Child Health Examination Forms  (11/15) 

Students entering kindergarten (or first grade if not previously enrolled in kindergarten), sixth and ninth grades at any Illinois public or private school (including charter schools) must provide proof of physical examination on a form approved by both the Illinois Department of Public Health and the Illinois State Board of Education. Students entering an Illinois school from out of state or out of country for the first time at any grade level must also provide the physical exam form. The exam must be completed no earlier than a year (365 days) prior to the start of attendance at an Illinois school.

The Child Health Examination Form labeled 11/15 must be used by students who need to provide proof of the physical exam for school year 2017-18. Either of the Child Health Examination Forms labeled 11/15 or 2/13 are acceptable for students prior to school year 2017-18.
 
Illinois law requires that schools have on file medical verification of certain immunizations for students entering school.  Immunization dates and records must be submitted on the Child Health Form, signed, stamped, and dated by the health care provider.  A complete list of immunization requirements is available in six languages at http://www.immunize.org. 
 

• CHILD'S PHYSICAL EXAMINATION FORM CAN BE FOUND AT:  http://www.dph.illinois.gov/sites/default/files/forms/certificate-ofchild-health-examination-03032017.pdf.
• CERTIFICADO DE EXAMEN DE SALUD DEL NIÑO(A):  http://www.isbe.state.il.us/research/pdfs/health_exam_form_sp.pdf.

 
Immunization Requirements
Illinois state law requires immunization records to be on file.  A schedule of Child and Adolescent Immunizations is available on the Centers for Disease Control website.
 
Dental Exams
In compliance with Illinois Public Act 093-0946, by May 15th of that school year, students entering kindergarten, 2nd and 6th grade are required to have a dental exam on file.  The dental exam form is available on the Illinois Department of Public Health website.
 
Eye Exams
Illinois law requires proof of a comprehensive eye examination for all children entering kindergarten, or enrolling in a public, private or parochial school for the first time in Illinois.  The examination must have been completed within one year prior to the child beginning school and submitted to school no later than October 15th of the year the child is first enrolled. The examination must have been completed within one year prior to the child beginning school.  The eye exam form is available on the Illinois Department of Public Health website.
 
Vision and Hearing Screenings are done annually for all students in pre-school, special education, kindergarten, second and eighth grade as well as for all new-to-district students.  Vision Screening also is done for students in fifth grade.  Hearing Screening also is done for students in first and third grades.  Additionally, vision or hearing screenings can be requested by a parent or teacher.
 
Kindergarten Health Requirements
The following Illinois health requirements must be met prior to completing registration for a child entering kindergarten: physical examination done within one year prior to the first day of school, a required blood lead test or assessment in compliance with Section 7.1 of the Lead Poisoning Prevention Act, all necessary immunizations completed within one year prior to the first day of child care. Additionally, proof of a comprehensive eye exam is due by October 15th and proof of a dental exam is due by May 15th (see above sections).
Please click the links below for the required forms:

IL Physical Form

IL Physical Form (In Spanish)

State of Illinois Eye Exam Report

Dental Exam

Dental Exam Waiver