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General Health Information and Forms

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General Health Information and Forms

Illinois State Law - School Immunization Reporting

Per Illinois state law (097-0910), "every school shall report to the State Board of Education by November 15, in the manner which that agency shall require, the number of children who have received the necessary immunizations and the health examination (other than a dental examination or eye examination) as required, indicating, of those who have not received the immunizations and examination as required, the number of children who are exempt from health examination and immunization requirements on religious or medical grounds." 

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Physical Examination
All students entering Kindergarten, 6th grade, or entering an Illinois school for the first time for the 2012-2013 school year need to have a new physical exam, Chicken Pox vaccine, and the Hepatitis B immunization series completed by October 15, 2014

State Of Illinois Child Health Exam Form


Student Athletes- Sports Physical Examination
A sports physical is required each year for those students in grades 5-12 who want to try out for a sport.  All students trying out must have a current physical on file BEFORE trying out.

IESA/IHSA Sports Physical Form


TDap Vaccine Requirement
Beginning with the 2013-2014 school year, all students entering, advancing or transferring into grades 6-8 will be required to show proof of receipt of one dose of Tdap vaccine

TDAP Vaccine Letter - Illinois Department of Public Health


Dental Examination
All students entering Kindergarten, 2nd grade, or 6th grade must have a dental exam completed.

Dental Health Information - Requirements

Child Dental Health Exam Form - IL Dept. of Public Health

Dental Exam Waiver Form - IL Dept. of Public Health


Vision Examination
All students entering Kindergarten need to have a vision examination before October 15 of their entrance year to school.

Eye Exam Form - State of Illinois


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Madison CUSD 12602 Farrish StreetMadison, IL  62060

PH: 618-877-1712Fax: 618-877-2690

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