BTHS District 201

Health & Safety

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”

When is it Due?

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.

Physical Exam Requirements

The physical exam must be documented on the state of Illinois “Certificate of Child Health Examination” form. The exam must be dated 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).

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.

Completing the Form

The Health History section (located on the top-half of the physical exam form) must be completed and signed by a parent or legal guardian. Please answer all yes/no questions in the Health History section, including questions about medications and allergies.  Please provide more information for any questions answered “yes”.  Please record the student’s name on both sides of the physical exam form.

Approval to participate in Physical Education and Interscholastic sports (near the bottom of the physical examination form) must be checked by the examining physician, advanced practice nurse, or physician’s assistant. Modifications, if indicated, must be specified.

Information, including the student’s name, should be entered on both sides of the 2-sided state form, “Certificate of Child Health Examination”.

Guidelines for Completion of Other Health Records

Emergency Information Cards

Please complete an emergency information card. The information requested allows us to contact alternate adults in case of student illness or injury when a parent or guardian is unavailable. Parents and legal guardians have the responsibility to provide updated health and contact information as changes occur during the student’s enrollment.

Existing Health Needs

If your child has a special health need, please contact the School Nurse to discuss his/her condition prior to the start of the school year. Medical information concerning a safe school routine can then be efficiently passed on to teachers.

If your student requires any prescription or nonprescription medication (including Tylenol and ibuprofen) during school hours, please complete the appropriate Medication Authorization Form annually.

Sports/Marching Band Physicals

Students must have an annual physical exam on file prior to participating in any sports/marching band program (including tryouts and practice).  The physical exam must indicate the student is clear for participation in sports.Sports/Marching Band physicals are valid for 13 months from the date of the exam.  

Please note:  All 9th graders are required to submit the State of Illinois Certificate of Child Health Examination form for entry into 9th grade.  IHSA sports physical forms cannot be substituted in place of the required form.  The 9th grade physical exam (documented on the State of Illinois Certificate of Child Health Examination form) may qualify as a sports physical for freshman students, as long as the medical provider has approved participation in interscholastic sports on the form.  

The Health Office works with the Athletic Office to ensure all athletes have a current physical exam on file.  Students are encouraged to arrange their physical exam date to assure sports eligibility throughout their athletic season.

Dental Exam

All children in ninth grade must present proof of having been examined by a licensed dentist before May 15th of the current school year in accordance with rules adopted by the IDPH. If a child in the ninth grade fails to present proof by May 15th, the school may hold the child’s report card until the child presents: (1)  proof of a completed dental examination, (2) proof of a completed Dental Examination Waiver form, or (3) proof of a dental appointment that will take place within 60 days after May 15th. TheSuperintendent or designee shall ensure that parent(s)/guardian(s) are notified of this dental examination requirement at least 60 days before May 15th of each school year.