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Community Consolidated School District 180

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Health Information for the 2017-2018 Academic Year

Health Information for the 2017-2018 School Year

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Dear Parent or Guardian,

The State of Illinois requires that all children entering school in prekindergarten, kindergarten or first grade, sixth grade, and ninth grade have a complete physical examination as well as immunizations records on file. The State of Illinois requires that all transfer students must also have a physical examination and immunization record on file, which complies with Illinois State law. A dental examination is required for all students entering kindergarten, second and sixth grade.  A vision exam is required for all kindergarten students and all new students entering the school district.

The immunization record should have each immunization recorded by month, day, and year. Your child should have at least four DPT’s (diphtheria, tetanus, and pertussis) and four polio’s with the last dose for each having been received on or after their fourth birthday and at least 6 months between the last two doses of each immunization. All students in sixth through twelfth grade must have a Tdap.  All students in kindergarten through twelfth grade must have two doses of measles (Rubeola), mumps and rubella immunizations given on or after one year of age with each dose being at least one month apart.  All students in prekindergarten must have one measles (Rubeola), mumps, and rubella immunization given on or after one year of age.  All students must have a varicella immunization on or after their first birthday.  All students in kindergarten, first, second, third, sixth, seventh, eighth, ninth, tenth, eleventh and twelfth grade must have proof of receiving a second varicella immunization on or after one year of age and at least 1 month after the first varicella immunization.  All students in prekindergarten, and sixth through eighth grade need a series of three (3) Hepatitis B immunizations. There must be at least four (4) weeks between the first two doses. The interval between the second and third dose must be at least two (2) months. The interval between the first and third dose must be at least four (4) months.  All students in sixth, seventh, and eighth grade must show proof of one Meningococcal Conjugate vaccine on or after the tenth birthday.  All students in prekindergarten must show proof of immunization(s) for pneumococcal immunization per the pneumococcal vaccination schedule.  All prekindergarten students must show proof of receiving Hib immunizations per recommended vaccination schedule with at least one Hib on or after 1 year of age.  The health history section of the physical form needs to be completed by the parents and/or guardians. This section needs to be signed and dated by the parent or guardian.  The State of Illinois requires a legible physician signature and/or a physician signature with a stamp providing the name of the physician, address, and phone number on the Illinois physical form. The physical form must be dated. The immunization portion of the physical form also must be signed and dated by your physician or responsible health care provider.

In addition to the above requirements, the Illinois State Board of Education has indicated that the physician must screen children between the ages of six months and six years for lead poisoning. Please make sure that your physician is aware of this requirement. The screening may be a questionnaire or may be a blood test.

In addition all students entering kindergarten or first grade, sixth grade, and ninth grade must have diabetic screening as part of the health examination.  Each child must be assessed for the risk of having or developing Type 2 Diabetes.  This section on the physical form must be completed by the physician.

Tuberculosis (TB) skin test is not a requirement; however, we strongly recommend that you check with your health care provider to see if your child is a risk for TB.

In an effort to help you comply with these laws, attached please find a Certificate of School Health to be completed by your family physician and a dental form to be completed by your dental health care provider and a vision exam form to be completed by an optometrist or ophthalmologist.  Please make an appointment with your health care provider soon to have the form completed. Please return the completed form to your school by Monday, August 14, 2017.

If you need assistance in providing immunizations for you child, please contact the DuPage County Health Department at 630-682-7400.  Thank you for your cooperation in this important part of your child’s schooling.


Dental Letter (5/17)

Physical Exam and Immunization Letter (05/17)


Illinois Certificate of Religious Exemption



Sports Participation Letter

Sports Physical Permission Slip


Asthma Action Plan Letter

Medication Permission Form