In Compliance with Oklahoma Statutes, Title 70 §3244
Certification of Compliance
Hepatitis B, Measles, Mumps and Rubella (MMR
Oklahoma Statutes, Title 70 §3244, requires that all students who enroll as a full
student in an Oklahoma pub
lic or private postsecondary institution provide documentation of
vaccinations against hepatitis B, measles, mumps and rubella (MMR).
The statute requires that Institutions notify students of the vaccination requirements and provide
nal information concerning hepatitis B, measles, mumps and rubella
(MMR), including the risks and benefits of the vaccination.
The statute permits that when the vaccine is medically contraindicated and a licensed physician
has signed a written statement
to that effect, such student shall be exempt from the vaccination.
Further, the statute permits a student or if the student is a minor, the student’s parent or other legal
representative, to sign a written waiver stating that the administration of the v
the student’s moral or religious tenants.
_____________________________________________________________________________
______________________________________________________________________________
h date: _________________________Term/Year of first enrollment: ___________________
Social Security Number or Student ID: ______________________________________________
I have been notified by my institution of the requirement that I must provide documen
having received vaccinations against hepatitis B, measles, mumps and rubella (MMR), and
I have received and reviewed the educational information provided by my institution
concerning hepatitis B, measles, mumps and rubella (MMR), including the
Further, I certify that: (
Place a check in the applicable space, below.)
______ I have been vaccinated and have provided documentation in support as required by
Oklahoma Statute, Title 70 §3243, or
m exempt from the requirement and have attached a written statement from a
licensed physician, which indicates that a vaccine is medically contraindicated, or
______ The administration of the vaccine conflicts with my moral or religious tenets.
e: ___________________________________________ Date: _____________________
When student is under 18 years of age, the following must be completed:
As the parent or other legal representative, I certify that the student named above is a minor
e administration of the vaccine conflicts with my moral or religious tenets.
Signature: ___________________________________________ Date: _____________________
