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Hi everyone.


New here, first post.

Just wanted to share my little experience with our doc today. After having to politely let him know I wasn't going to discuss our decision to not vax, he handed me a paper to sign which stated that I had recieved that vax information, knew the doc wanted to vax, and that "I knew I was putting my child and other children in danger by not vaxing my child". I refused to sign it, as I completed disagreed that we were putting anyone in danger.

It hit me right there, are they trying to get non vaxing parents to say they know they're putting their kids in danger, in writing, so they can go after them later???

What do you think???
 

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That's standard operation procedure for peds, per AAP guidelines. Doncha love it? Good for you for not signing it
 

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BTW... exactly what vaccine information had you received, or was that just mule droppings or male bovine excrement
 

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Quote:

Originally Posted by Momtezuma Tuatara View Post
BTW... exactly what vaccine information had you received, or was that just mule droppings or male bovine excrement

lol!!!

good for you for not signing it. and welcome to MDC and the vax forum!
 

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That AAP formis also used as a scare tactic in order to get parents to change their minds.

From the AAP:

Despite doctors' and nurses' best efforts to explain its importance, some families will refuse vaccination for their children. The use of this or a similar form, demonstrating the importance you place on appropriate immunizations and focusing the parent's attention on the unnecessary risk for which they are accepting responsibility, may in some instances induce a wavering parent to accept your recommendations.

http://www.cispimmunize.org/pro/pdf/...%204-11-06.pdf

.
 

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On the AAP website where the form is available, it does state that the form the following,

"This form may be duplicated or changed to suit your needs and your patients' needs."

see original form below:

http://www.cispimmunize.org/pro/doc/...oVaccinate.doc

I have modified it the following way,

Consent Declined for Vaccines

Child's Name: _________________________Child's ID #_______________________

Parent's/Guardian's Name(s):__________________________________________ ___

My child's health care provider, _________________has advised me that my child (named above)
should receive the following vaccines:
Recommended Declined
Hepatitis B vaccine .
Diphtheria, Tetanus, acellular Pertussis (DTaP) vaccine .
Diphtheria Tetanus (DT or dT) vaccine .
Haemophilus influenzae type b (Hib) vaccine .
Pneumococcal conjugate vaccine .
Polio vaccine (IPV) .
Measles, mumps, rubella (MMR) vaccine .
Varicella (chickenpox) vaccine .
Influenza (flu) vaccine .
Meningococcal vaccine .
Hepatitis A vaccine .
Other __________________________________________

I have read the Centers for Disease Control and Prevention's (CDC) Vaccine Information Sheet(s) explaining the vaccine(s) and the disease(s) they prevent. I have had the opportunity to discuss these with my child's health care provider, who has answered all of my questions regarding the recommended vaccine(s). I understand the following:
The intended purpose of recommending the above listed vaccine(s)
The risks and benefits of the recommended vaccine(s)
If my child does not receive the vaccine(s), the consequences may include:
-Contracting the illness the vaccine should prevent. (the outcomes of these illnesses may include one or more of the following: pneumonia, illness requiring hospitalization, death, brain damage, meningitis, seizures and deafness. Other severe and permanent effects from these vaccine-preventable diseases are possible as well)
-transmitting the disease to others
-the need for my child to stay out of daycare of school during disease outbreaks

If my child does receive the vaccine(s), the consequences may include:
-Contracting the illness the vaccine should have prevented
-Transmitting the disease to others
-Suffering from any of the adverse events listed in the package insert(s) and possibly adverse events not yet listed and/or associated with the vaccine. (the outcomes of these adverse events may include one or more of the following: illness requiring hospitalization, death, brain damage, meningitis, seizures and deafness. Other severe and permanent effects from these vaccines are possible as well)
-Chronic illness and/or death

My health care provider, the American Academy of Pediatrics, the American Academy of Family
Physicians, and the Centers for Disease Control and Prevention have all strongly recommended that the
vaccine(s) be given based on the information they have been given by the drug companies producing the vaccines.
I am not giving consent for the vaccine(s) recommended for my child, as indicated above, by checking the appropriate box under the column titled "Declined."

I know I may re-address this issue with my health care provider at any time.

I acknowledge that I have read this document in its entirety and fully understand it.

Parent/Guardian Signature ________________________________ Date ___________________

Witness ______________________________________________ Date ___________________

Modified from original form:

http://www.cispimmunize.org/pro/doc/...oVaccinate.doc
 

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Quote:

Originally Posted by Momtezuma Tuatara View Post
BTW... exactly what vaccine information had you received, or was that just mule droppings or male bovine excrement

: LMAO!!
 

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Quote:

Originally Posted by suschi View Post
On the AAP website where the form is available, it does state that the form the following,

"This form may be duplicated or changed to suit your needs and your patients' needs."

see original form below:

http://www.cispimmunize.org/pro/doc/...oVaccinate.doc

I have modified it the following way,

Consent Declined for Vaccines

Child's Name: _________________________Child's ID #_______________________

Parent's/Guardian's Name(s):__________________________________________ ___

My child's health care provider, _________________has advised me that my child (named above)
should receive the following vaccines:
Recommended Declined
Hepatitis B vaccine .
Diphtheria, Tetanus, acellular Pertussis (DTaP) vaccine .
Diphtheria Tetanus (DT or dT) vaccine .
Haemophilus influenzae type b (Hib) vaccine .
Pneumococcal conjugate vaccine .
Polio vaccine (IPV) .
Measles, mumps, rubella (MMR) vaccine .
Varicella (chickenpox) vaccine .
Influenza (flu) vaccine .
Meningococcal vaccine .
Hepatitis A vaccine .
Other __________________________________________

I have read the Centers for Disease Control and Prevention's (CDC) Vaccine Information Sheet(s) explaining the vaccine(s) and the disease(s) they prevent. I have had the opportunity to discuss these with my child's health care provider, who has answered all of my questions regarding the recommended vaccine(s). I understand the following:
The intended purpose of recommending the above listed vaccine(s)
The risks and benefits of the recommended vaccine(s)
If my child does not receive the vaccine(s), the consequences may include:
-Contracting the illness the vaccine should prevent. (the outcomes of these illnesses may include one or more of the following: pneumonia, illness requiring hospitalization, death, brain damage, meningitis, seizures and deafness. Other severe and permanent effects from these vaccine-preventable diseases are possible as well)
-transmitting the disease to others
-the need for my child to stay out of daycare of school during disease outbreaks

If my child does receive the vaccine(s), the consequences may include:
-Contracting the illness the vaccine should have prevented
-Transmitting the disease to others
-Suffering from any of the adverse events listed in the package insert(s) and possibly adverse events not yet listed and/or associated with the vaccine. (the outcomes of these adverse events may include one or more of the following: illness requiring hospitalization, death, brain damage, meningitis, seizures and deafness. Other severe and permanent effects from these vaccines are possible as well)
-Chronic illness and/or death

My health care provider, the American Academy of Pediatrics, the American Academy of Family
Physicians, and the Centers for Disease Control and Prevention have all strongly recommended that the
vaccine(s) be given based on the information they have been given by the drug companies producing the vaccines.
I am not giving consent for the vaccine(s) recommended for my child, as indicated above, by checking the appropriate box under the column titled "Declined."

I know I may re-address this issue with my health care provider at any time.

I acknowledge that I have read this document in its entirety and fully understand it.

Parent/Guardian Signature ________________________________ Date ___________________

Witness ______________________________________________ Date ___________________

Modified from original form:

http://www.cispimmunize.org/pro/doc/...oVaccinate.doc
could this get stickied somewhere?
 

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I hate the double standards in the medical world.

WHY DON'T DOCTORS HAVE TO SIGN A PAPER CLAIMING RESPONSIBILITY WHEN THEY VACCINATE? IF THEY ARE "REQUIRING" PARENTS TO SIGN A FORM CLAIMING RESPONSIBILITY FOR NOT VACCINATING, THEY SHOULD HAVE TO SIGN A FORM CLAIMING RESPONSIBILITY *FOR* VACCINATING.

Honestly, if a doctor asked me to sign a form stating I'd claim repsonsibility if my child got sick from not getting vaccinated (which inherently claims responsibility if my child gets another child sick too), I'd ask him/her if they would sign the following three forms if I *DID* get my child vaccinated (to which they would say, "that's ridiculous" and I would say, "Exactly"):

CONSENT TO FOLLOWING VACCINE SCHEDULE

If we, the parents of,(Child's name), consent to your vaccine schedule, you-the doctor,(Physician's name), promise that my child, (child's name) , will remain immune to normal illnesses and to the virus/bacteria that he/she is being vaccinated against and will stay healthy and free of any and all vaccine reactions. If any reactions, illnesses, or disorders happen because of the vaccines, you will take full responsibility, professionally, and financially-and agree to comply with the following two forms.

MOM

DAD

Signature of Physician

***
ACCEPTANCE OF RESPONSIBILITY

I, the undersigned, having assumed decision making power independently, or having been appointed to such, by a government bureaucracy or corporation controlled by such, do require the following individual(s):

to receive the following vaccination(s):

contrary to laws of this state that provide medical, religious, and/or philosophical exemptions.

I further agree that the stated individual(s) are in excellent to perfect health prior to the administration of such immunization(s).

Consistent with this demand, is my personal acceptance of full responsibility for any and all damages resulting from such immunizations. As a result, I agree to provide compensation amounting to $1,000,000 to the family(s) of the persons you are requiring to receive the aforementioned vaccinations for each resulting vaccine related injury(s) and/or disease(s) as follows:

Death
http://www.909shot.com/richie.htm
Sudden infant death syndrome
http://www.909shot.com/nicky.htm
Shaken baby syndrome
http://www.nexusmagazine.com/shakenbaby.html
Cerebral bleeding
http://www.sbs5.dircon.co.uk/faq.htm
Cancer
http://www.909shot.com/prsv40.htm
Tumors
http://www.gulfwarvets.com/virus.htm
Asthma
http://vaccines.net/Asthma/allergie.htm
Auto-immune disease(s)
http://lupus.about.com/health/lupus/...y/aa061200.htm
Polio
http://www.909shot.com/polio696.htm
Bowel blockage
http://www.909shot.com/rotaviru.htm
Autism
http://www.wkap.nl/oasis.htm/301652
Brain damage
http://www.freeyurko.bizland.com/vacscene.html
Mental retardation
http://www.chronicillnet.org/online/Fisher.html
Crippling arthritis
http://x-l.net/Lyme/news/skb.lawsuit.12.99.html
Paralysis
http://www.909shot.com/terry.htm
Mercury poisoning
http://www.gulfwarvets.com/kids.htm
Diabetes
http://vaccines.net/
Blindness
http://www.909shot.com/hepbnlr.htm
Loss of IQ
http://www.909shot.com/hepbnlr.htm
Pain
http://www.twoffice.com/integrityfirst
Seizures
http://www.freeyurko.bizland.com/vacscene.html
Chronic fatigue syndrome
http://www.chronicillnet.org/online/Fisher.html

*Note that virtually all of these conditions /diseases are incurable by modern medicine, but easily prevented by abstinence!

Name (print): Position:
Signature: Date:

***
EVERY TIME A VACCINE IS GIVEN

I (Physicians Name) do hereby state I have advised the parent(s) of (Child's Name) that in my professional opinion the child should be given (Vaccine's Name) include manufacturer name, serial # , batch # I have this day(mm/dd/yy) administered this medication after advising the parents that the child is at little or no risk from the treatment.

I hereby do agree to take full responsibility should the child at any time suffer or develop any permanent condition deleterious or injurious to their health as a result of this treatment. I will pay any and all costs relating to the care and treatment of this child for the rest of his/her natural life. I further agree that if my earnings are insufficient to meet these costs I will sell my home, my business, and all material possessions to put the proceeds towards meeting these costs.

Witness: Parent or other

Signature of Physician/Nurse administering

It would NEVER happen. Parents should never even be ASKED to sign such a form (like what the AAP recommends) if the physicians themselves would never sign such a form.
 
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