Guidelines for Completion of Health Registration Records
The School Code of Illinois provides for exclusion from school for students not in compliance with health requirements.
GUIDELINES for completion of the “Certificate of Child Health Examination”
- Freshman health records must be turned in to the Health Office by the first day of the school year. Transfer students must submit health records within 30 days of the registration.
- Information, including the student’s name, should be entered on both sides of the 2-sided state form, “Certificate of Child Health Examination”.
- The exam must be no earlier than one year prior to the first day of attendance at Belleville West and Belleville East. The exam form must be signed and dated by the examining physician (MD or DO), advanced practice nurse (APN) or physician’s assistant (PA).
- All immunization dates must be recorded (month/day/year) and the section must be signed by a physician or other health care provider. If an immunization is medically contraindicated, a statement must be written by the MD, DO, APN or PA and attached to the student’s physical exam form. The St. Clair County Health Department offers immunizations at a reduced cost during weekly clinics (618.233.6170).
- Approval to participate in Physical Education and Interscholastic sports (near the bottom of the page) must be checked by the examining physician, advanced practice nurse, or physician’s assistant. Modifications, if indicated, must be specified.
- The Health History section (half page) must be completed and signed by a parent or legal guardian.
- Arrange for an appointment with your physician or clinic now or as soon as possible. Physical examination schedules fill quickly during the summer months. Make a copy of the health records for your home file and return the forms by mail as soon as they are completed.