Vaccine Refusal and Screening Policy Toolkit

Medical practices face unique sets of challenges when handling patients who opt against recommended vaccinations, as well as need to properly educate staff to help screen for at-risk patients who may have or have been exposed to contagious diseases.

Having the right set of policies in place to communicate to patients can help provide a better patient experience when it comes to discussing vaccinations, making it clear where the providers stand on noncompliance with recommendations.

This toolkit includes the relevant sample policies and forms to address these specific issues:

Sample Vaccine Policy and Statement for Patient Retention
This sample vaccine policy and statement helps address patients who are noncompliant with recommended vaccinations while retaining them with the practice.

Sample Vaccine Policy and Statement for Patient Termination
Medical practices that might consider terminating patients for being noncompliant with recommended vaccinations can use this sample policy and statement to convey the need for screenings and the consequences for vaccine refusal.

Screening Patients for Contagious Disease or Possible Exposure
This member-benefit sample script can help practice staff screen at-risk patients who may have or have been exposed to a contagious disease.

Form: Refusal to Consent to Vaccination (Pediatrics)
This member-benefit sample form is a tool for practices to document refusal to consent to vaccination in a pediatric patient's medical record.

Form: Refusal to Consent to Vaccination (Adults)
This member-benefit sample form is a tool for practices to document refusal to consent to vaccination in an adult patient's medical record.