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LAC DPH Health Update: School and Childcare Immunizations and Filing Medical Exemptions

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Key Messages

  • Childhood immunization rates have fallen substantially in California during the COVID-19 pandemic, leaving many children at risk of vaccine-preventable diseases, such as measles, mumps, pertussis, chickenpox, and associated complications.
  • As schools and childcare facilities re-open, clinicians are asked to contact families of children who have fallen behind on their immunization schedule to provide needed immunizations.
  • All immunization-related medical exemptions for children enrolled at California K-12 schools and childcare agencies must now be filed electronically via the California Department of Public Health (CDPH) California Immunization Registry at CDPH CAIR ME. See New Process for Filing Medical Exemptions below.

School and Child Care Immunizations

The COVID-19 pandemic has resulted in a significant decline in outpatient pediatric visits. As a result, many children are missing one or more doses of their routine immunizations.  As children return to school and childcare, it is important to increase immunity in the pediatric community to prevent resurgences of vaccine preventable disease.  

Actions Requested of Providers

Ensure that pediatric patients are up to date with routine childhood immunizations by:

  • Reviewing patient records and identifying children who are behind on their CDC 2021 Recommended Child and Adolescent Immunization Schedule and
  • Contacting the families of children missing childhood immunizations to provide the required immunizations before (or as soon as possible after) the child returns to school/childcare

The American Academy of Pediatrics and CDC have useful resources on providing pediatric preventive care, including immunizations, during the pandemic.

New Process for Filing Medical Exemptions 

As of January 1, 2021, all California health care providers (MD and DO) are required to submit new immunization-related medical exemptions (ME) on behalf of children enrolled at California’s K-12 schools and childcare agencies electronically via the CDPH CAIR Medical Exemptions from Immunizations for School and Child Care webportal: CDPH CAIR ME.

This new medical exemption process is guided by the Senate Bills SB 276 and SB 714 (Pan, 2019). These two pieces of legislation were passed in response to the rise in medical exemptions since California eliminated personal belief exemptions. CDPH will review all medical exemptions from schools where fewer than 95% of students have been vaccinated, from physicians who submit five or more exemptions in one calendar year, and for children who attend schools that have not submitted their required vaccination rate reports.

Below are resources related to the new process for filing immunization medical exemptions. Visit the DPH Vaccine Preventable Disease and Control Program (VPDC) school toolkit webpage for the most current version of these resources.

How to File an Immunization Medical Exemption (ME) for a California TK-12 Student or Licensed daycare attendee

  • Step 1:   The parent or legal guardian requests a ME by registering on CDPH CAIR ME
    This is the mandatory first step for all immunization exemptions, even if it is the physician who advises on the need for a medical exemption. The parent will get an ME request number.

    Tips:  Pop-ups must be enabled on the computer.  The parent/guardian must have an email address.
  • Step 2:  The parent gives the ME request number to the physician.
  • Step 3: The physician completes a one-time registration on CDPH CAIR ME
    The registration process is automated and includes a license verification check. 

    Tip: The system only accepts numeric values in the Medical License Number Field.
  • Step 4:  For each exemption request, the physician logs in to CDPH CAIR ME and enters either the ME request number or the child’s name to locate the exemption request.
  • Step 5:  The physician clicks on the request and completes all required fields. Supporting documentation can be uploaded. The physician then issues the exemption.
    Note: Because the system doesn’t currently provide a digital copy of the request, providers should make at least one copy (2 pages) to provide to the parent/guardian. It may be useful for the parent/guardian to make additional copies for their records.  
  • Step 6:  The parent/guardian provides a copy of the exemption to their child’s school/childcare facility. 

Additional Resources from and EZIZ

Medical Exemptions


Visit the LAC DPH COVID-19 Hub and Vaccination Hub