California Vaccine Exemption Forms: CAIR-ME Filing and Appeals

In California, the vaccine exemption form you need depends on the setting. For a child entering school, childcare, or a preschool program, the only accepted exemption is a medical exemption filed electronically by a California-licensed physician through the state’s CAIR-ME system; paper forms and notes from out-of-state doctors will not be accepted. For a job, there is no state exemption form at all: you submit a written request to your employer for a religious accommodation or a disability-based medical accommodation, and the employer decides whether it can accommodate you without undue hardship. California eliminated personal belief and religious exemptions for school entry in 2016, so a school-age child cannot opt out for religious reasons.

School and Childcare Medical Exemptions

Since January 1, 2021, every new medical exemption for school or childcare entry must be filed through the California Immunization Registry–Medical Exemption website (CAIR-ME). Schools and childcare facilities cannot accept any other documentation as a valid medical exemption.¹

Who Can Issue the Exemption

Only a physician (MD or DO) licensed in California may issue the exemption, and the physician must first conduct an in-person physical exam consistent with the standard of care.² If the doctor filing the exemption is not the child’s primary care physician, the form asks for an explanation of why.¹

Some physicians are blocked from filing exemptions. A doctor with a pending accusation before the Medical Board of California or the Osteopathic Medical Board related to immunization standards of care cannot submit exemption forms until the accusation is resolved in the physician’s favor. A doctor on probation for immunization-related conduct is similarly barred until probation ends, and CDPH can bar a physician whose practice creates a public health risk from filing exemptions for at least two years.³

What Actually Qualifies

The exemption must rest on the child’s specific physical condition or medical circumstances, and the form asks for a separate medical basis for each vaccine being exempted. The reason must meet American Academy of Pediatrics criteria for a recognized contraindication.² Recognized contraindications include severe immunodeficiency (which rules out live vaccines), a prior severe allergic reaction to a vaccine component, encephalopathy following a pertussis-containing vaccine, and pregnancy.⁴

A general preference to avoid vaccination, family beliefs, or worries about ingredients that are not documented contraindications will not support a valid exemption. When the physician submits the form, they also authorize CDPH, the Medical Board, and the Osteopathic Medical Board to review the underlying records.¹

How Long the Exemption Lasts

An exemption can be temporary or permanent. A temporary exemption lasts no longer than 12 months from the signing date. Even a permanent exemption ends when the child enters the next grade span, and California defines three spans: birth through preschool, transitional kindergarten or kindergarten through 6th grade, and 7th through 12th grade.⁵ Moving into a new span means getting a new exemption if the condition still applies. A permanent exemption can also end sooner if CDPH revokes it.

No Fee for the Form

California law prohibits a physician from charging you for filling out the exemption form itself, or for a physical exam to renew a temporary exemption.¹ If a physician’s office bills for the paperwork, that charge violates state law.

How to File Through CAIR-ME

The parent starts the process, not the doctor. The workflow:

Create a CAIR-ME account at cair-me.cdph.ca.gov and log in.
Submit an exemption request in the system. CAIR-ME generates a Medical Exemption Request Number.
Give that request number to your child’s physician. The physician sets up their own CAIR-ME account, pulls up your child’s request using the number or name, and enters the medical information.
After the exam and after entering a medical basis for each exempted vaccine, the physician submits the form electronically.
The completed form is printed, signed, and provided to the school or childcare facility, or transmitted to the school through CAIR where that link exists.⁶

Parent initiates, physician completes, school receives. Nothing filed outside CAIR-ME counts.¹

What Happens After Filing

Submission is not the end. CDPH can review exemptions and flag some for a mandatory clinical review by a physician or registered nurse on its immunization staff. Review is triggered when the child’s school has an overall immunization rate below 95 percent, when the issuing physician has submitted five or more exemptions in a calendar year, or when the school does not report vaccination rates to CDPH.

If the reviewer finds the exemption does not meet the medical criteria, CDPH can revoke it. The child is not immediately kicked out. Within 30 calendar days of the revocation, the child has to begin the immunization schedule for conditional admission and stay enrolled that way, unless the parent files an appeal inside that same 30-day window.¹

Appealing a Revoked Exemption

If CDPH revokes your child’s exemption, you have 30 days to appeal to the Secretary of California Health and Human Services. The appeal is filed through CAIR-ME. Miss the window and the appeal page will show that the period has closed.⁷

An independent panel of three licensed physicians with immunization or primary care experience reviews each appeal under CDC, ACIP, and AAP guidelines. You can upload up to 20 PDFs of medical records and supporting documentation. The panel may ask for more information, giving 30 days to respond to a first request and 15 days to a second. The Secretary adopts the panel’s determination and issues a written decision, which is final; there is no further administrative review. While the appeal is pending (if you filed it on time), the child can keep attending school without starting catch-up vaccinations.⁷

When Conditional Admission Is the Better Fit

If your child has started but not finished a vaccine series, an exemption may not be what you need. A child can be conditionally admitted if they have received all doses currently due for their age or grade and are not behind on any scheduled dose at admission.⁸

The school will tell you the dates the remaining doses are due and will check the child’s records at least every 30 days. For a student transferring from another U.S. school whose immunization records have not arrived yet, the school can admit the child for up to 30 school days, after which the child is excluded until records show up.⁸

Workplace Religious Accommodations

There is no religious exemption from California’s school immunization law. In the workplace, however, both federal law and California law protect employees whose sincerely held religious beliefs conflict with a vaccine requirement, and no state-issued form controls the request.

Under Title VII of the Civil Rights Act, employers with 15 or more employees must reasonably accommodate a sincerely held religious belief unless doing so would cause undue hardship. The belief must be religious rather than political, philosophical, or personal, but it does not have to come from an organized religion. Employers should generally treat a stated religious belief as sincere unless there is an objective basis to question it. After the 2023 Supreme Court decision in Groff v. DeJoy, undue hardship means a burden that is “substantial in the overall context of an employer’s business,” considering the size, nature, and operating cost of the employer, not a minor inconvenience.⁹

California’s Fair Employment and Housing Act adds another layer. Under Government Code Section 12940, an employer must explore every available reasonable alternative before denying a religious accommodation and cannot claim undue hardship unless accommodating the belief would create significant difficulty or expense. FEHA also prohibits an accommodation that segregates the employee from other workers or the public, unless the employee specifically requests that arrangement.¹⁰

How to Ask

Submit a written statement to your employer, usually through Human Resources, describing the religious belief that conflicts with the vaccination requirement and asking for an accommodation. The employer then has to engage in an interactive process to explore options such as regular testing, remote work, masking, or reassignment. If the employer can accommodate you without substantial hardship, it must. If it cannot, it can deny the request but should document why accommodation would create undue hardship.⁹

Workplace Medical Accommodations

Employees with a qualifying disability under the Americans with Disabilities Act or FEHA can also request a medical accommodation from a workplace vaccine requirement, separate from any religious claim. The ADA covers employers with 15 or more employees. You must have a physical or mental impairment that substantially limits a major life activity and that prevents you from safely receiving the vaccine.¹¹ The same interactive process and undue hardship analysis applies. A note from your treating physician documenting the medical basis is standard.

Fraudulent Forms Carry Real Penalties

Falsifying vaccination records or exemption paperwork exposes you to criminal charges. Under Penal Code Section 471.5, altering a medical record with fraudulent intent, or creating a false medical record with fraudulent intent, is a misdemeanor. That covers fake vaccination cards, forged physician signatures, and fabricated immunization records handed to schools.¹²

Physicians face separate consequences: CDPH can report a doctor whose exemption practice creates a public health risk to the Medical Board or Osteopathic Medical Board, and can bar that physician from filing exemptions for at least two years.³ If false vaccination documents are submitted to a federal employer or federally regulated entity, the federal false statements statute (18 U.S.C. § 1001) can apply, with penalties of up to five years in federal prison.¹³

A Note on Privacy

School medical exemption records filed through CAIR-ME are shared with CDPH, the Medical Board, and the Osteopathic Medical Board as the statute authorizes; the issuing physician consents to that when submitting.¹ In the workplace, HIPAA is often misread. The HIPAA Privacy Rule applies to health plans, healthcare clearinghouses, and healthcare providers running standard electronic transactions. It does not prevent an ordinary employer from asking your vaccination status, and it does not stop you from sharing your own health information with your employer.¹⁴ If your employer is also a healthcare provider, HIPAA governs how they handle your protected health information but still does not stop them from asking whether you have been vaccinated.

1
California Legislative Information. California Health and Safety Code 120372
2
California Department of Public Health. Obtaining a Medical Exemption – Guide for Parents and Physicians
3
California Legislative Information. Senate Bill 714 – Immunizations
4
Centers for Disease Control and Prevention. Contraindications and Precautions
5
California Department of Public Health. Exemption FAQs
6
California Department of Public Health. California Immunization Registry – Medical Exemption IMM-1363 Instructions
7
California Health and Human Services Agency. Medical Exemptions Appeal Policy and Procedures
8
Legal Information Institute. California Code of Regulations Title 17 Section 6035 – Conditional Admission
9
U.S. Equal Employment Opportunity Commission. Religious Discrimination
10
California Legislative Information. California Government Code 12940
11
U.S. Equal Employment Opportunity Commission. What You Should Know About COVID-19 and the ADA, the Rehabilitation Act, and Other EEO Laws
12
California Legislative Information. California Penal Code 471.5
13
Office of the Law Revision Counsel. 18 U.S. Code 1001 – Statements or Entries Generally
14
U.S. Department of Health and Human Services. HIPAA, COVID-19 Vaccination, and the Workplace