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Vaccine Form to Give to Doctor | How to Legally Say ‘No’ to Vaccines

Source Doc Available at:  http://www.elliscountyobserver.com/?p=19440

January 28, 2011

 

Vaccine Form to give to Doctor

Want assurances from your pediatrician about vaccines? Here’s a form designed by Ken Anderson you can give them to fill out — although there is no physician anywhere on earth who will sign it. (American, of course, but could easily be converted to the UK) This does not apply to freeborn children as they are not wards of the state! www.thinkfree.ca

Physician’s Warranty of Vaccine Safety

I (Physician’s name, degree)_________________________, _____ am a physician licensed to practice medicine in the State of ________________. My State license number is _______________ , and my DEA number is _______________. My medical specialty is ________________________

I have a thorough understanding of the risks and benefits of all the medications that I prescribe for or administer to my patients. In the case of (Patient’s name) ___________________________ , age _________ , whom I have examined, I find that certain risk factors exist that justify the recommended vaccinations. The following is a list of said risk factors and the vaccinations that will protect against them:
Risk Factor ____________________________________________
Vaccination ___________________________________________
Risk Factor ____________________________________________
Vaccination ___________________________________________
Risk Factor ____________________________________________
Vaccination ___________________________________________
Risk Factor ____________________________________________
Vaccination ___________________________________________
Risk Factor ____________________________________________
Vaccination ___________________________________________
Risk Factor ____________________________________________
Vaccination ___________________________________________

I am aware that vaccines typically contain many of the following fillers:

* aluminum hydroxide
* aluminum phosphate
* ammonium sulfate
* amphotericin B
* animal tissues: pig blood, horse blood, rabbit brain,
* dog kidney, monkey kidney,
* chick embryo, chicken egg, duck egg
* calf (bovine) serum
* betapropiolactone
* fetal bovine serum
* formaldehyde
* formalin
* gelatin
* glycerol
* human diploid cells (originating from human aborted fetal tissue)
* hydrolized gelatin
* mercury thimerosol (thimerosal, Merthiolate(r))
* monosodium glutamate (MSG)
* neomycin
* neomycin sulfate
* phenol red indicator
* phenoxyethanol (antifreeze)
* potassium diphosphate
* potassium monophosphate
* polymyxin B
* polysorbate 20
* polysorbate 80
* porcine (pig) pancreatic hydrolysate of casein
* residual MRC5 proteins
* sorbitol
* tri(n)butylphosphate,
* VERO cells, a continuous line of monkey kidney cells, and
* washed sheep red blood

and, hereby, warrant that these ingredients are safe for injection into the body of my patient. I have researched reports to the contrary, such as reports that mercury thimerosol causes severe neurological and immunological damage, and find that they are not credible.

I am aware that some vaccines have been found to have been contaminated with Simian Virus 40 (SV 40) and that SV 40 is causally linked by some researchers to non-Hodgkin’s lymphoma and mesotheliomas in humans as well as in experimental animals. I hereby warrant that the vaccines I employ in my practice do not contain SV 40 or any other live viruses. (Alternately, I hereby warrant that said SV-40 virus or other viruses pose no substantive risk to my patient.)

I hereby warrant that the vaccines I am recommending for the care of (Patient’s name) _______________ _______________________ do not contain any tissue from aborted human babies (also known as “fetuses”).

In order to protect my patient’s well being, I have taken the following steps to guarantee that the vaccines I will use will contain no damaging contaminants.

STEPS TAKEN: ______________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________

I have personally investigated the reports made to the VAERS (Vaccine Adverse Event Reporting System) and state that it is my professional opinion that the vaccines I am recommending are safe for administration to a child under the age of 5 years.

The bases for my opinion are itemized on Exhibit A, attached hereto, — “Physician’s Bases for Professional Opinion of Vaccine Safety.” (Please itemize each recommended vaccine separately along with the bases for arriving at the conclusion that the vaccine is safe for administration to a child under the age of 5 years.)

The professional journal articles I have relied upon in the issuance of this Physician’s Warranty of Vaccine Safety are itemized on Exhibit B , attached hereto, — “Scientific Articles in Support of Physician’s Warranty of Vaccine Safety.”

The professional journal articles that I have read which contain opinions adverse to my opinion are itemized on Exhibit C , attached hereto, — “Scientific Articles Contrary to Physician’s Opinion of Vaccine Safety”

The reasons for my determining that the articles in Exhibit C were invalid are delineated in Attachment D , attached hereto, — “Physician’s Reasons for Determining the Invalidity of Adverse Scientific Opinions.”

Hepatitis B

I understand that 60 percent of patients who are vaccinated for Hepatitis B will lose detectable antibodies to Hepatitis B within 12 years. I understand that in 1996 only 54 cases of Hepatitis B were reported to the CDC in the 0-1 year age group. I understand that in the VAERS, there were 1,080 total reports of adverse reactions from Hepatitis B vaccine in 1996 in the 0-1 year age group, with 47 deaths reported.

I understand that 50 percent of patients who contract Hepatitis B develop no symptoms after exposure. I understand that 30 percent will develop only flu-like symptoms and will have lifetime immunity. I understand that 20 percent will develop the symptoms of the disease, but that 95 percent will fully recover and have lifetime immunity.

I understand that 5 percent of the patients who are exposed to Hepatitis B will become chronic carriers of the disease. I understand that 75 percent of the chronic carriers will live with an asymptomatic infection and that only 25 percent of the chronic carriers will develop chronic liver disease or liver cancer, 10-30 years after the acute infection. The following scientific studies have been performed to demonstrate the safety of the Hepatitis B vaccine in children under the age of 5 years.
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________

In addition to the recommended vaccinations as protections against the above cited risk factors, I have recommended other non-vaccine measures to protect the health of my patient and have enumerated said non-vaccine measures on Exhibit D , attached hereto, “Non-vaccine Measures to Protect Against Risk Factors” I am issuing this Physician’s Warranty of Vaccine Safety in my professional capacity as the attending physician to (Patient’s name) ________________________________. Regardless of the legal entity under which I normally practice medicine, I am issuing this statement in both my business and individual capacities and hereby waive any statutory, Common Law, Constitutional, UCC, international treaty, and any other legal immunities from liability lawsuits in the instant case. I issue this document of my own free will after consultation with competent legal counsel whose name is _____________________________, an attorney admitted to the Bar in the State
of __________________ .
__________________________________ (Name of Attending Physician)
__________________________________ L.S. (Signature of Attending Physician)
Signed on this _______ day of ______________ A.D. ________
Witness: _______________________________ Date: _____________________
Notary Public: ___________________________Date: ______________________

CIA Assassinations & Depopulation Using Vaccinations:
A Conspiracy Reality Underlies the Swine Flu Black Op

Los Angeles–CIA assassinations and paramilitary operations secreted from congressional overseers and the American people have extended into the realm of swine flu bioterrorism and vaccinations for profitable depopulation according to medical journalist and CIA analyst, Dr. Leonard Horowitz.

The CIA spent years advancing secret squads to blow things up and kill humans according to U.S. intelligence officials interviewed by Greg Miller of the Los Angeles Times. (July 16, 2009) What the Times failed to report was current connections between drug industrialists and CIA officials that best explain the mysterious emergence of the swine flu virus in Mexico, and the international media’s curious response to the planned pandemic, according to Dr. Horowitz–a Harvard-trained investigator and award-winning author of several books on this subject.

Current and former U.S. intelligence officials disclosed a broader effort than media coverage has portrayed, including black-ops about which congressional oversight committees and Americans knew nothing, the Times published.

The “broader dimensions” of this program, Miller wrote, “may account for why some lawmakers, particularly Republicans, have been critical of CIA Director Leon E. Panetta’s decision last month to kill” funding for the operation that trained America’s deadliest assassins.

Some house Democrats are calling for an investigation to help explain why top counter-terrorism officials, with close ties to Bush Administration Vice President, Dick Cheney, “saw a need for the CIA to develop its own elite paramilitary teams, rather than relying on U.S. military special operations troops.”

In particular, officials said, ambitions for the program expanded to include creating teams that were made up not only of CIA personnel, but counterparts from other countries, presumably Pakistan; and to be capable not just of killing high-value targets, but also executing raids and other operations to gather evidence and intelligence that might lead to” CIA-trained Holy War assassin, Osama bin Laden.

In 1986, William Casey, CIA chief under Reagan, approved a Pakistani intelligence proposal to recruit Islamic fundamentalists worldwide to conduct covert operations. When the Pakistanis recruited, and the bin Ladens and Saudis financed, the Afghanistan black-operatives at that time, American officials, including previous CIA director, George H.W. Bush, “funneled more than $2 billion in guns and money” during the 1980s in the “largest covert action program since World War II,” the Washington Post, reported (7/19/92).

The CIA, often referred to as “the Company,” maintained ties to wealthy financiers, including Carlyle Group investors Mohammed bin Laden and George H.W. Bush, co-investors in this mega defense contractor along with James Baker III, who oversaw the Florida vote recount in Bush, Jr’s contested 2000 election. In addition, Donald Rumsfeld, Defense Secretary under Gerald Ford and George W. Bush, whose connections to the global drug-cartel include his launching of the Tamiflu-manufacturing company Gilead Sciences, conducted business dealings with Carlyle Group executive, Frank C. Carlucci.(JudicialWatch.org,11-30-2001)

In November 2005, George W. Bush urged Congress to pass $7.1 billion in emergency funding to prepare for the possible bird flu pandemic, of which one billion was solely dedicated to the purchase and distribution of Tamiflu.

Earlier, in June 1996, Gilead launched its first commercial product, Vistide (cidofovir injection) for the treatment of cytomegalovirus (CMV) in AIDS patients. “If you want to know where the herpes virus pandemic mostly comes from,” Dr. Horowitz wrote, “think of contaminated vaccines spread to produce cancer for profit by the Carlyle-CIA-backed cartel.”

Cytomegalovirus is one of three herpes type viruses, including herpes B, simian cytomegalo from monkeys used in vaccine development, and Epstein Barr, another vaccination infection.

Epstein-Barr virus (EBV), now known to cause AIDS-like immune deficiency, and one of the three AIDS-linked cancers called lymphomas, was first cultured from a Burkitt’s lymphoma cell line in 1964 that Dr. Horowitz traced to CIA-directed vaccine experiments conducted by the American biological weapons lab called Litton Bionetics. Bionetics operated in Maryland, Virginia, Eastern Zaire and Northwest Uganda during the 1960s according to National Cancer Institute documents discovered by Horowitz. The covert African operation was conducted under the supervision of Frank Carlucci.

Carlucci has been a Managing Director of Carlyle since 1989 and its Chairman since 1993. Carlucci became the point man for CIA-directed “health care” programs in various parts of Africa during the early 1960s. He became the deputy director of the CIA in 1978, deputy secretary of defense in 1980, and national security adviser during the Iran-contra scandal. Carlucci also served as chief “political officer” in the African Congo’s American Embassy at the time Burkett’s lymphoma was allegedly discovered, and obviously distributed in this region of Africa by way of contaminated vaccines, according to substantial evidence compiled by Dr. Horowitz including an interview with one of the doctors engaged in the vaccination operation.

All of this is published, and meticulously evidenced using reprinted scientific and government documents in Dr. Horowitz’s best of three national bestselling books, Emerging Viruses: AIDS & Ebola–Nature,  Accident or Intentional? (Tetrahedron Press, 1998) Barack Obama’s minister, Rev. Jeremiah Wright, recommended reading this book, in defense of harsh criticism he received for his sermon condemning the US Government for creating HIV. For those who do not believe our government would conduct such hideous atrocities, technically called genocide, Barack Obama disavowed his minister.

Under CIA supervision and covert actions by government officials linked to Carlyle on behalf of the global petrochemical-pharmaceutical cartel, new diseases have emerged. Dr. Horowitz evidences these including Burkitt’s lymphoma, nasopharyngeal carcinoma, infectious mononucleosis, AIDS and today, the circulating swine flu, and avian flu threats.

While the Carlyle-Bush-Baker-Carlucci-Rumsfeld connections are troubling enough in their own right, they look even worse when you consider how many different ways Carlyle is profiting from the war on terrorism and bioterrorism. Speaking in particular about Carlucci, and his three main partners at Carlyle, Dan Broidy, author of The Iron Triangle, an illuminating history of the Carlyle Group, wrote, “It’s not an exaggeration to say that September 11″ made these “Carlyle investors very, very rich men.” This is also the case for Dick Cheney, tied to the Halliburton Co. that administers converted military bases to serve as quarantine camps planned by FEMA to be used this fall when the World Health Organization may call for such drastic measures.

Recall also that Donald Rumsfeld was replaced as Defense Secretary because of his administration of the Iraqi war and human rights violations in torturing prisoners, state enemies, and suspected terrorists. “I pray this doesn’t foreshadow how quarantined Americans who refuse vaccinations will be treated in these FEMA camps administered by Halliburton,” Dr. Horowitz said.

Alleging CIA operations to administer assassinations had been generally disappointing, according  to the Los Angeles Times interviewed CIA spokesman, George Little, one wonders who was behind the suspicious deaths of John and Bobby Kennedy, Martin Luther King, Vince Foster, Democratic Senate candidate Mel Carnahan, who went on to win the race as a dead man against his rival John Ashcroft (whose campaign was largely funded by Enron, and who went on to become appointed the U.S. Attorney General); Democratic Senate incumbent Paul Wellstone, whose reelection would have shifted the entire balance of power in the Senate during pivotal Bush administration projects fundamental to where we are today regarding “national security,” “biodefense,” and forced vaccinations and quarantines impacting every American.

“Keeping CIA activities like this secret is the biggest challenge,” another former U.S. intelligence official told the LA Times.

Most recently, the program’s focus had shifted toward intelligence collection, officials said. According to past CIA Director, William Colby, since the end of the cold war, the primary function of The Company has been to act as industrial espionage agents on behalf of multi-national corporations, the largest financially engaged with Carlyle.

In 2001, Dr. Horowitz exposed the anthrax mailings as sourcing from the CIA’s “Project Clearvision.” The anthrax was mailed to enemies of Carlyle, including democratic drug legislation opponents, Senators Patrick Leahy and Tom Dashle. The hyper-weaponized germ sourced from the Battelle Memorial Institute in West Jefferson, Ohio, under the direction of CIA-anthrax ace, William Patrick, III, who assayed the mailed virus’s spreading capacity two years before the attacks. According to Dr. Horowitz, and many other experts, this was done to promote sales of Bayer’s CIPRO; and stockpiles of BioPort, LLC’s congressionally-certified deadly anthrax vaccine.

US military leaders reported finding a BioPort annual prospectus in a cave allegedly used to shelter Osama bin Laden in 2002, probably because Carlyle clients, including Mohammad bin Laden, had invested in the company. Today, BioPort, renamed BioThrax, is allied with drug cartel giants Acambis, Sanofi Pasteur, and other companies that make money from people sustaining side effects from their drugs and vaccines; especially the ones exclusively stockpiled by our federal officials.

Regarding company assassins carrying out close-range killings, a former CIA official told Greg Miller from the LA Times,  “This is something they don’t really have a capacity for.”

“But long-range killings through manufactured frights, forced vaccinations, mass quarantines, and compelled druggings,” Dr. Horowitz wrote, “is obviously central to their genocidal operations on behalf of Carlyle and Halliburton investors.”

On July 16, 2009, it was announced that by fall, government health officials and social service workers will be canvassing every American household, carrying four required flu vaccines, that shall be given to those persuaded to take them. The campaign is mostly “targeting” children and the elderly.

In response, there are now many reasonable, responsible, intelligent, and patriotic Americans, including many health professionals, who have decided to leave the United States before flu season.

-end -

NOTE TO JOURNALISTS: For interviews with Dr. Horowitz please contact Jackie Lindenbach at 208-265-8065; or by E-mail: tetra@tetrahedron.org

229 Gypsy Bay Road, Sagle, ID 83860 208-265-2575 (FAX) 208-265-2775 Web: http://www.tetrahedron.org

CLICK HERE TO READ DR. HOROWITZ’S LATEST ARTICLE:

57 TRILLION REASONS TO MURDER 100 MILLION AMERICANS

{The way I read the latest on the swine flu, the vacinations will be forced upon us, whether we like it or not! Virginia Brooks}

How To Legally Say ‘NO’
To All Vaccines
Crusador Interviews Book Author & Acclaimed
International Vaccine Expert Dr. Sherri Tenpenny
6-27-09

Millions of Americans have come to distrust vaccines and mainstream medicine’s vaccine agenda. There is a growing movement in this country and around the world that questions the safety and effectiveness of all vaccines for obvious reasons. Many childhood disorders such as autism, ADD/ADHD, SIDS and others have been linked to vaccines. Thousands of soldiers who served in the military have been severely disabled or in some cases even died after receiving their mandated shots. Vaccines are the most controversial subject in all of medicine.
The standard line heard from most parents once their eyes are open to the risks of vaccines is, “How will I get my child into day care or in school without their shots.” Those working in the healthcare field or soldiers in the military are faced with similar questions. To help educate the people further about how to legally avoid all vaccines, Dr. Sherri Tenpenny has put together a brand new book that is absolutely necessary to have in your possession if you or a loved one don’t want to vaccinate but are not sure how to get around it. As Dr. Tenpenny says on the back cover of her book, “Saying No To Vaccines is not intended to be a balanced view of vaccination literature. Pro-vaccine information is readily accessible through the American Academy of Pediatrics, the CDC, healthcare and government-sponsored organizations. This book balances the debate.”
Below is a copy of an interview Crusador editor Greg Ciola conducted with Dr. Tenpenny shortly after the release of her new book:
Crusador: What was the impetus for writing your new book “Saying NO To Vaccines”?
Parents needed a tool that did their homework for them. The evidence is there to support their decision to not vaccinate; you just have to do a little work to find it. Everyone seems to be so afraid of “bugs” and their potential ability to make us sick. But the reality is that we swim in “bugs” every day and we are not dropping over like flies. The only “bugs” we seem to obsess over are associated with vaccines. Only two generations ago, measles, mumps and chickenpox were normal experiences of childhood. Why we have complete fear of these infections is media and money driven and unfounded.
If the focus of Public Health was on sleep, exercise, clean water and safe, non-GMO food, we would have a healthy society without vaccines but we would not have billion dollar industries employing millions of people to keep us “healthy.” The fact is, we are a very UNhealthy society with vaccines, so the Public health and argument that we must vaccinate ‘for greater good’ is a failure.
I put a large body of research into my first book, FOWL! and my two DVDS, documenting the dangers of vaccination. “Saying No To Vaccines” was the next logical step. It answers the question, “I’ve decided not to vaccinate, now what do I do?”

Crusador: What are some of the issues you cover in the book that aren’t covered in your two DVD’s “Vaccines: The Risks, The Benefits, The Choices” and “Vaccines: What CDC Documents and Science Reveal”?
There is very little overlap between Saying No to Vaccines and the DVDs. The foundational premise of the book is to give answers refuting the 25 most common arguments used to promote vaccination. For example, parents are often told the vaccine-preventable diseases of childhood can be serious and if their child is not vaccinated, their child could die. I tell them how to refute that argument and give documentation from the medical literature to demonstrate that statement is nothing more than fear mongering. Parents are told by pediatricians there is “no evidence that vaccination harms the immune system” and there is “no evidence that vaccination can lead to chronic disease.” I used the medical literature to prove the opposite is true.
Crusador: What are the most common questions you get about vaccines?
The most frequently-asked question I get is about vaccination exemption, meaning, “How do I refuse the vaccine and still get my kids into school or keep my job,” so by design a large part of the book covers exemptions. I included a lot of detail on how to avoid vaccinations for school situations, including college, professional situations where a job may require certain vaccines, if you are in a nursing home, foreign adoption, the military, even if you are incarcerated. I have also included a chapter on frequently- asked questions about vaccination. Saying No To Vaccines has an entire section on “most frequently asked questions.”
Crusador: There is a huge divide in this country between those who think you should vaccinate versus those who feel you shouldn’t. The majority is still on the side of thinking that vaccines are THE answer to long-term immunity. When you do speaking engagements or radio interviews or simply talk to a pregnant woman about the need to question the safety of vaccines further, how do you present your information to make someone think twice?
Even though I strongly believe that vaccines cause more harm than the “good” they supposedly do, it is important for people to see the evidence of harm  from a scientific perspective  and not just take my word for it. All of my information, every slide and every paragraph in my book, is referenced from a highly reputable medical journal or from the Centers for Disease Control, the CDC. People can see for themselves the one-sided, biased view of the vaccine industry, promoting that vaccines are “safe” and “protective.” Almost 100% of the time, once people pull back the veil and see the rest of the story, they know that vaccination is not what the drug companies claim it to be.
Crusador: Do you feel that there is such a thing as a “safe” vaccine? If there isn’t, how do you counter the mainstream medical mentality that vaccines may not be entirely without risks, but those risks are far less than the risks we would face without vaccines at all?
I really felt that parents needed strong answers for when they decided to not vaccinate. Very few people are willing to say something. The risk of the vaccine is greater than the risk of the disease. The “Green Our Vaccines” movement was partially behind the reason I wrote this book. Many activists, people with very good intentions, hedge and put their support behind “safer” vaccines which are a chemical impossibility. People just need to SAY NO.
Crusador: Tell our readers a little more about the exemption clauses you discuss in your book. The medical establishment has done a terrific job of intimidating people into thinking they have to take vaccines and yet, rarely if ever will you hear about the ways to exempt yourself and family from taking vaccines.
A medical exemption is available in all 50 states but must be recommended by a doctor. The exemption can be difficult to obtain and often, it only excuses future vaccination with a shot that has already caused a severe reaction. There are three exemptions available in this country medical, religious and philosophical. As of now, 19 states accept a philosophical exemption. It is the easiest of the three to use. You request a form from the school nurse, state the reasons you don’t want to vaccinate your child, sign it and give it to the school. Generally, that’s it. However, different school systems have different rules. Some require the form annually, some require both parents to sign the exemption form, some require it to be notarized and so forth. You can find links to your state laws and more information by going to <http://www.DrTenpenny.com
> www.DrTenpenny.com  .

Religious exemptions are available in all other states except West Virginia and Mississippi (which only have medical exemptions). Religious exemptions can be tricky and in some states, very difficult to obtain and defend. I often recommend that people consult an attorney for this type of exemption. Some states, such as New York and New Jersey, are difficult. New York has been known to use something called a “sincerity test.” Parents are literally interrogated by an attorney representing the school district regarding how sincere their religious assertions are for refusing a vaccine. A panel then decides if you are sincere enough in your beliefs to allow you to refuse vaccination on religious ground. I find these tactics absolutely appalling and akin to Inquisitioners of the Middle Ages.
Crusador: Where do you see the whole pro-vaccine movement going and what threats to our Constitutional freedoms do you see coming down the pike?
The dogged determination of those who oppose vaccines, and in particular mandatory vaccination, has gained traction at a grass roots level and garnered a lot of attention from the media. I feel that we have the pro-vaccinators on the ropes. Our arguments are hard to deny and the global autism epidemic can no longer be ignored. Pro-vaccinators are using manipulation, threats and fear tactics, trying to convince everyone that vaccines are not only safe but absolutely necessary. I see the vaccine industry like a wounded Tyrannosaurus Rex, gnashing its teeth and flailing its ugly head. It won’t die quickly and it will probably get worse before it gets better.

Crusador: There are many people in this country, myself included, who are concerned that there is an evil agenda to mass vaccinate the entire planet in the event of a health emergency. Do you feel that there are genuine reasons to be concerned and what might we expect to see unfold in an emergency?
Executive orders and recommendations from the Department of Health and Human Services (HHS) have been written that stop just short of allowing government-enforced mandatory vaccination for anthrax, smallpox and bird flu. The only way to change these policies is by standing together and boldly saying no.
Crusador: Are you still confident that with enough knowledge about the risks and dangers of vaccines enough people will wake up and say NO before Big Pharma forces its will upon the populace?
I’m not sure. People tend to be sheep  Americans in particular. Look what we have allowed a small number in the White House and 545 people in Congress to do to our country. And even those people who want to effect a change have little time and few resources to do so. No one wants to stand out, speak up and challenge authority. Whatever happened to those bra-burning activists of the 1960s? However, people really are involved now, more than ever. It only takes a small, vocal minority to really make a difference. As stated years ago by Margaret Mead, “Never doubt that a small group of thoughtful, committed citizens can change the world; indeed it is the only thing that ever has.”
Crusador: Thank you for your time, Sherri. These are excellent answers. I encourage everyone reading this interview to make every effort they can to get a copy of your new book and share it with their friends and loved ones because it is a great tool to give the average person confidence to “SAY NO TO VACCINES”.
Thank you, Greg for helping me get this message out to more people.

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