Health Services

Health Service Forms

Dental Form
Emergency Medical Form
Medication Administration Consent Form
Physical Form

Notice: The Lake County Health Department can provide resources for low cost/free physicals to families in need. Call (847) 377-8000 and ask for the medical clinic.

Information

State Law requires each student entering (ninth grade) or students transferring in from an out of state school and home schooled students taking classes to have a physical examination and evidence of up-to-date immunizations. The mandatory exam will remain in effect for (1) calendar year. A completed physical examination and proof of immunizations must be submitted before a student can begin school in August.

Sports physicals are not accepted! Enclosed in the enrollment packet is the “Certificate of Child Health Examination Form”.

Both sides need to be completed and signed by both Parent/Guardian and Physician.

Students planning to participate in the athletic program require a sports physical. This does not apply to Incoming freshman because they need a Certificate of Child Health Examination, this will work as the sports physical. We encourage you to schedule examinations after June and before sports practice begins in mid-August, for students to be able to participate for the entire school year.

Please be aware that if the necessary immunization is unavailable, you will need a signed waiver from the health care provider deferring that immunization until the affected vaccination supplies become available. Section 665.23© Child Health Examination Code.

Remember the deadline for providing the school with the necessary physical and immunizations for students is the first day of school.

Immunizations—the immunization history shall include month/day/year and signed and dated by the Physician or RN who has given the vaccination.

Diphtheria, Tetanus, Pertussis (DTP/DTap) – must have 3 or more doses with the last dose being a booster and having been received on or after the 4 th birthday
Diphtheria, Tetanus, (DT or Td ) – one booster within the last 10 years.
Polio (IPV/OPV) - minimum of 3 or more doses administered at the appropriate age, with the last dose being a booster on or after the 4 th birthday.
Mumps, Measles, Rubella (MMR) – 2 vaccinations with the first dose at 12 months of age or older.
Hepatitis B- series of 3 vaccinations. If this series is not completed a follow-up date needs to be present for the next vaccination.

Dental examinations are recommended at this time.