Request for Exemption from Immunizations Fillable
EXEMPTION FROM IMMUNIZATIONS DECLARATION Student Health Services • P.O. Box 43692 Lafayette, LA 70504-3692 Phone: (337) 482-1293 Fax: (337) 482-1872
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studenthealth.louisiana.edu
studenthealth.louisiana.eduLesotho Liberia Malawi Moldova Mozambique Myanmar Namibia Nigeria Pakistan Papua New Guinea Peru Philippines Russian Federation Sierra Leone Somalia South Africa Swaziland ... PPD (Mantoux) Skin test read and documented in millimeters of induration or IGRA blood test results. Both must be within the last 12 months.
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