COVID Vaccine Exemptions – Non-Employed Providers

UMMS expects all non-employed providers at a UMMS hospital to be vaccinated against COVID-19. In accordance with Federal and State law, UMMS provides exceptions for providers who:

• Have a medical reason or contraindication
• Have a religious objection based on their own sincerely held religious beliefs

Please note that submission is not a guarantee of approval.

Medical Reasons

If a non-employed provider has a medical reason, such as an allergy to the vaccine or vaccine component in the Pfizer, Moderna or J&J vaccine that would prevent them from getting one or more of the COVID-19 vaccines, the provider must complete both steps below. Visit the CDC's website to review the ingredients of all three vaccines.

1. Have their medical provider attest to the medical reason the non-employed provider cannot receive the COVID-19 vaccine(s). The medical provider will need to complete the COVID-19 Vaccination Medical Exemption form (PDF version | Word document).
2. Go to the Self-Reporting and Exemptions form (via the yellow "Submit Your Exemption Request" button below). Fill out the online form and upload the medical documentation from the treating medical provider.

Religious Reasons

To seek an exemption on religious grounds, a non-employed provider must attest that they have a sincerely held religious belief that would prevent them from receiving a COVID-19 vaccine. The non-employed provider must complete both steps below.

1. Provide supporting documentation of the non-employed provider's sincerely held religious belief using one of the following options.
   • A sworn affidavit from the non-employed provider using the Affidavit in Support of Religious Objection to COVID-19 Vaccine form (PDF version | Word document), OR;
   • A letter from a member of the clergy attesting to the non-employed provider's sincerely held religious beliefs. Letters from clergy must be printed on letterhead.
2. Go to the Self-Reporting and Exemptions form (via the yellow "Submit Your Exemption Request" button below). Fill out the online form and upload the completed Affidavit in Support of Religious Objection to COVID-19 Vaccine form.

Submit Your Exemption Request.

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