Complete information (name, DOB etc.). 2. Indicate which vaccine(s) the medical exemption is referring to. 3.Medical exemptions may, but are not required to, be submitted to the New York State. Department of Health, (NYSDOH) Bureau of Immunization for review. Ndicate which vaccine(s) the medical exemption is referring to. 3. This statement must specify those immunizations which may be detrimental and the length of time they may be detrimental. This form is used for requesting a medical exemption from immunizations for students in New York City. You may then resubmit your request with the necessary changes. New Mexico Immunization Exemption Law (24-5-3):.