Refusal of immunization should be tracked in the consent for immunization. You can include a note to document your discussion re: the refusal and a warning to give providers a heads up. Refusals do not go under exemptions because this would cause the forecaster not to work correctly. See QRC 1.7.
It is Public Health’s obligation to offer vaccination according to the schedule. Client’s may decline today but accept an immunization in the future. Removing the immunization from the forecast could possibly result in someone not being offered a immunization in the future. Use warnings for documenting clients that do not want to be called. Best practice is to check for warnings each time the client record is accessed.