Q. Patients are asking me to write notes or complete forms for COVID-related exemptions or clearances. How do I respond?
Patients may ask you to write notes or complete forms exempting them from wearing a mask, returning to work in-person, or getting vaccinated. The Ontario government’s decision to institute a vaccine passport will likely increase such requests for exemptions.
If you are asked by your patient to provide information to support a medical exemption from receiving a COVID-19 vaccine, your patient must have a legitimate medical condition that would warrant an exemption.
The National Advisory Committee on Immunization (NACI), the Ministry of Health, and some public health units have provided guidance regarding contraindications for COVID-19 vaccines. The Ministry of Health has also provided guidance for specific allergy populations in the COVID-19 Vaccination: Allergy Form document.
Generally speaking, there are very few acceptable medical exemptions to the COVID-19 vaccination (e.g., an allergist/immunologist-confirmed severe allergy or anaphylactic reaction to a previous dose of a COVID-19 vaccine or to any of its components that cannot be mitigated; a diagnosed episode of myocarditis/pericarditis after receipt of an mRNA vaccine). Given the rarity of these exceptions, and in light of the fact that vaccines have been proven to be both safe and effective, any notes written for patients who qualify for a medical exemption need to clearly specify:
- the reason they cannot be vaccinated against COVID-19 (i.e., document clear medical information that supports the exemption); and
- the effective time period for the medical reason (i.e., permanent or time-limited).
While physicians are generally required to complete third party medical reports for patients when requested, the circumstances of the pandemic support physicians declining to write notes or complete forms when the patient making the request does not have a medical condition that warrants an exemption. If you find yourself in this situation, clearly and sensitively explain to your patient that you cannot provide them with a note or form, along with the reasons why.