Flu exemption forms for medical staff

Thank you for being a member of our medical staff. Per our bylaws, all credentialed providers need to provide proof of annual influenza vaccination on or before October 31, 2025. A religious/medical exemption must be submitted for approval by 5 p.m. October 20, 2025.

• Medical exemption form
• Religious exemption form

Please send proof of vaccination or completed request for exemption form to Employee Health via fax at 816.407.2036 or email at employeehealthdepartment@libertyhospital.org.

Vaccines also are available 7:30 a.m.-3 p.m. Monday-Friday Sept. 29-Oct. 31 in Employee Health located on the second floor of the main hospital.

On Tuesdays, you also can get your shot in The Cafe during these hours:

• Sept. 30 - 11 a.m.-1 p.m.
• Oct. 7 - 7-9 a.m.
• Oct. 14 - 11 a.m.-1 p.m.
• Oct. 21 - 7-11 a.m.
• Oct. 28 - 11 a.m.-1 p.m.

Failure to receive proof of vaccination by the deadline established by Medical Executive Committee (Monday, November 10, 2025) may lead to temporary relinquishment of clinical privileges until you comply with this requirement.