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COVID-19 vaccine exemption requests: Patient FAQ

Oct 1, 2021

What are the current criteria for medical exemptions for vaccination?

There are virtually no medical conditions that universally warrant a complete exemption from a first or second dose of the COVID-19 vaccine. A patient’s moral objection to vaccination, or likelihood of termination from school enrolment or employment, is not considered a sufficient clinical reason for exemption.

Who can issue an exemption from vaccination?

Your primary care physician or primary care nurse practitioner is qualified to determine if you have a condition that constitutes a medical exemption from COVID-19 vaccination. However, the likelihood of obtaining an exemption from vaccination is extremely unlikely.

Is my physician or nurse practitioner obligated to provide me with an exemption?

No. Physicians and nurse practitioners are highly unlikely to provide patients with an exemption from COVID-19 vaccination. Physicians and nurse practitioners will only offer an exemption based on the latest medical evidence from authorities like Alberta Health, Alberta Health Services, the National Advisory Council on Immunization and the Centers for Disease Control and Prevention. 

Can I go to any physician or nurse practitioner to request exemption from vaccination?

No. Please see your primary care physician or primary care nurse practitioner to request an assessment on whether you qualify for an exemption. Do not request exemptions from an emergency room physician or nurse practitioner who practices in an emergency. 

What should I expect when I ask my physician or nurse practitioner for a vaccine exemption?

Your physician or nurse practitioner will assess whether you have a condition that constitutes a medical exemption. This assessment may be conducted in person or virtually. As the qualifying criteria for vaccination exemption are extremely limited, we expect that nearly all requests will be denied. 

Why wouldn’t a physician or nurse practitioner provide an exemption from vaccination?

A physician or nurse practitioner is expected to deny any exemption request from a patient without a condition that constitutes a medical exemption as outlined in the Alberta Health COVID-19 Immunization-Medical Exemption Policy. A physician or nurse practitioner could be investigated for unprofessional conduct if they provide an exemption that is inconsistent with the latest evidence. 

What are the conditions that constitute a medical exemption from immunization? 

Clinical decisions on COVID-19 vaccination exemption are expected to align with recommendations set out by the Alberta Health Services COVID-19 Scientific Advisory Group. Clinical decisions may also be made based on the latest evidence from the National Advisory Council on Immunization, the Centers for Disease Control and Prevention and the Alberta Health COVID-19 Immunization - Medical Exemption Policy (alberta.ca).

Will vaccination exemptions be given to pregnant women, or those trying to become pregnant?

No. Pregnancy, or attempting to become pregnant, does not warrant exemption from vaccination. COVID-19 vaccines are safe and effective for pregnant individuals and their babies, and vaccination may occur at any time, or during any trimester of pregnancy. Since the outset of the pandemic, the only pregnant women admitted to ICU in Alberta have been unvaccinated. COVID-19 has severe impacts on the mother’s health and also the child’s. Alberta Health Services has very helpful information on COVID-19 vaccination and pregnancy. 

Can I complain to the College of Physicians and Surgeons of Alberta (CPSA) or the College and Association of Registered Nurses of Alberta (CARNA) if I am denied an exemption request?

CPSA expects physicians to assess all patient requests for vaccination exemptions. CPSA would only investigate a complaint if a physician has refused to provide an assessment, or if the physician issued an exemption for an unwarranted medical condition. CPSA accepts evidence-based clinical judgements by physicians.

CARNA has the same expectations for nurse practitioners. CARNA expects nurse practitioners to assess all patient requests for vaccination exemptions and will only investigate a complaint if the nurse practitioner refused to provide an assessment or if the nurse practitioner issued an exemption for a condition that does not constitute a medical exemption. CARNA accepts evidence-based clinical judgements by nurse practitioners.

What happens if patients become verbally or physically abusive?

Patients who do not receive the response they are hoping for must treat the physician, nurse practitioner, clinic staff and other patients with respect. Patients cannot put undue pressure on the physician or nurse practitioner and must understand the physician’s or nurse practitioner’s obligation to evidence-based decision making. Abusive patients will be asked to leave the premises and may be subject to termination of the therapeutic relationship with the physician or nurse practitioner and/or prosecution by law enforcement.

How quickly will my physician or nurse practitioner respond to a request for an exemption?

Physicians and nurse practitioners have a responsibility to triage and manage the needs of all their patients, ensuring those with an urgent, serious need for care are prioritized for evaluation. Depending on your physician’s or nurse practitioner’s workload, a request for assessment related to vaccination exemption may require advance booking or deferral to a future appointment.

Do I need to carry the exemption letter with me at all times?

In the rare event that a physician or nurse practitioner provides a patient with an exemption from COVID-19 vaccination, you may be asked to provide proof of an exemption by showing the vaccine exemption letter if requested by your school, workplace or business you intend to visit.

If I am not given an exemption, does that mean I need to be vaccinated?

COVID-19 vaccination is not mandatory in Alberta. However, an increasing number of schools, businesses and jurisdictions are now requiring students, staff and visitors to be fully vaccinated. Choosing not to be vaccinated may limit your ability to participate in certain in-person activities.

Can my physician or nurse practitioner be exempt from vaccination?

It is highly recommended that all physicians and nurse practitioners providing patient care in community medical clinics be fully vaccinated against COVID-19. The likelihood of any individual, including a physician or nurse practitioner, being exempted from vaccination is extremely low. 

How can I protect myself and others if I cannot be vaccinated?

An exemption from COVID-19 vaccination should not be misinterpreted as a “free pass.” You remain at an elevated risk of acquiring, transmitting and experiencing severe outcomes from COVID-19, particularly if you have a condition that constitutes a medical exemption. Unvaccinated individuals should diligently follow public health precautions like indoor masking, physical distancing, monitoring for symptoms, avoiding crowded areas and heightening hygiene practices. You should also speak to your physician or nurse practitioner about obtaining the vaccine once new evidence emerges, your condition which constitutes a medical exemption improves, or as new vaccine products become available.

How can I find out if my physician or nurse practitioner is vaccinated?

Physicians and nurse practitioners are under no obligation to disclose their health status to their patients. If a physician or nurse practitioner does not wish to disclose their health status, patients have the right to ask what other protection methods, such as those listed above, are in place. Clinics are obligated to follow strict Infection Prevention and Control Standards that are designed to offer protection in the absence of staff or patient vaccination. Many clinics also undertake COVID-19 prevention strategies, which may include the use of barriers, requiring mask use by staff and patients, arranging for virtual care, postponing non-urgent visits and scheduling appointments. 

Can medical clinic staff ask me about my vaccination status?

Yes. It is essential for medical staff to know your immediate health history. Clinic staff may ask about a patient’s vaccination status as part of their point-of-care risk assessment and are likely to strongly encourage vaccination to any patient who was eligible. 

Can my physician or nurse practitioner refuse to see me if I am not vaccinated?

Patients who are not fully vaccinated cannot be denied care. Clinics are obligated to follow strict Infection Prevention and Control Standards. These measures are designed to offer protection from transmission in the absence of staff or patient vaccination. Many clinics also undertake COVID-19 prevention strategies, which may include the use of barriers, requiring mask use by staff and patients, arranging for virtual care, postponing non-urgent visits and scheduling appointments.

What can I do if I can’t qualify for an exemption, but remain concerned about COVID-19 vaccinations?

COVID-19 vaccination is safe and effective for nearly every individual aged 12 or older and CPSA and CARNA strongly recommend COVID-19 vaccination to anyone who is eligible. To inform your personal decision-making on COVID-19 vaccination, we recommend resources provided by Immunize Canada, the National Advisory Committee on Immunization and  Alberta Health.