A.M.A.
Affidavit for Tribal Medical Contraindication to VaccineAboriginal Medical Association ? ? ?Pursuant to:Article 24 UNDRIP - Article 24Indigenous peoples have the right to their traditional medicines and to maintain their health practices, including the conservation of their vital medicinal plants, animals and minerals. This is to Certify that Immunization against_________________________________ forName of Disease__________________________________ is medically Name of Client/TravelerContraindicated because of the following conditionsClients genetic bio-variance could cause massive allergic reaction to vaccine ingredients which have several side effects that are allergens to the client. Client is a certified IPA or Xi-Amaru Tribal Citizen member legally protected by International LawFurther Notes: Client Full Name:Client DOB:Tribal ID #:75917106Contact: 267-258-8864 Direct Contact to Dr AliDate: Dr Amaru Xi-AliName of PhysicianAmaru Xi-AliSignature of Physician ................
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