Request a COVID-19 Vaccine Medical Exemption for a Client

Practitioner acknowledgement

By submitting a medical exemption request you acknowledge and confirm that as a medical practitioner:

• You are a member in good standing with one of the following designations: Ontario physician (designated as "MD") or registered nurse in the extended class (designated as "Registered Nurse (Extended Class)", "RN(EC)", "Nurse Practitioner" or "NP")
• You are providing information regarding a medical exemption related to the COVID-19 vaccination.
• That your patient consents to the collection of their personal health information by you for the purpose of maintaining a health care record.
• That your patient is aware that information provided to the Durham Region Health Department (a Public Health Unit "PHU") may be used and/or disclosed to create a record indicating exemption from COVID-19 immunization as well as other purposes authorized and required by law. For example:
  • To address questions or communications between you and the PHU as may be needed to clarify the exemption, in order to create an exemption in COVaxON, a health record system under the custody and control of the Ministry of Health.
  • Disclosure to the Chief Medical Officer of Health where the disclosure is necessary for a purpose of the Health Protection and Promotion Act.
  • Disclosure, as part of the patient’s provincial electronic health record, to health care providers who are providing care to the patient.