Wisconsin Health Provider COVID Vaccine Declination Form Says Employees ‘Endangering Others’


A COVID vaccine declination form from a Wisconsin health provider, Hudson Physicians, says an employee must understand that by declining the vaccine they are “endangering” others. The form also states that by signing the form, the employee is acknowledging that “COVID-19 is a serious virus.”

The person who shared the form on Facebook, Jessica Klatt, has been a voice for medical freedom in Wisconsin since the beginning of the COVID pandemic.

Klatt told The Tennessee Star that she obtained the exemption form from an employee with Hudson Physicians.

Klatt said, “I received the COVID vaccine exemption request from an employee of Hudson Physicians. The employee had stated she had no intention of signing this form that coerced her into saying she was a danger to patients, family and community, nor was she getting the vaccination.”

Klatt said the form appears to be “shaming” or “bullying” people into taking the vaccine even if it goes against their personal health beliefs.

The exemption request states that by signing the form, the signee acknowledges that these statements are “true and accurate.” One of the statements reads: “By declining the vaccination, I may endanger my health and the health of those with who I have contact, including patients in this healthcare setting, my coworkers, my family and my community.”

Another of the statements that employees are signing to agree to includes that the person signing knows and is choosing to decline the vaccine despite that the Centers for Disease Control (CDC) guidance strongly suggests taking the COVID vaccine. It also tells employees that they must understand that if they “become infected with COVID-19” they can “spread severe illness to others.”

Wisconsin has had 0.2 deaths per 100,000 as per the Becker Hospital Review, making Wisconsin’s COVID deaths among the lowest in the nation. According to the Wisconsin COVID dashboard, just over 50% of Wisconsin residents have been fully vaccinated against COVID. The COVID dashboard also shows that just over 25% of Wisconsin’s current active COVID cases are made up of fully vaccinated individuals.

Klatt told The Star that the employee who shared the form was ultimately fired in an email from the CEO of Hudson Physicians.

She said, “The employee had told the CEO that she wanted to have everything that was said to her verbally to be in written form.”

According to Klatt, the employee also said that the CEO of Hudson Physicians could set up a meeting with her and her attorney.

After requesting that, “the email response from the CEO was that she was terminated as of September 3rd. She was fired via email,” Klatt said.

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Hayley Tschetter is a reporter with The Minnesota Sun | Star News Network. Follow Hayley on Twitter or like her Facebook page. Send news tips to [email protected].







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