Medical Forms2018-07-06T20:40:17+00:00

Medical Forms

HEALTH

New Preschoolers
Physical examination must be completed within one calendar year prior to the date of entry.  The exam must include up-to-date immunizations and medical history signed by the parent.  Pre-Schoolers must have at least one dose of the pneumococcal vaccine (PCV14).

Kindergarten
Physical examination must be completed within one calendar year prior to the date of entry.  The exam must include up-to-date immunizations and medical history signed by the parent.

6th Grade
Physical examination must be completed within one calendar year prior to the date of entry.  The exam must include up-to-date immunizations and medical history signed by the parent.  Students entering sixth grade must have proof of one dose of the Tdap vaccine and proof of one dose of MCV4 vaccine on or after the 11th birthday.

State of Illinois Certificate of Child Health Examination

DENTAL

All Illinois children in Kindergarten, 2nd Grade, and 6th Grade are required to have an oral health examination.  Examinations must be performed by a licensed dentist, and he/she must sign the Proof of School Dental Examination form.

Proof of School Dental Examination form

VISION

Illinois law requires that proof of an eye examination by an optometrist or physician (such as an ophthalmologist) be submitted to the school no later than October 15 of the year the child is first enrolled, the Kindergarten year, or as required by the school for other children.  The examination must be completed within one year prior to the first day of the school year the child enters the Illinois school system for the first time.

State of Illinois Eye Examination Report

ST. ANN RELEASE FORMS

Medical Information and Emergency Notification Form
Medication Authorization Form
Physician Request for Self-Administration of Medication
Authorization for Medical Treatment

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