CHA is a recognized school of the State of Illinois and IHSA, and all health requirements must be followed. Please complete, sign and return all health forms to CHA by the first day of school (August 26, 2019) or sooner. Questions? Contact Mrs. Jenny Chan, CHA Nurse.
New for 2019-2020 school year!
- In addition to a physical exam, the State of Illinois is also now requiring proof of Dental Exam for students entering Grade 9.
- Students in Grade 12 must provide proof of second meningococcal vaccine. Only one dose is required if received at age 16 or older.
Health Requirements Per Grade:
- All New Preschool Students: physical exam
- All New Grade K-12 Students: physical and eye exams*
- All Kindergarten Students: physical, dental and eye exams
- All Grade 2 Students: dental exams
- All Grade 6 Students: physical and dental exams
- All Grade 9 Students: physical and dental exams
- ALL Grade 12 Students: Proof of second meningococcal vaccine. Only one dose required if received at age 16 or older.
- Athletes (Grade 6-12): concussion form and physical/sports exams
* If your student is in compliance and transferring from an Illinois school, new forms are not needed. Please have your former school include your health forms during transfer of records. If your student has a religious exemption on file for one or more immunizations, your physician will need to sign a new form for the 2019-20 school year. Thank you for completing the form prior to the first day of school.
Health Forms
Vision & Hearing Screenings The state requires students in PreK3-3rd grade, students with an Individual Service Plan and new students to have vision screenings. Hearing screenings are required for students in Preschool, Kindergarten, Grade 2, Grade 8, students with an Individual Service Plan and new students. This year, Vision & Hearing Screening will be held during school hours, on Monday and Tuesday, November 4 and 5, 2019. Fees for screenings will be charged to student accounts. If your child had a vision exam form turned in dated within one year of entry, your child may be exempt from the vision screen. More information is forthcoming.
Illinois State Physical Exam Form (Due by the first day of school, August 26, 2019) Required for all Kindergarten, Grade 6, Grade 9 students, and all NEW Preschool students. New K-12 students must provide the exam from former Illinois school or provide a new exam. Annual Exemption Date is October 15, 2019. Students who have not turned in a required physical exam will be excluded from school beginning October 15 and until the exam is turned in.
Illinois State Physical Exam certificate – PARENTS, PLEASE FILL OUT AND SIGN PAGE 2
Immunization Requirements
The State of Illinois requires children to have certain immunizations for entrance into schools. Please see immunization list:
State of Illinois Immunization Requirements
Religious Exemption for Immunizations Form (Due by the first day of school, August 26, 2019)
Required for all grades if you have an exemption for any required immunization. If your student has a religious exemption on file for one or more immunizations, your physician will need to sign a new form for the 2019-20 school year. New forms are required for new students and students entering Kindergarten, 6th grade and 9th grade.
Illinois Religious Exemption Form for Immunizations
Eye Exam Form (Due by the first day of school, August 26, 2019)
Required for all Kindergarten students. New K-12 students must provide the exam from former IL school or provide a new exam. Eye exams must be dated within one year of entry.
Illinois Eye Exam form
Dental Exam Form (Due by the first day of school, August 26, 2019)
Required for all students entering Kindergarten, Grade 2, Grade 6 and Grade 9. Dental Exam must be dated after November 15, 2018.
Illinois Dental Exam form
Medication Authorization & Over the counter Medication
If you would like Health Services to have the ability to give your student a stocked over-the counter medicine (such as Tylenol, Ibuprofen or Benadryl) or a prescription medicine during school, we require a Medication Authorization Form signed by a doctor.
Medication Authorization Form (Required for students needing medication at school)
OTC (Over-the-Counter) Medication Form (Recommended, good for 5 years)
Severe Allergy or Medical Concern
New doctor orders will need to be submitted before Aug. 15. If your child has a severe allergy or medical concern, you must contact the school nurse so teachers can be informed before school begins. Some forms require a physician’s signature. If your student has an emergency action plan on file with Health Services due to severe allergies or medical conditions, please be sure to communicate any changes or updates for next year. For more specifics, review the SevereAllergy/Medical Concern Resource Guide (including form)
Forms Needed Annually:
Emergency Action Plan & Treatment Authorization
Medication Authorization Form not required for emergency medications that are listed in Action Plan.
Epi-Pen/Inhaler Self-Administration Permission
Forms Needed Once Per Enrollment (unless your child has a change in his/her medical condition):
Severe Allergy or Medical Concern History Form
Individual Health Care Plan
Nut-Aware Guidelines
All students and families are asked to read and follow these guidelines throughout the school year. Please note that no homemade food items may be brought for classroom/school events.
Nut-Aware Guidelines
Food List for a Nut-Aware Environment
Medical Management Plans (updated annually)
Asthma Action Plan & Self Administration Permission Form
Diabetic Medical Management Plan (DMMP) Updated annually.
Emergency Allergy Action Plan
Seizure Plan
Required Athletic Forms (Gr 6-12)
All students participating in an interscholastic sport must have a current physical exam on file before practice/try-outs begin. Students may use the Illinois Physical Exam form or the IHSA Pre-Participation Physical Exam form. Please return all forms to the CHA (not CLA) Office. An athlete must have a current physical (within 13 month of date of exam) during the entire athletic season. A summer exam is recommended for year-long eligibility.
IHSA Consent, Asthma & Concussion Information Form (student & parent signature required).
