Illinois Administrative Code › Title 77 - PUBLIC HEALTH › Part 665 - CHILD AND STUDENT HEALTH EXAMINATION AND IMMUNIZATION CODE › Subpart B - HEALTH EXAMINATION › Section 665.150 - Report Forms

Current through Register Vol. 48, No. 28, July 12, 2024
Health examinations shall be reported on the forms that the
				  Department of Public Health and the Illinois State Board of Education prescribe
				  for statewide use. The required form is the Certificate of Child Health
				  Examination provided by the Department. For eye examinations, the required form
				  is the Illinois Department of Public Health Eye Examination Report. For dental
				  examinations, the required form is the Illinois Department of Public Health
				  Dental Examination Report.
a) For
				transfer students from out of the State or out of the country, or from a
				federal Head Start program, a health form that is comparable to the Illinois
				requirements may be accepted only at the time of first entry into an Illinois
				school. (A statement by a physician or other health care provider indicating
				only that an examination was conducted is not acceptable.)
b) The physical examination shall include
				gender and date of birth; an evaluation of height, weight, BMI, blood pressure,
				skin, eyes, ears, nose, throat, mouth/dental; cardiovascular (including blood
				pressure), respiratory, gastrointestinal, genito-urinary, neurological, and
				musculoskeletal evaluations; spinal examination; evaluation of nutritional
				status; lead screening; and other evaluations deemed necessary by the health
				care provider.
c) The strongly
				recommended evaluations include hemoglobin or hematocrit, urinalysis, and
				testing for sickle cell disease. It is also recommended that the examiner list
				any medications that the child takes routinely, diet restrictions/needs,
				special equipment needed, other needs, or known allergies.
d) The health care provider shall summarize
				on the report form any condition that he/she suspects indicates a need for
				special services.
e) The medical
				history section of the form shall be completed and signed by the parent or
				legal guardian of the student. The medical history shall be inclusive, as
				indicated on the Certificate of Child Health Examination form.
f) The individual verifying the
				administration of required immunizations shall record as indicated on the
				Certificate of Child Health Examination form that the immunizations were
				administered as required by this Part and any other Department rules requiring
				immunizations.
g) Vision and
				hearing screening are required under the Child Vision and Hearing Test Act [410
				ILCS 205 ] and the Department's rules governing hearing screening (77 Ill. Adm.
				Code 675) and vision screening (77 Ill. Adm. Code 685). Completion of the
				vision and hearing screening data section of the Certificate of Child Health
				Examination is optional.
h) If the
				vision and hearing screening data section is completed, it shall be completed
				with information provided by the vision and hearing screening personnel
				certified by the Department.
i) If
				the student is required to have a sports physical in the year that coincides
				with the child health examination requirement, the Certificate of Child Health
				Examination may be accepted as proof of examination for interscholastic sports
				if the statement regarding participation in interscholastic sports is completed
				by the health care provider.
j) The
				health care provider shall indicate on the form the results of a tuberculosis
				skin test screening, if conducted.