Exemption Guidance
Exemption Guidance

Vaccination programs are an important part of military public health and deployment readiness. However, sometimes a particular vaccination is not indicated for an individual to receive. There are 2 main types of exemptions from immunizations: medical and administrative. A medical exemption is a function that can only be validated by a health care professional. An administrative exemption is a non-medical function that is usually controlled by the individual's unit commander.

Where can I get more information?

For exact guidance please see Army Regulation 40–562, BUMEDINST 6230.15B, AFI 48–110_IP, CG COMDTINST M6230.4G (page 6)

Healthcare professionals at the Immunization Healthcare Branch are available for consultation regarding exemption recommendations. Both healthcare professionals and service members are encouraged to contact the IHB Clinical Services for vaccine medical exemption guidance.

What are the different types of Military Exemptions?
Medical

An underlying health condition

  • Temporary Exemptions may be granted for up to 365 days based on:
    • Temporary contraindications to vaccines (e.g., pregnancy, acute illness, treatments causing immune suppression)
    • Pending completion of an ongoing medical evaluation
    • Medical Supply exemption: lack of vaccine supply
  • Permanent Exemptions may be granted indefinitely based on one of the following**:
    • HIV infection, prolonged or permanent immune suppression
    • Determination by a medical provider that further vaccination will seriously endanger patient's health status*
    • Medical, Reactive exemption: Previously severe reaction after specific vaccine (e.g., anaphylaxis)
    • Medical, Immune exemption: Evidence of existing immunity (e.g., by serologic antibody test, documentation of previous infection or natural infection presumed)

*Air Force, permanent medical exemptions require a medical evaluation board and/or flying waiver in accordance with AFI 48-123.
**Indefinite or permanent exemptions may be reversed if an alternate form of prophylaxis is available, if a medical condition or vaccination guideline changes, or if a provider experienced in vaccine adverse-event management determines that the risk of acquiring the disease is greater than the risk of vaccine exposure.

Table: Medical exemption codes
Code Meaning Explanation of example Duration
MA Medical assumed Prior immunization reasonably inferred from individual's past experiences (for example, basic military training), but documentation missing. Code used to avoid superfluous immunization. Code can be reversed upon further review. Indefinite
MD Medical, declined Declination of optional vaccines (not applicable to many military vaccinations), religious waivers. Indefinite
MI Medical, immune Evidence of immunity (for example, by serologic antibody test, "take" after smallpox vaccination); documented previous infection (for example, chickenpox infection); natural infection presumed (for example, measles, if born before 1957). Indefinite
MP Medical, permanent HIV infection, prolonged or permanent immune suppression, other contraindication determined by physician. Can be reversed if the condition changes. For tuberculosis, positive tuberculosis test. Indefinite
MR Medical, reactive Permanent restriction from receiving additional doses of a specific vaccine. Use only after severe reaction after vaccination (for example, anaphylaxis). Report such reactions to VAERS. Code can be reversed if an alternate form of prophylaxis is available. Do not code mild, transient reactions as MR. Code events referred for medical consultation as MT. Indefinite
MS Medical, supply Exempt due to lack of vaccine supply. Up to 90 days
MT Medical, temporary Pregnancy, hospitalization, events referred for medical consultation, temporary immune suppression, convalescent leave, pending medical evaluation board, any temporary contraindication to immunization. Up to 365 days
Army Regulation 40–562, BUMEDINST 6230.15B, AFI 48–110_IP, CG COMDTINST M6230.4G (page 28)
Administrative
  1. Separation or retirement within 180 days provided the following conditions are met*:
    • Service member is not assigned, deployed or scheduled to perform duties in an area where specific immunization is indicated
    • The commander has not directed immunization because of overriding mission requirements
  2. Separation of civilian employees and contractor personnel within 30 days
  3. Religious
    • Granted according to Service-specific policies
    • Command decision made with medical and chaplain consultation
Table: Administrative exemption codes
Code Meaning Explanation of example Duration
AD Administrative, deceased Individual is deceased. Indefinite
AL Administrative, emergency leave Individual is on emergency leave. Up to 30 days
AM Administrative, missing Missing in action, prisoner of war. Indefinite
AP Administrative, PCS Permanent change of station. Up to 90 days
AR Administrative, refusal Personnel involved in actions under the Uniformed Code of Military Justice, religious waiver. Until resolution
AS Administrative, separation Pending discharge, separation (typically within 60 days), retirement (typically within 180 days).  
AT Administrative, temporary Absent without leave, legal action pending (other than code AR). Up to 90 days
NR Not required Individuals who received immunization while eligible, subsequently changed occupational category and now serve as civilian employees or contract workers not otherwise required to be immunized. Indefinite
Army Regulation 40–562, BUMEDINST 6230.15B, AFI 48–110_IP, CG COMDTINST M6230.4G (page 28)
How is an exemption documented?

Electronic and paper health records should annotate temporary and/or permanent medical exemptions.

Can I get a second opinion on a vaccination exemption recommendation?

Individuals who disagree with a provider's exemption recommendation may be referred for a second opinion to providers experienced in vaccine adverse-event management, such as the IHB Clinical Services.

Where can I find information about exemptions for beneficiaries?

Beneficiaries not in the military should contact their local state health department for state laws.

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