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Illinois Certificate of Child Health Examination Code
November 14, 2018

The required Certificate of Child Health Examination form has been revised to accommodate changes in the Illinois Child Health Examination Code. Begin to use this new form immediately.

Health Examination for all public, private/independent and parochial school students in Illinois must include:

Physical examination which shall include an evaluation of: height, weight, blood pressure, BMI, skin, eyes, ears, nose, throat, mouth/dental, cardiovascular, respiratory, gastrointestinal, genito-urinary, neurological, musculoskeletal, spinal examination, nutritional status, lead screening and other evaluations deemed necessary by the examiner. The strongly recommended evaluations include hemoglobin or hematocrit, urinalysis, and sickle cell. The examiner should list any medications the child takes routinely, diet restrictions/needs, special equipment needed, or other needs, and known allergies.

Medical history, which 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.

At or about the same time that he/she receives a health examination, every child shall present proof to the local school authority of having received immunizations against preventable communicable diseases as required by Section 665 of the Child Health Examination Code.

A diabetes screening shall be included as a required part of each health examination and the health care provider shall document results of the diabetes risk assessment on the Certificate of Child Health Examination form.

Lead screening is a required part of the health examination for children age six years or younger prior to admission to a preschool, nursery school, kindergarten or other child care program. If the health care provider did not perform the assessment, the school nurse could administer the questionnaire. Any single “Yes” or “Don’t Know” answer requires a blood lead test, as does residing in a high risk ZIP code.


TITLE 77: PUBLIC HEALTH, CHAPTER I: DEPARTMENT OF PUBLIC HEALTH, SUBCHAPTER i: MATERNAL AND CHILD HEALTH, PART 665, CHILD HEALTH EXAMINATION CODE.

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