New statewide immunization regulations took effect on July 1, 2019 and Jan 1, 2020 which affect all new and continuing enrollment (see FAQ 11 and 12 below).

To be compliant with the state Health and Safety Code, Sections 120325-120375, public and private elementary and secondary schools in California are required to check immunization records for all new student admissions at TK/Kindergarten through 12th grade, along with all students advancing to 7th grade before entry. 


Below are resources for public/private schools, pre-kindergarten facilities, parents, and providers to assist with enrollment. If you are an academic institution or clinical organization that would like onsite training about these new laws, please go to the training request page or scroll below.

School districts and other educational institutions have the authority to require stricter guidelines. For parents/guardians, please refer to your child's school for additional immunization requirements.


The primary source for clarifications and questions regarding school immunization law is  We encourage you to visit the site for complete details of the state statutes for California school immunizations.




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Medical Exemption Changes 2019-2021


job Aids

ACIP 2021 Pediatric Immunization Schedule

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Summary of 2020 IAC Pediatric Immunization Schedule

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CDPH Catch-up Schedule for School 

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Combination Vaccines (CDPH)

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2019 CA School Immunization Record (blue book) (CDPH)

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San Diego County Public Health Centers

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(For the new 2021 rules regarding electronic medical exemptions, please visit this dedicated page or access the medical exemption page at

Below is guidance for medical exemptions effective July 1, 2019 based on state law and regulations. All criteria must be met in order for schools to accept written documentation prior to Dec 31, 2020.


Based on recent law, the Health and Safety Code Section 120370 states: 

(2) Commencing January 1, 2020, a child who has a medical exemption issued before January 1, 2020, shall be allowed continued enrollment to any public or private elementary or secondary school, child care center, day nursery, nursery school, family day care home, or developmental center within the state until the child enrolls in the next grade span.

For purposes of this subdivision, “grade span” means each of the following:

(A) Birth to preschool, inclusive.
(B) Kindergarten and grades 1 to 6, inclusive, including transitional kindergarten.
(C) Grades 7 to 12, inclusive.

Students transferring to a new school after July 1, 2019 must meet the latest immunization requirements, which include meeting new medical exemption criteria.


The primary source for clarifications and questions regarding school immunization law is  We encourage you to visit the site for complete details of the state statutes for California school immunizations.



​​Starting July 1, 2019, a parent or guardian must submit a signed, written statement from a physician (MD or DO) licensed in California which states:

  • The specific nature of the physical condition or medical circumstance of the child for which a licensed physician does not recommend immunization.

  • Each specific required vaccine that is being exempted.

  • Whether the medical exemption is permanent or temporary.

  • If the exemption is temporary, an expiration date no more than 12 calendar months from the date of signing


1) Is the child's full name and birth date listed?

2) Is the date on the letter Jan 1, 2020 or later for children enrolling for the first time as a new student or transfer, or if the child will begin pre-k, kindergarten, or seventh grade?

3) Upon submission, did a current CA-licensed MD or DO sign the medical exemption? No other professions, states, or countries qualify. A provider can be verified through the California State Department of Consumer Affairs. 

4) Did the MD or DO identify a specific physical condition or medical circumstance stating the reason why the provider does not recommend immunization?


5) Did the MD or DO list the exempted vaccines separately?

6) Did the MD or DO state whether to exempt the vaccines either permanently or temporarily? And if it is temporary, did the MD or DO indicate that the expiration date(s) is no longer than one year from the date of the signed letter? 




FAQs #1-9 represent local concerns by school staff and parents. Responses were reviewed by the California Department of Public Health in April 2020.

FAQs #10+ are new FAQs posted on the state page. 


The primary source for clarifications and questions regarding school immunization law is  We encourage you to visit the site for complete details of the state statutes for California school immunizations.


1A. Is there a way to relax the immunization requirements for new/transfer students whose schools have opted for a distance learning program for the rest of the 2019-20 school year? 

1B. Also, will the pandemic affect requirements for the 2020-21 school year?

Even with current school closures, immunization requirements for admission to school or child care in California for the 2019-20 and  2020-21 school year remain in place. Any updates will be posted on, and SDIP staff will forward important notifications. 


2. Can a foster student who is not up to date with immunization requirements be excluded from pre-k or school?

There is no exception in immunization law for children in foster care who are not compliant with immunization requirements. 

School staff have additional resources to ensure that a foster student is up-to-date with required immunizations. School staff can work with the foster child’s social worker and the foster child’s last school. 

3. Can a pre-k or school accept a medical exemption from a deceased or a retired provider?

Physicians who have died or who have retired are no longer licensed to practice medicine. A physician must be licensed at the time a medical exemption is filed at a school during entry, transfer, or enrollment in the next grade span. Medical exemptions issued by physicians who are no longer licensed should not be accepted by the school.


4. What happens if an MD or DO that signed a medical exemption dies or retires in the middle of the year?

For children continuing in the same school or facility during the same grade span, an exemption remains valid until the student becomes a new admission or enrolls in the next grade span.


5. If two parents have different opinions on a medical exemption, can one parent revoke the filed medical exemption?

For example, one parent submits an ME and another parent claims there was never a legitimate medical basis for the exemption.

Similar to current practice, parties can notify public health if they have concerns about a medical exemption. Public health will be able to review exemptions on a case by case basis, based on criteria specified in the new law.


6. Is the state (CDPH) on track in implementing electronic submissions of medical exemptions by Jan 1, 2021? If so, how will it be done?

Yes, the California Department of Public Health (CDPH) is working to have electronic submissions of medical exemptions in CAIR by January 1, 2021.


As details emerge, please monitor SDIP staff will also provide pertinent information when available.

7. How will pre-k facilities and schools know whether an electronic medical exemption is submitted and then accepted/denied?

The process by which schools receive MEs is anticipated to be similar to the current process. Schools/facilities will be notified when exemptions are revoked.

As details emerge, please monitor SDIP staff will also provide pertinent information when available.

8. Will the exclusion of the hepatitis B requirement for 7th grade entry be reconciled to meet ACIP requirements?

This limitation is in the state statute and, therefore, can only be changed through legislation. 
Schools may encourage students to obtain all the recommended vaccines for their age, including hepatitis B for seventh graders.  

9. Where do our families get vaccines if their doctor has limited hours or limiting patient visits during COVID-19 restrictions? 

Under/uninsured families can utilize local Vaccines for Children providers. These families can also access the County of San Diego’s public health centers. Both can be reached by calling 2-1-1 San Diego.


Insured families can see if other providers in their network and/or neighborhood pharmacies can provide covered vaccines. Families can also explore reimbursements with their health insurance for out of pocket expenses. 

10. To meet the chickenpox immunization requirement for TK/K-12 admission or for advancement into 7th grade, may a school accept an immunization record that indicates a "history of chickenpox disease"? 

No, this is not sufficient documentation to meet school requirements. Medical exemption documentation may be used for a child who had chickenpox disease that was documented by a physician. For more information on medical exemption documentation requirements, see section above.

11. Do children with a prior medical exemption who are being admitted into the next grade span (e.g., starting transitional kindergarten/kindergarten or 7th grade) in 2020 need to obtain a new medical exemption document in 2020 or may they re-use a document dated before 2020?  

They will need to submit a new medical exemption document to their school in 2020. The parent or guardian will need to submit a new medical exemption from a physician licensed in California to the school or child care facility. 

NOTE: As of 9/16/20, CDPH announced that the following state guideline/FAQ was removed from statewide school procedures for requiring a medical exemption in the following scenario. Until this date, these were state requirements for new students entering a different childcare facility or school.