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District 119: Lists and Forms: Medical

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Medical Forms

Medical Information

 

Physical Form

 

Illinois Health Physical Form

  • All Pre-K, Kindergarten, 6th grade, and 9th grade students must have a recent Physical
  • Students new to Illinois must have a physical completed on a State of Illinois Physical Form
  • Sports physicals must be done yearly.
  • Students should be up-to-date on immunizations (bring shot record)
Vision

Eye Exam Report

Eye Exam Waiver

  • Vision exams are required for all students entering Kindergarten or an Illinois school for the first time.
  • Illinois law requires that proof of an eye examination be submitted before October 15 of the current school year that the student received an eye examination within one year prior to entry of kindergarten or the school.
  • A physician licensed to practice medicine in all of its branches or a licensed optometrist must perform the required eye examination
Dental

Dental Exam Proof

Dental Exam Waiver

  • Forms must be completed for students in grades Kindergarten, 2nd, and 6th. 
  • A dental examination form completed by the dentist, or waiver, if the student qualifies.
  • The completed form must be turned in to the school nurse by May 15th of that school year. 

 
Authorization Forms

Medical Authorization

 

Non Prescription Medication Authorization

 

 

 
 

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