No students entering school, including those entering kindergarten or first grade, those from out-of-state, and those from nonpublic schools, will be permitted to enroll without proof of immunization, provided that no student shall be denied admission to school if (1) the student has not been immunized due to medical reasons if the student has a written statement from the student’s doctor excluding the student from the immunization, or (2) in the absence of an epidemic or immediate threat of an epidemic, the student’s parent or guardian files with school authorities a signed, written statement that the immunization and other preventative measures conflict with the parent’s or guardian’s religious tenets and practices, affirmed under the penalties of perjury. Immunization requirements are as noted below:

Medical
Physicians (MD or DO) or Public Health Nurses are authorized to indicate specific vaccines medically exempted (because of risk of harm) on the certificate. Other vaccines remain required. The medical reason for the exemption does not need to be provided.

Religious
This exemption requires a signed statement by the parent/guardian that vaccination conflicts with their religious tenets or practices. If the child needs documentation of a health examination for the school, it must be noted by the healthcare provider on the immunization certificate. In that case, the provider should check the box in section (1a) that the parent has sought a religious exemption to explain why immunization information is absent or incomplete.

Tennessee follows published CDC guidelines. For vaccines with critical minimum age requirements (e.g., MMR, varicella) or minimum dose intervals, doses are considered valid if given up to 4 days before the minimum age or dose interval. Doses administered more than 4 days early are considered invalid and should be repeated as recommended.

Injectable or nasally administered live vaccines not administered on the same day should be administered at least 4 weeks apart. The 4-day "grace period" should not be applied to the 28-day interval between injectable or nasally administered live vaccines not administered at the same visit.  If injectable or nasally administered live vaccines are separated by less than 4 weeks, the second vaccine administered should not be counted as a valid dose and should be repeated.  The repeat dose should be administered at least 4 weeks after the last invalid dose.

A positive serology (year of test documented) is acceptable as an alternative to immunization for measles, mumps, rubella, hepatitis A, hepatitis B or varicella.  For varicella, documentation of provider diagnosed varicella or provider-verified credible history of disease given by a parent or guardian also is acceptable. By documenting a history of disease, the provider is asserting that he or she is convinced that the child has had chickenpox.