Health Services
Page Navigation
- Lincolnwood School District 74
- Medical Forms
-
Medical Forms & Requirements
The Lincolnwood Schools operate in accordance with the State Law and Lincolnwood Board of Education Policy. Physical examinations and proof of adequate immunizations are required of all new students to District 74, all children entering Pre-Kindergarten, Kindergarten or students starting First Grade without Kindergarten experience, and students entering Sixth Grade. Because there are several required medical forms or varied medical conditions your child may have, we have developed a checklist below. Please look at the grade your child will be entering and submit all required forms.
Note: Please check to make sure your child is in compliance with Illinois State Law. Please remember to fill out your child's health history on the 2nd page of the State of Illinois Certificate of Child Health Examinations form.
Physical examinations cannot be more than twelve (12) months in advance of the first day of school. ALL REQUIRED MEDICAL FORMS SHOULD BE FILLED OUT AND SENT IN BEFORE THE FIRST DAY OF THE SCHOOL YEAR. Any child not in compliance with the above requirements by October 15th will be excluded from school that day and until proof of compliance is presented to the school. All new students who are first-time registrants, entering after October 15th, shall have 30 days following registration to comply with the health examination and immunization regulations.
For students new to Lincolnwood Schools
- Certificate of Child Health Examination: You will need a doctor's physical and up-to-date immunizations.
- Eye Examination Report: Any students new to Illinois public schools will need an eye exam. Illinois law requires that an optometrist or ophthalmologist perform an eye exam and complete the State of Illinois Eye Examination Report.
- Proof of School Dental Examination Form: Please have dentist complete this form.
For new Pre-Kindergarten Students
- Certificate of Child Health Examination: You will need a doctor's physical and up-to-date immunizations. A lead screening or blood test and a diabetes screening must be indicated on this form.
- Childhood Lead Risk Assessment Questionnaire: If you respond "Yes" or "Don't know" on this form, your child's doctor must perform a blood lead test.
For Kindergarteners or students starting First Grade without a Kindergarten experience
- Certificate of Child Health Examination: You will need a doctor's physical and up-to-date immunizations. A lead screening or blood test and a diabetes screening must be indicated on this form.
- Childhood Lead Risk Assessment Questionnaire: If you respond "Yes" or "Don't know" on this form, your child's doctor must perform a blood lead test.
- Proof of School Dental Examination Form: Please have dentist complete this form.
- Eye Examination Report: Please have an optometrist or ophthalmologist complete this form.
For First Graders with a Kindergarten experience
Please be sure all medical requirements are up to date. Check the immunization section below.
For Second Graders
- Proof of School Dental Examination Form: Please have dentist complete this form
For Third, Fourth, and Fifth Graders
Please be sure all medical requirements are up to date. Check the immunization section below.
For Sixth Graders
- Certificate of Child Health Examination: You will need a doctor's physical and up-to-date immunizations. REQUIREMENT!! - Any child entering sixth grade shall show proof of receiving one dose of Tdap. (See letter from IL Dept. of Public Health)
- Proof of School Dental Examination Form: Please have dentist complete this form
For Sixth, Seventh and Eighth Graders
- ALL 6th, 7th, and 8th Graders - Since Fall of 2013, ALL students entering, advancing, or transferring into 6th, 7th, and 8th grades are required to show proof of one dose of Tdap vaccine regardless of the interval since the last Dtap, DT or Td dose.
- Sports Physical - Examination: Please fill out with your doctor so that your middle school child may participate in an after school sport.
Vision and Hearing Screening
Vision screening will begin, as mandated, for the following students: Pre-Kindergarten, Second Grade, Eighth Grade, Transfer Students, Special Needs, and Teacher Referrals in the month of October. Hearing screenings will also be done for Pre-Kindergarten, Kindergarten, First Grade, Second Grade, Third Grade, Special Needs, Transfer Students, and Teacher Referrals.
Vision screening is not a substitute for a complete eye and vision evaluation by an eye doctor. Your child is not required to undergo this vision screening if an optometrist or ophthalmologist has completed and signed an eye examination report indicating that an eye examination has been administered within the previous 12 months. A copy of the eye examination needs to be on file in the school's health office.
If an eye examination report is not on file in the health office, your child will be screened if he/she is required to be by the State of Illinois.
ALL STUDENTS:
If you have any questions regarding any of the above instructions, please contact the school nurse in your child's building.
Other Medical Forms that you may need to fill out:- Food Allergy Action Plan Form: If your child has a severe allergy to food, bees, or other allergies that requires an Epi-pen, please fill out this form with your doctor.
- Student Asthma Action Card: If your child has asthma, please fill out this form with your doctor.
- Order/Authorization for Administration of Medication at School Form: To receive any over-the-counter or prescription medications at school (including any pain relievers), please fill out this form and have your doctor sign.
Please bring in all medications, including inhalers and Epi-pens, to the Health Office by the first day of school.