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AAP Refusal to Vaccinate Form (PDF 92KB)
Health care providers may decide it is in their best interest to formally document a parent's refusal to accept vaccination for a minor child. This form, which should not be considered a legal document without advice from a lawyer, may be used as a template for such documentation. Microsoft Word version (DOC 248KB)
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AAP Clinical Report, Responding to Parental Refusals of Immunization of Children
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Coding Resources For Parental Refusal to Vaccinate (PDF 68KB)
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Sample Office Policy/Letter to Parents about Refusal to Vaccinate (6/9/08) This posting is not official Academy policy. Some pediatric practices have chosen not to accept patients who do not vaccinate, and this is a sample of how one practice addresses the issue. (DOC 34KB)
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Sample Office Poster: My kids are immunized! (DOC 3,108KB)