State of Illinois Certificate of Child Health Examination - isbe 2025

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The document is a Certificate of Child Health Examination required for children in licensed child care facilities in Illinois. It includes sections for immunization records, health history, vision and hearing screenings, physical examination requirements, and emergency action plans. Parents or guardians must provide medical history and consent for sharing information with school personnel. Health care providers are responsible for verifying the child's health status and immunizations.
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  1. Click ‘Get Form’ to open the State of Illinois Certificate of Child Health Examination in the editor.
  2. Begin by entering the student's name, birth date, sex, race/ethnicity, and school information in the designated fields.
  3. Complete the immunization section by having a healthcare provider fill in the dates for each vaccine administered. Ensure that any contraindications are documented as required.
  4. For alternative proof of immunity, provide details regarding clinical diagnoses or laboratory confirmations as applicable.
  5. Fill out the vision and hearing screening section with results from an IDPH certified technician.
  6. Parents or guardians should complete the medical history section, detailing allergies, medications, and any significant health issues.
  7. Finally, ensure that a healthcare provider signs and dates the form after verifying all information provided.

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Certificate of Child Health Examination

Jan 31, 2024 Diagnosis of Asthma? Yes. No. Child wakes during night coughing? Yes. No. Birth Defects? Yes. No. Developmental delay?

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