Chronic Illness Verification Form - Child Welfare & Attendance (CA Dept of Education) The Chronic Il 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering the student's name, date of birth, and grade in the designated fields. This information is crucial for identifying the student.
3. Next, have the physician complete their section. They should provide their signature, printed name, address, chronic illness diagnosis, symptoms that may not require an office visit, expected frequency of episodes, and length of absences per episode.
4. Ensure that the physician attaches their business card to verify authenticity. This step is essential for compliance with school district requirements.
5. In the Parent/Guardian Authorization section, sign and date the form. Remember to initial if you wish to be informed before any contact is made with the physician regarding your child's absences.
6. Review all entries for accuracy before submitting. Once completed, save your document and share it as needed.

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