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COVID-19 Vaccine Medical Exemption Requirements


Individuals who believe they are eligible for a medical exemption must undergo a clinical assessment by an Ontario physician (designated as “MD”) or registered nurse in the extended class (designated as “Registered Nurse (Extended Class)”, “RN(EC)”, “Nurse Practitioner” or “NP”) to determine if they are at risk to receiving any COVID-19 vaccine.

If you have received a medical exemption from receiving the COVID-19 vaccine, please note the following process for submitting the required documentation.

Once your physician or nurse practitioner has completed the required documentation (either the Haldimand-Norfolk Health Unit Statement of Medical Exemption form or a letter including the same information) it may be faxed to the Haldimand-Norfolk Health Unit at 519-426-9974.


Once received, your medical exemption will be added to your record and a staff member will notify you by phone that your exemption has been verified and entered.


Beginning December 15th, you will be eligible to download an enhanced vaccine certificate (with a QR code) from the Ontario Portal.

Please note the following conditions that are eligible for a medical exemption:


Pre-existing conditions

  • Severe allergic reaction or anaphylaxis to a component of a COVID-19 vaccine
  • Myocarditis prior to initiating a mRNA COVID-19 vaccine series (individuals aged 12-17 years old)
  • Contraindications to Initiating an AstraZeneca/COVISHIELD COVID-19 Vaccine Series
  • History of capillary leak syndrome (CLS)
  • History of cerebral venous sinus thrombosis (CVST) with thrombocytopenia
  • History of heparin-induced thrombocytopenia (HIT)
  • History of major venous and/or arterial thrombosis with thrombocytopenia following any vaccine
  • Adverse Events Following COVID-19 Immunization
  • Severe allergic reaction or anaphylaxis following a COVID-19 vaccine
  • Thrombosis with thrombocytopenia syndrome (TTS)/Vaccine-Induced Immune
  • Thrombotic Thrombocytopenia (VITT) following the Astra Zeneca/COVISHIELD COVID-19 vaccine
  • Myocarditis or Pericarditis following an mRNA COVID-19 vaccine
  • Serious adverse event following immunization (e.g. results in hospitalization, persistent or significant disability/incapacity)


  • Actively receiving monoclonal antibody therapy OR convalescent plasma therapy for the treatment or prevention of COVID-19