the Covid-19 vaccine.  The allergist refuses to sign-off on the exemption.  The allergist is questioning whether a prior “minor” allergic reaction to a vaccination is sufficient to qualify for an exemption?

A. There is no definite medical exemption to the Covid-19 vaccination.  Some patients have had acute allergic reactions either to previous vaccines or to first shot of a Covid-19 vaccine.  However, these reactions are generally rare, and most of those side-effects can be appropriately managed through observation and the use epinephrine and other medications.  A minor anaphylactic reaction to a prior vaccine may not provide a sufficient basis for a medical exemption for the Covid-19 vaccine.

In the rare situation where, a medical provider does determine that the Covid-19 vaccine would be detrimental to the health and safety of the patient, the provider should thoroughly document the dangers posed and whether the condition preventing the vaccination is temporary or permanent.  If the condition is temporary, the exemption should reflect such.  Further, all discussions with the patient regarding the risks and benefits of the vaccination should be documented in the medical record.

IMPORTANT – There is currently a ‘medical exemption’ under the current Covid-19 mandate for healthcare workers in NYS and it includes the following language:

“(1) Medical exemption. If any licensed physician or certified nurse practitioner certifies that immunization with COVID-19 vaccine is detrimental to the health of member of a covered entity’s personnel, based upon a pre-existing health condition, the requirements of this section relating to COVID-19 immunization shall be inapplicable only until such immunization is found no longer to be detrimental to such personnel member’s health. The nature and duration of the medical exemption must be stated in the personnel employment medical record, or other appropriate record, and must be in accordance with generally accepted medical standards, (see, for example, the recommendations of the Advisory Committee on Immunization Practices of the U.S. Department of Health and Human Services), and any reasonable accommodation may be granted and must likewise be documented in such record. Covered entities shall document medical exemptions in personnel records or other appropriate records in accordance with applicable privacy laws by: (i) September 27, 2021 for general hospitals and nursing homes; and (ii) October 7, 2021 for all other covered entities. For all covered entities, documentation must occur continuously, as needed, following the initial dates for compliance specified herein, including documentation of any reasonable accommodation therefor.”