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Please find the new Certificate of Child Health Examination Form which has been changed to accommodate:
- Tdap requirement
- New blood test for TB (remember the health care provider decides if the test is needed)
- Gathering information regarding asthma
State law requires the use of this form for school physicals and physicals for children enrolled in licensed daycare.
Use of the 2012 form is to begin immediately.
Sports physicals: IHSA and IESA have a form available for use but it is not required. The Certificate of Child Health Examination form can be accepted for sports.
Victoria Jackson, RN, MSN, IL/NCSN
School Health Program Coordinator
Illinois Department of Human Services
815/823 E. Monroe Street
Springfield, Illinois 62701
217-785-5368
victoria.jackson@illinois.gov
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