Health Information for the 2020-2021 School Year
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 before the first day of school Questions? Contact the Health Services office, 847-446-5252, x 2129, or email: firstname.lastname@example.org.
- 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 2020-21 school year. Thank you for completing the form prior to the first day of school.
Overview of Health Requirements
Because CHA is recognized by the State of Illinois and is an approved school of the Illinois High School Association (IHSA), all health requirements must be followed. All completed health forms are due on or before the first day of school. Students not in compliance with health forms will face expulsion and/or withholding of report cards until necessary forms are completed and turned in (ILCS 27-8.1). Please fax or email completed forms to email@example.com. Questions? Contact the Health Services office, 847-446-5252, x 2129, or email: firstname.lastname@example.org.
Printable Health Form Requirements
For your convenience, the two links below offer printable quick reference charts showing health form requirements for either new or returning students. Detailed health form information can be found below these links.
Health Forms Requirements for NEW STUDENTS
Health Forms Requirements for RETURNING STUDENTS
Per the IDPH and CHA’s All School COVID-19 Sickness Protocol, any student who has been sent home from school with potential symptoms may need to be quarantined for at least 10 days after symptoms first appeared. (Refer to the Sick Student Flow Chart for details of how CHA will handle such situations to help address the health safety of all our students.)
To return to school, your child must be fever free for 24 hours without fever reducing medication and have improving symptoms unless determined by a physician that symptoms are not due to COVID-19. A doctor’s signature on the Return to School Form is required before a student may return to school from quarantine.
Vision & Hearing
The state requires vision screening for students in PK3-Grade 3, students with an Individual Service Plan, and new students. These are due before first day of school. New K-12 students must provide the exam from former Illinois school or provide a new exam. Eye exams must be dated within one year of entry.
Illinois Eye Exam form
Hearing screenings are required for students in Preschool, Kindergarten, Grade 2, Grade 8, students with an Individual Service Plan and new students.
When vision and hearing screenings are held at CHA, fees 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. Contact Health Services for details.
Illinois State Physical Exam Form
Due before the first day of school.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. Students who have not turned in a required physical exam before the start of the school year will be excluded from school until the exam is turned submitted to the Health Services office. Exam forms must be dated within 1 year of entry. Illinois State Physical Exam certificate – PARENTS, PLEASE FILL OUT AND SIGN PAGE 2
The State of Illinois requires children to have certain immunizations for entrance into schools. Please see immunization list:
State of Illinois Immunization Requirements
Due before the first day of school. 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 2020-21 school year. New forms are required for new students and students entering Kindergarten, 6th grade and 9th grade.
Illinois Religious Exemption Form for Immunizations
Dental Exam Form
Due before first day of school. Required for all students entering Kindergarten, Grade 2, Grade 6 and Grade 9. Dental Exam must be dated after November 15, 2019.
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 August 10. 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 Severe Allergy/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
Medical Management Plans (updated annually)
Asthma Action Plan & Self Administration Permission Form
Diabetic Medical Management Plan (DMMP) Updated annually.
Emergency Allergy Action Plan
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.]
Food List for a Nut-Aware Environment
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).