Group: Immunizations

6 C.C.R. 1009-2 The Infant Immunization Program and Immunization of Students Attending School

II. Exemptions from Immunization

It is the responsibility of the parent(s) to have his or her student immunized unless the student is exempted. A student may be exempted from receiving the required immunizations in the following manner:

A. Medical exemption – By submitting a medical exemption form with the statement of medical exemption signed by an advanced practice nurse or physician licensed to practice medicine or osteopathic medicine in any state or territory of the United States indicating that the physical condition of the student is such that immunizations would endanger his/her life or health or is medically contraindicated due to other medical conditions. This form is to be submitted once, and must be maintained on file at each new school the student attends.

B. Religious exemption – By submitting a nonmedical exemption form signed by the parent(s) or the emancipated student indicating that the parent(s) or emancipated student is an adherent to a religious belief whose teachings are opposed to immunizations.
Beginning July 1, 2016,

1. Prior to kindergarten entry, a nonmedical exemption form must be submitted at each interval in the 2016 ACIP Birth-18 years immunization schedule at which immunizations are due. The 2016 ACIP immunization schedule is incorporated in Section III (B). This documentation is required only for those vaccines required to prevent the diseases listed in Section III (A). Exemptions will expire at the time next immunizations are due according to the 2016 ACIP birth-18 years immunization schedule or when the student is enrolled to attend kindergarten.

2. From kindergarten through twelfth grade, a nonmedical exemption form must be submitted once per school year. Exemptions will expire annually on June 30th, the last official day of the school year.

C. Personal belief exemption – By submitting a nonmedical exemption form signed by the parent(s) or the emancipated student indicating that the parent(s) or emancipated student has a personal belief that is opposed to immunizations.

Beginning July 1, 2016,

1. Prior to kindergarten entry, a nonmedical exemption form must be submitted at each interval in the 2016 ACIP Birth-18 years immunization schedule at which immunizations are due. The 2016 ACIP immunization schedule is incorporated in Section III (B). This documentation is required only for those vaccines required to prevent the diseases listed in Section III (A). Exemptions will expire at the time next immunizations are due according to the 2016 ACIP birth-18 years immunization schedule or when the student is enrolled to attend kindergarten.

2. From kindergarten through twelfth grade, a nonmedical exemption form must be submitted once per school year. Exemptions will expire annually on June 30th, the last official day of the school year.

D. In the event of an outbreak of disease against which immunization is required, no exemption or exception from immunization shall be recognized and exempted persons may be subject to exclusion from school and quarantine.

VI. Official school immunization records

A. Official school immunization records shall include:

1. An official Certificate of Immunization or an Alternate Certificate of Immunization approved by the Department of Public Health and Environment shall include one of the following forms of documentation with the dates and types of immunizations administered to a student:

a. A paper or electronic document that includes information transferred from the records of a licensed physician, registered nurse, or public health official, or

b. An electronic file or hard copy of an electronic file provided to the school directly from the immunization tracking system established pursuant to Section 25-4- 2403, C.R.S., or from a software program approved by the Department of Public Health and Environment, or

2. An official medical exemption form with the date and vaccines exempted from, or

3. An official nonmedical exemption form with the date, type of exemption taken and the vaccines exempted from.

B. Any immunization record (original or copy) provided by a physician licensed to practice medicine or osteopathic medicine in any state or territory of the United States, registered nurse, or public health official may be accepted by the school official as proof of immunization. The information is to be verified by the school official and transferred to an official Certificate of Immunization.

C. Schools shall have on file an official school immunization record for every student enrolled. The official school immunization record will be kept apart from other school records. When a student withdraws, transfers, or is promoted to a new school, the school official shall return the Certificate of Immunization to the parent(s) or emancipated student upon request or transfer it with the student’s school records to the new school. Upon a college or university student’s request, the Certificate of Immunization shall be forwarded as specified by the student.

Ref: 6 C.C.R. 1009-2

25-4-904. Rules and regulations – immunization rules – rule-making authority of state board of health

1. The state board of health shall establish rules and regulations for administering this part 9. Such rules and regulations shall establish which immunizations shall be required and the manner and frequency of their administration and shall conform to recognized standard medical practices. Such rules and regulations may also require the reporting of statistical information and names of noncompliers by the schools. The department of public health and environment shall administer and enforce the immunization requirements.

2. All rule-making authority granted to the state board of health under the provisions of this article is granted on the condition that the general assembly reserves the power to delete or rescind any rule of the board. All rules promulgated pursuant to this subsection (2) shall be subject to sections 24-4-103 (8) (c)and (8) (d) and 24-4-108, C.R.S.

Ref: C.R.S. 25-4-904

25-4-903. Exemptions from immunization – rules

(1) (Deleted by amendment, L. 97, p. 409, § 2, effective July 1, 1997.)

(2) A parent or legal guardian shall have his or her student immunized, unless the student is exempted pursuant to this section, or an emancipated student or a student eighteen years of age or older shall have himself or herself immunized, unless the student is exempted pursuant to this section. A student is exempted from receiving the required immunizations in the following manner:

(a) By submitting to the student’s school a completed certificate of medical exemption from a licensed physician, physician assistant authorized pursuant to section 12-240-107 (6), or advanced practice nurse that the physical condition of the student is such that one or more specified immunizations would endanger his or her life or health or are medically contraindicated due to other medical conditions; or

(b)

(I) By submitting to the student’s school either a completed certificate of completion of the online education module or a completed certificate of nonmedical exemption signed by one parent or legal guardian, an emancipated student, or a student eighteen years of age or older that the parent, legal guardian, or student is an adherent to a religious belief whose teachings are opposed to immunizations or has a personal belief that is opposed to immunizations.

(II)
(A) A complete certificate of completion of the online education module is acquired upon completing the online education module described in subsection (2.7) of this section.
(B) A complete certificate of nonmedical exemption must include the signature of a person who is authorized pursuant to title 12 to administer immunizations within his or her scope of practice to the student for whom the certificate of nonmedical exemption is sought. Nothing in this subsection (2)(b)(II)(B) requires a person authorized pursuant to title 12 to administer immunizations within his or her scope of practice to sign a certificate of nonmedical exemption. Notwithstanding any law or rule to the contrary, a body that regulates the professional conduct of a person who is authorized pursuant to title 12 to administer immunizations within his or her scope of practice to the student for whom the certificate is sought shall not order a disciplinary action against the person because the person authorized to sign the certificate signed such certificate pursuant to this subsection (2)(b)(II)(B). It is unlawful for the employer or any professional organization to retaliate against a person because the person authorized to sign a certificate signed such certificate pursuant to this subsection (2)(b)(II)(B).

(2.2)

(a)
(I) A licensed physician, physician assistant authorized pursuant to section 12-240-107 (6), or advanced practice nurse shall provide a copy of a completed certificate of medical exemption to the student’s parent or legal guardian, the emancipated student, or the student eighteen years of age or older.
(II) The certificate of completion of the online education module must be immediately available to download or print upon completion of the online education module. The certificate of completion of the online education module developed by the department of public health and environment must include the same information as the certificate of nonmedical exemption pursuant to subsection (2.3) of this section.
(III) A person authorized pursuant to title 12 to administer immunizations within his or her scope of practice to the student for whom the certificate of nonmedical exemption is sought and who signs the certificate of nonmedical exemption form shall provide a copy of a completed certificate of nonmedical exemption to the student’s parent or legal guardian, the emancipated student, or the student eighteen years of age or older.

(b)
(I) A licensed physician, physician assistant authorized pursuant to section 12-240-107 (6), or advanced practice nurse shall submit the medical exemption data to the immunization tracking system created in section 25-4-2403.
(II) A person authorized pursuant to title 12 to administer immunizations within his or her scope of practice to the student for whom the certificate of nonmedical exemption is sought and who signs the certificate of nonmedical exemption shall submit the nonmedical exemption data to the immunization tracking system created in section 25-4-2403.
(III) Notwithstanding subsections (2.2)(b)(I) and (2.2)(b)(II) of this section, a licensed physician, a physician assistant authorized pursuant to section 12-240-107 (6), an advanced practice nurse, or a person authorized pursuant to title 12 to administer immunizations within his or her scope of practice is not subject to a regulatory sanction for failing to submit medical exemption or nonmedical exemption data to the immunization tracking system.

(2.3)

(a) On or before January 1, 2021, the department of public health and environment shall develop and post on its website a standardized certificate of medical exemption form and a standardized certificate of nonmedical exemption form. The department of public health and environment shall post any updated form on its website.

(b) At a minimum, the forms developed by the department of public health and environment must:
(I) Include a notice that informs the student’s parent or legal guardian, the emancipated student, or the student eighteen years of age or older of the option to exclude the student’s medical or nonmedical exemption information from the immunization tracking system established in section 25-4-2403;
(II) Be limited to requests for information related to collecting data pertaining to a medical or nonmedical exemption, including but not limited to:
(A) The student’s immunization information and the vaccine or vaccines for which the exemption applies; and
(B) Whether a medical exemption or a nonmedical exemption is claimed;
(III) Not require the student’s parent or legal guardian, the emancipated student, or the student eighteen years of age or older to provide any demographic data except the student’s name, date of birth, sex, and school’s name and location, and the parent’s or legal guardian’s name;
(IV) Include references to scientifically based information regarding the benefits and risks of immunizations; and
(V) Not require the student’s parent or legal guardian, the emancipated student, or the student eighteen years of age or older to provide any information that would identify the religious faith or describe the reasons for the personal belief of the student’s parent or legal guardian, the emancipated student, or the student eighteen years of age or older who is claiming a nonmedical exemption. The existing immunization tracking system established in section 25-4-2403 must not receive or store any information that would identify the religious faith or the reasons for the personal belief of the student’s parent or legal guardian, the emancipated student, or the student eighteen years of age or older who is claiming the exemption.

(c) The forms developed by the department of public health and environment must not require a parent or legal guardian, emancipated student, or student eighteen years of age or older to sign or indicate agreement with any language regarding immunizations that may be contrary to a religious belief or personal belief that is opposed to immunizations in order to complete the form.

(2.5) The state board of health shall promulgate rules regarding:

(a) Immunization information, including exemption rates, that is available to the public through the department, including evidence-based research, resources and information from credible scientific and public health organizations, peer-reviewed studies, and an online learning module; and

(b) The frequency of submission of exemption forms.

(2.7)

(a) The online learning module administered by the department of public health and environment pursuant to subsection (2.5)(a) of this section must:
(I) Include medical and scientific data that is evidence-based and peer reviewed by credible scientific and public health organizations concerning both the benefits and risks of immunizations and evidence-based practices. The module must fairly present both the benefits and risks of immunizations and include data concerning the risk of immunization injury.
(II) Be interactive; and
(III) Include other criteria adopted by the department of public health and environment.

(b) The online learning module must not require a parent or legal guardian, emancipated student, or student eighteen years of age or older to sign or indicate agreement with any language regarding immunizations that may be contrary to a religious belief or personal belief that is opposed to immunizations in order to complete the online learning module.
(3) The state board of health may provide, by regulation, for further exemptions to immunization based upon sound medical practice.
(4) All information distributed to parents by school districts regarding immunization shall inform them of their rights under subsection (2) of this section.
(5) In addition to the requirements pursuant to section 25-4-902 (4)(b), each school shall make the immunization and exemption rates of their enrolled student population publicly available upon request.

Ref: C.R.S. 25-4-903

25-4-902. Immunization prior to attending school – standardized immunization information

1. Except as provided in section 25-4-903, no child shall attend any school in the state of Colorado on or after the dates specified in section 25-4-906 (4) unless he or she has presented the following to the appropriate school official:

a. An up-to-date certificate of immunization from a licensed physician, a licensed advanced practice nurse, or authorized representative of the department of public health and environment or county, district, or municipal public health agency stating that the child has received immunization against communicable diseases as specified by the state board of health, based on recommendations of the advisory committee on immunization practices of the United States department of health and human services or the American academy of pediatrics; or

b. A written authorization signed by one parent or guardian or an authorization signed by the emancipated child requesting that local health officials administer the immunizations.

c. (Deleted by amendment, L. 97, p. 408, § 1, effective July 1, 1997.)

2. If the student’s certificate of immunization is not up-to-date according to the requirements of the state board of health, the parent or guardian or the emancipated student or the student eighteen years of age or older shall submit to the school, within fourteen days after receiving direct personal notification that the certificate is not up-to-date, documentation that the next required immunization has been given and a written plan for completion of all required immunizations. The scheduling of immunizations in the written plan shall follow medically recommended minimum intervals approved by the state board of health. If the student begins but does not continue or complete the written plan, he or she shall be suspended or expelled pursuant to this part 9.

3. Notwithstanding the provisions of subsection (1) of this section, a school shall enroll a student who is in out-of-home placement within five school days after receiving the student’s education information and records as required in section 22-32-138, C.R.S., regardless of whether the school has received the items specified in subsection (1) of this section. Upon enrolling the student, the school shall notify the student’s legal guardian that, unless the school receives the student’s certificate of immunization or a written authorization for administration of immunizations within fourteen days after the student enrolls, the school shall suspend the student until such time as the school receives the certificate of immunization or the authorization.

4. On or before March 1, 2011, the department of public health and environment shall develop and provide to the department of education a standardized document regarding childhood immunizations. The department of education shall post the standardized immunization document on its web site on or before January 15, 2011, and each year thereafter. The standardized document shall be updated annually and shall include, but need not be limited to:

a. A list of the immunizations required for enrollment in a school and the age at which the immunization is required; and

b. A list of immunizations currently recommended for children by the center for disease control advisory committee on immunization practices and the recommended age at which each immunization should be given.

5. The document created pursuant to subsection (4) of this section shall comply with the provisions of section 25-4-903 (4) regarding allowable exemptions from required immunizations.

Ref: C.R.S. 25-4-902