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Keeping Your Child in School in New York
Understanding “In Process” Status & Medical Exemptions (ME) • Davenport Law PLLC
What “In Process” Legally Means (10 NYCRR § 66‑1.1(j))
Started series + age‑appropriate appointments to complete per ACIP catch‑up schedule.
Had blood drawn for serology and awaiting results (≤ 14 days).
Serology negative → appointments scheduled within 30 days to begin/complete doses.
Must stay on schedule; if a required dose is missed, child is no longer “in process” unless otherwise exempt (ME).
Yes—“In Process” + ME Can Coexist
A valid ME for a specific vaccine keeps the student compliant for that shot.
Student stays “in process” for the remaining, non‑exempt vaccines (continue appointments).
If a dose is missed but an ME covers that dose, the student remains compliant.
ME Basics Under NY Law
Core standard (PHL § 2164(8)):
• If a NY‑licensed physician certifies an immunization may be detrimental, requirements are inapplicable until no longer detrimental.
What to submit:
• DOH‑5077 medical exemption form (signed by NY‑licensed physician).
ME must be re‑issued annually (indicate appropriate duration).
Submission Checklist (Parents)
Prior DOH‑5077 ME form referencing ACIP contraindication/precaution; otherwise, proof you’re in process (i.e., printout of official NYSIIS Immunization Schedule for your child).
Proof of appointments (printout or portal screenshot).
Serology: lab order/receipt + date results expected (if using this path).
Cover letter to principal/superintendent (use provided templates).
Script: Day‑1 Denial But You Have an Appointment
Say this:
“My child is ‘in process’ under 10 NYCRR § 66‑1.1(j). The school shall admit a child who is in process under § 66‑1.3(b). Please put any contrary position in a written exclusion notice citing the statute.”
Attach:
• Appointment proof.
• In‑Process letter template.
• Any serology receipt (if applicable).
Scenario B: ME for One Vaccine; Catch‑Up on Others
Submit ME for the exempt vaccine(s) + proof of appointments for the rest.
Student remains in school: ME covers exempt dose; appointments keep you “in process” on others.
Re‑issue ME annually; keep to only vaccines actually required for grade level.
Scenario C: Serology Path
Attend while awaiting results (up to 14 days from blood draw).
If negative, schedule required doses within 30 days; provide proof to school.
If positive for accepted diseases (e.g., MMR, varicella, Hep B), submit as proof of immunity.
Scenario D: Annual Reissue & Missed Prior‑Year Doses
If last year’s doses were missed, you may lose “in process” unless covered by ME.
Meet pediatrician promptly to map ACIP catch‑up or issue ME where medically appropriate.
Use appointments + letters to maintain attendance.
Due Process: Written Notice Before Any Exclusion
Schools must provide formal written notice of any exclusion and the legal basis.
Keep a timeline: date you supplied proofs; date of any lab draws; dates of appointments.
Rule of thumb on the 14‑day clock:
• It runs after a missed ACIP minimum interval when not otherwise exempt.
• It does not permit Day‑1 refusal when a student is lawfully “in process.”
Working with Your Doctor (One‑Pager Talking Points)
Bring concise ACIP excerpts on contraindications/precautions and the NY DOH ME form.
Ask for a targeted ME only for vaccines actually due this year (or to cover vaccines from a prior year); avoid over‑scoping.
If uncertain, use serology and/or temporary ME while evaluating safety.
Plan to re‑issue annually at the physical.
Q&A (We’ll take questions from the chat)
And here are sample letters for your school and an FAQ prepared by Chad Davenport:
And below are the sample letter and FAQs prepared by Chad Davenport.
Sample Letter
[Parent/Guardian Name]
[Your Address]
[City, NY ZIP Code]
[Your Email]
[Your Phone Number]
[Date]
VIA EMAIL AND HAND DELIVERY
[Principal's Name]
Principal, [School Name]
[School Address]
[City, NY ZIP Code]
[Superintendent's Name]
Superintendent, [School District Name]
[School District Address]
[City, NY ZIP Code]
Re: Informational Memorandum Regarding the Legal Requirements for Medical Exemptions
Submitted with the Medical Exemption for: [Student's Name], DOB: [Student's DOB]
Dear Principal [Principal's Last Name] and Superintendent [Superintendent's Last Name]:
Enclosed you will find a medical exemption for my child, [Student's Name], completed and signed by their New York State licensed physician, [Physician's Name, M.D./D.O.].
We provide this accompanying letter as a helpful resource to clarify the district's legal responsibilities upon receiving a valid medical exemption. The process of accepting a medical exemption is a legal and administrative matter, not a medical one, and recent federal court rulings have been very clear about the limited role of school districts in this process.
We respectfully request that you share this letter and the enclosed legal authorities with the school district’s legal counsel so they may properly advise you of your legal obligations and help the district avoid the errors that other districts have made.
New York State Law is Clear: The District's Role is Not to Medically Evaluate the Exemption
The controlling law, New York Public Health Law § 2164(8), is straightforward. It states that a child is exempt from school immunization requirements:
“If any physician licensed to practice medicine in this state certifies that such immunization may be detrimental to a child’s health, the requirements of this section shall be inapplicable until such immunization is found no longer to be detrimental to the child’s health.”
The language of the law is mandatory ("shall be inapplicable") and requires only the certification of "any" licensed physician. The law does not grant school officials, or even the district's consulting physician, the authority to conduct their own medical review, second-guess the treating physician’s clinical judgment, or deny an exemption because they disagree with the medical reasoning. The district's role is to ensure the form is facially valid (i.e., completed and signed by a NYS-licensed physician), not to re-adjudicate the medical necessity.
Federal Courts Have Repeatedly Confirmed that School Districts Lack Discretion
Any ambiguity about the role of a school district has been resolved by the federal courts. The U.S. Court of Appeals for the Second Circuit (which governs New York) and federal district courts within the state have consistently ruled that school districts cannot substitute their judgment for that of a treating physician.
In Miller v. McDonald, the Second Circuit stated that the law “does not create a system in which school officials are given improper discretion to evaluate the reasons given for a requested medical exemption.” 130 F.4th 258, 269 (2d Cir. 2025).
In A.A.C. v. Starpoint Cent. Sch. Dist., a federal court found a school district acted unlawfully because its physician “improperly second-guessed the treating physician’s conclusion,” which “exceeds the bounds of his statutory authority in reviewing a request.” Civil No. 1:24-CV-01047-JLS-LGF, ECF Doc. No. 90, at 2, 22 (W.D.N.Y. Apr. 25, 2025) (citing Miller, 130 F.4th at 269).
In Doe v. Oceanside Union Free School District, another federal court ordered a school to accept a medical exemption, finding that an improper denial is a form of disability discrimination under the Americans with Disabilities Act (ADA). Civil No. 2:25-CV-02304-GRB-ST, ECF Doc. No. 41 (E.D.N.Y. Aug. 12, 2025).
These rulings confirm that the question of whether a vaccine may be detrimental to a child's health is a determination reserved exclusively for the certifying physician.
The NYSDOH Guidance Document is Misleading and Contrary to Law
We understand that the New York State Department of Health (NYSDOH) has distributed a document titled “Medical Exemption Review Procedures for Schools.” Please be advised that this document is non-binding guidance and does not have the force of law.
Crucially, this guidance document contradicts what the federal courts have ruled is legally required of school districts and what is allowed. The NYSDOH guidance incorrectly suggests that school officials have the discretion to conduct a substantive medical review and make a “final determination” on whether to accept the substantive reasons for the exemption.
This is legally incorrect. The federal courts have been clear that this practice of "second-guessing" a licensed physician is not permitted. Relying on this legally flawed guidance from the NYSDOH, rather than the plain language of the law and the rulings of the federal courts, has caused other school districts to act unlawfully and face financial and legal consequences.
Our Request
Based on the clear text of New York Public Health Law § 2164(8) and the definitive rulings from the federal courts, your only lawful course of action is to accept the enclosed, facially valid medical exemption.
This will ensure that my child’s right to an education is protected and that the district is acting in full compliance with its legal obligations. We trust that after your review of this information, and consultation with your legal counsel, you will agree.
We respectfully request written confirmation of the acceptance of this medical exemption within five (5) business days as disability accommodation requests must be promptly addressed.
Thank you for your time and attention to this important matter.
Sincerely,
[Parent/Guardian Signature]
[Parent/Guardian Printed Name]
FAQ
NYS Vaccine Medical Exemption FAQ for Parents
This FAQ is intended to provide general information for parents in New York State based on recent court rulings. It is not a substitute for legal advice from a qualified attorney regarding your specific situation.
The New Court Ruling (Doe v. Oceanside)
Q: What happened in the big court case on August 12, 2025? What does it change?
A: A federal court in New York granted a preliminary injunction, ordering the Oceanside Union Free School District to immediately accept a student's medical exemption and allow her to return to school.
This is a major victory for three key reasons:
It reaffirms that schools cannot second-guess your doctor. The judge's decision builds on previous cases, making it clearer than ever that a school's role is administrative, not medical.
It frames the denial as disability discrimination. The court granted the injunction based on the student's claim under the Americans with Disabilities Act (ADA). This is powerful because it establishes that denying a valid medical accommodation is a federal civil rights issue.
It allows parents to go straight to federal court. Because an improper denial can be considered a violation of the ADA, families are not required to go through the lengthy state-level Commissioner's Appeal or Article 78 process. They can seek immediate relief, like a Temporary Restraining Order (TRO), in federal court.
The Basics of Your Exemption
Q: What makes a medical exemption legally valid in New York?
A: The law is very simple. A valid medical exemption requires a certification from "any physician licensed to practice medicine in this state" stating that a specific immunization "may be detrimental to a child’s health" (NY Public Health Law § 2164(8)). The school district doctor does not have to agree. Rather, the only requirements are:
The form must be filled out by a NYS licensed physician.
The physician must use the official NYSDOH form (DOH-5077).
The physician must decide that there is a contraindication or precaution that is not inconsistent with ACIP or other nationally recognized evidence. The definition under ACIP for these are:
Contraindications to vaccination are conditions that increase the risk for a serious adverse reaction. Vaccines should not be administered when a contraindication is present.
Precautions are conditions that might increase the risk for a serious adverse reaction, cause diagnostic confusion, or compromise the ability of the vaccine to produce immunity.
It does not matter if the school district doctor or any other doctor agrees with your treating physician that your child’s condition fits these parameters.
Q: Can my school district or its doctor deny an exemption because they disagree with my doctor's medical reasoning?
A: No. This is the most critical point. Federal courts have been clear and consistent: school districts do not have the discretion or authority to second-guess the medical judgment of a licensed physician.
The court in the Starpoint case stated that a school physician “improperly second-guessed the treating physician’s conclusion” and that this “exceeds the bounds of his statutory authority.”
The U.S. Court of Appeals for the Second Circuit ruled in Miller v. McDonald that school officials do not have discretion "to evaluate the reasons given for a requested medical exemption."
The Eastern District Court Judge agreed that the plain language of the statutory scheme and the Second Circuit’s instructions do not give any discretion to school districts to deny medical exemptions so long as they are prepared by NYS licensed physicians on the correct form.
The school's job is only to verify that the form is complete and signed by a New York-licensed physician. They cannot overrule the doctor's opinion.
Q: My school says they are following the NYS Department of Health (NYSDOH) guidance. What about that?
A: The NYSDOH's "Medical Exemption Review Procedures" document is merely guidance, not law. Furthermore, the procedures it suggests—where schools conduct their own medical review and make a "final determination"—are contrary to what the federal courts have ruled the law actually allows.
School districts that follow this misleading guidance are acting unlawfully. The law, as interpreted by the courts, is what matters.
Qualifying for an Exemption
Q: Who qualifies for a medical exemption?
A: Any child whose New York State licensed physician believes a vaccine "may be detrimental" to their health qualifies. The doctor is not limited to a rigid list of reasons. A physician can use their professional judgment to determine what constitutes a potential detriment for that specific child.
Q: What are some valid reasons a doctor can use for an exemption?
A: A doctor can base their decision on many factors. Some common and legally sound reasons include:
Patient History: A doctor can legally rely on the verbal or written history provided by a patient or parent about a previous reaction. They are not required by law to have pre-existing documentation of that reaction. The court in the Starpoint case and the Oceanside case affirmed this principle.
Active Illness (Precautions): The CDC's own ACIP guidelines list "moderate or severe acute illness" as a precaution for all vaccines. An active infection, like Mycoplasma, is a valid medical reason to issue a temporary exemption until the illness resolves.
Family History and Genetic Factors: This is a strong and valid basis for an exemption. A physician can certify that a vaccine “may be detrimental” based on genetic factors, including:
Adverse Reaction in a Close Relative: If a parent or sibling had a severe reaction to a vaccine, this is a valid reason for an exemption. The physician can state that because of shared genes, the child has a genetic predisposition that puts them at higher risk of a similar reaction.
Known Genetic Mutations: Even if a specific genetic marker (like an MTHFR mutation) is not an official CDC list of contraindications, a physician can use their clinical judgment. If the doctor believes, based on medical literature and the child’s overall health, that the mutation could impair the child’s ability to detoxify or otherwise increase their risk of a vaccine injury, they can certify the exemption.
The key is that it must be the doctor's sincere, professional medical opinion about your specific child.
Q: For how long should the exemption be written?
A: Exemptions cannot be permanent or indefinite. New York State law requires that all medical exemptions be reviewed and reissued annually. Therefore, an exemption is valid for a maximum of one year. Your doctor should specify a duration on the form that is appropriate for your child’s medical situation, whether it is for a full school year or a shorter period while the child is under observation or awaiting further evaluation.
Q: Which vaccines should be listed on the exemption form?
A: The exemption should only list the specific vaccines that are actually required for your child to attend school for the current year. Do not check the boxes for all vaccines listed on the form. Your school nurse can provide you with a list of exactly which shots are due for your child’s grade level. Providing a targeted exemption for only the required vaccines is the proper procedure.
Handling School District Requests
Q: My school district is asking for my child's complete medical records to 'review' the exemption. Do I have to provide them?
A: No, you are generally not required to provide your child's entire medical file. This is a common tactic used by school districts, often based on the misleading NYSDOH guidance, to find a reason to deny the exemption.
What the Law Says: While a school "may require additional information supporting the exemption," the signed DOH form and the physician's letter are the supporting information required by law.
What the Courts Say: Federal courts have prohibited schools from "second-guessing" a physician's conclusion. Demanding the full medical record is a way for them to do exactly that—improperly re-evaluate your doctor's medical decision.
How to Respond: You can politely and firmly decline the request. A reasonable response could be:
The completed DOH form and supporting letter from my child's licensed physician contain all the information required by law to certify this medical exemption. Providing the entire medical file is not legally required and would allow the district to improperly substitute its judgment for that of a licensed physician, which federal courts have prohibited. If the district's medical director has specific questions, they are welcome to speak directly with my child's physician, with my consent.
This response protects your child's medical privacy and correctly frames the issue as a legal one, while still offering a reasonable path for communication between medical professionals.
What to Do Next
Q: What should I do when I submit my exemption?
A: It is highly recommended that you submit the "Parent Resource Letter" along with your physician-signed DOH-5077 form. This letter informs the school of the current law and recent court rulings, defines the issue as a legal one, and advises them to have their attorneys review it. This helps prevent an improper denial from a principal or nurse who may be relying on the outdated and incorrect DOH guidance.
Excellent summary of the process for obtaining vaccine exemptions for school children in New York (and I say that as government attorney with much experience in navigating regulatory procedures). It’s clear that a massive amount of work has gone into this effort to protect kids from untested and demonstrably dangerous medical interventions just to receive a basic education. It’s imperative that parents challenge the State’s policy to interfere with their right to make critical health decisions for their own children.