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Saturday, July 31, 2021

Health Requirements and Health/Medication Forms

Covid Information








The CDC, the IL Department of Public Health and the DuPage County Health Department are updating information about the coronavirus (COVID-19) on their websites regularly. 


Please see the following important information about the coronavirus: 






Illinois COVID-19 Hotline and Email Address

  • If you have questions about Coronavirus, call the Illinois Coronavirus Disease (COVID-19) Hotline at 1-800-889-3931, or send an email to DPH.SICK@ILLINOIS.GOV anytime, 24 hours a day, seven days a week.


Health Requirements by Grade Level

  • Preschool Students:
    • Physical Exam
    • Complete Immunization record signed by a doctor


    Kindergarten Students:
    • Physical Exam
    • Complete immunization record signed by a doctor
    • Dental Exam
    • Eye exam


  • Second Grade Students:
    • Dental Exam


  • Sixth Grade Students:
    • Physical Exam
    • Complete immunization record signed by a doctor including (1) Tdap, (1) meningitis-these are 6th grade requirements
    • Dental Exam


Physical Exams, immunization requirements, and eye exams are due at the start of school year and must be submitted no later than Friday, October 15, 2021. Dental forms are due prior to May 15, 2022.  The forms must be mailed or dropped off at the main office. 


Health Forms


Health Physical





Illinois Eye Exam Report


Sports Physical

IHSA Sports Physical


Religious Exemption for Immunizations

Illinois Certificate of Religious Exemption


Medication Forms

Medication forms need to be completed every school year.  Authorization for over-the- counter medication (i.e. Tylenol, cough drops, etc.) as well as prescription medication must have a medication permission form for each individual medication signed by the physician as well as a parent/guardian, giving the nurse authorization to administer the medication.

Medication must be brought to health office in the original container, labeled with the student’s name. Over-the-counter medication must be unopened and not expired.



Medication Permission Form

Medication permission form (one form required for each medication)



Illinois Food Allergy Emergency Action Plan and Treatment Authorization





Diabetes Management Plan






Exams and Immunization Requirements

Welcome to All Saints Catholic Academy (ASCA).  The purpose of this letter is to inform you of the health examination and immunization requirements in Illinois and the policy of our school.  ASCA will follow the mandates of the Illinois Department of Public Health with regards to required immunization of our students. 


Students will NOT be able to attend school after October 15, 2020 until ALL required information is received.


Physical Examinations

  1. Preschool, Kindergarten, 6th grade and new students to the school are required to submit (within one year of August 19, 2020) physical examination completed on the State of Illinois Certificate of Child Health form to the nurse no later than October 15, 2020.
  2. The health history portion of the examination form (yes/no questions on the back) is required to be completed and signed by the parent for the physical to be valid.
  3. Only faxed, mailed or hand delivered physical examination forms will be accepted.  You can send them in to ASCA at any time since the school will have summer hours.
  4. Out-of-state physical examinations written on approved forms, which meet current State of Illinois requirements, are acceptable if they are less than one year old.  An out-of-state student may, at the time of registration, provide an appointment card showing these requirements will be completed within 30 days.  At the end of thirty- day period, if the completed forms have not been presented to health services, the student will be excluded from school.



  1. The immunization section of the physical exam must include month/day/year of each immunization.
  2. The immunization section of the physical exam is required to be signed by a health care provider.
  3. A computer-generated list of immunizations requires a health care provider signature.
  4. All students entering 6th grade are required to have received (1) Tdap and (1) meningitis (after 11th birthday) immunizations.


Eye Exam

  1. A vision exam is required of all students entering Kindergarten, completed on the State of Illinois Eye Examination Report form by a physician who performs eye exams, or an optometrist dated within one year of the first day of school.



  1.  All students entering kindergarten, 2nd and 6th grade are required to present proof of an oral health examination on Illinois Dental Form competed by a licensed dentist.  This form will be due prior to May 15, of that academic year.


Sports Physical

Any student participating in intramural sports must turn in an IHSA sports physical form prior to the first practice.  A sports physical MAY NOT be used as the required school physical.  However, a physical exam competed on the Certificate of Child Health Exam form may be used as a sports physical. 


Religious Objections

  1.  Parents who are requesting a religious exemption to immunizations or examinations must complete the Illinois Certificate of Religious Exemption Form.
  2. The health care provider, responsible for performing the child’s examination must sign the form.


Medical Exemptions

Statements from physicians, indicating an immunization is medically contraindicated and predisposes the student to a potential health risk if vaccinated, should be attached to the physical form.

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