DHS: School Health Records FAQs

Compiled in consultation with IDHS, ISBE, and IDPH programs impacted by the Child Health Examination Code. FAQ School Health Issues 2013 (pdf)

Questions & Answers regarding School Health Record Issues - May 2013

Please review the following commonly-asked questions before contacting state consultants. If any of the answers need further explanation, or you do not find an answer to your question, contact the following:

Topics	Contact	Agency	Phone	Email
Compliance with health requirements waivers based on religious objection and questions regarding health requirements in the School Code	Jessica Gerdes	ISBE	(312)814-8252	jgerdes@isbe.net
Specific immunization requirements and medical waivers	Janet Daniels	IDPH	(630) 293-6800	janet.daniels@illinois.gov
Child Health Examination questions and approved forms	Victoria Jackson	IDHS	(217) 785-5368	victoria.jackson@illinois.gov
Vision and Hearing Screening and Referral questions	Christine Budorick	IDPH	(217) 782-4733	christine.budorick@illinois.gov
Reporting of school health data to ISBE questions	Dr. Marjurie Ribeiro	ISBE	(217) 782-3950	mribeiro@isbe.net

VALID FORMS

Can I still accept physicals documented on the prior 01-12 version of the form?
Yes for the 2013-2014 school year. The new 02-13 version will be required starting with the school year 2014-2015. (The only change on the 02-13 form is the removal of the words "for one year" from the sports participation authorization section.)

The Child Health Examination Code requires that all mandated school physicals "shall be reported on the uniform forms that the Department of Public Health and the Illinois State Board of Education prescribe for statewide use." For school year 2013-14 either the 01-12 or 02-13 form may be used.

Some electronic forms have been approved for use and a statement denoting that approval will appear on the form. These forms will closely resemble the State mandated form. The approved forms will include the statement "Approved SHP (date of approval)".
If you have additional questions about the appropriate form, contact Vyki Jackson at (217) 785-4525 for further assistance.
What type of "out-of-state" physical exam forms are acceptable? (i.e. many "out-of-state" health examination forms do not include sufficient information to determine compliance with the Physical Examination Requirements section on the "Certificate of Child Health Examination" form.)
Out-of-state forms are only accepted for students transferring into Illinois schools for the first time. The exam must have been completed within one year prior to the date of entry into an Illinois school and must cover all "required" elements as listed on the Certificate of Child Health Examination form. See 77 Illinois Administrative Code 665.150(b) (Child Health Examination Code) at http://www.ilga.gov/commission/jcar/admincode/077/07700665sections.html.
What does "enrolling for the first time" mean?
Enrolling for the first time means that the student has never previously attended an Illinois school. The child may be coming from another state or country or may have been home schooled. The child would need a physical that was completed within one year prior to the date of entry.
A child who was enrolled in an Illinois school, left the state and then returned to Illinois at a later time would only be required to obtain a new physical at the required grade levels, K, 6, 9. (Example: Child started school in Illinois in Kindergarten and submitted the required physical at that time. He left Illinois and lived in another state for 4 years. He is returning to Illinois in 5th grade. He would not need a new physical until 6th grade.)
The school has the option of requiring a new physical at anytime they have concerns about a child's health. The Child Health Examination Code section outlining the timetable for examinations states "Additional health examinations and further evaluations of students may be required when deemed necessary by local school authorities."
When did the change requiring physicals for entry into 6th grade instead of 5th grade take affect?
Beginning school year 2009-2010, all students entering sixth grade need to present a physical examination that was performed within one year prior to the date of entry.
Why was head circumference added to the form?
The form is used for both school enrollment and enrollment in licensed daycare. Head circumference should be measured at each regularly scheduled well-child visit throughout the first 24 to 36 months of life.

VALID SIGNATURES

Can a nurse practitioner or physician's assistant perform a school physical and sign the "Child Health Examination form"?
Section 27-8.1 in the Illinois School Code allows advanced practice nurses (APNs) and physician assistants (PA)s) who perform a health examination to sign the health exam form.
Can a chiropractor perform a school physical and sign the "Child Health Examination form"?

Neither the School Code nor the Child Health Examination Code authorizes a chiropractor to perform a school physical or sign the form. Physicians licensed to practice medicine in all of its branches, advanced practice nurses who have a written collaborative agreement with a physician which authorizes them to perform health examinations, or physician assistants who have been delegated the performance of health examinations by their supervising physician shall be responsible for the performance of the health examination and shall sign all school health examination report forms.
If a person other than an APN or PA has sign-off authority from the physician, can they sign the physician's name and then their name on the health exam form?

No - Section 27-8.1 in the School Code of Illinois states if anyone other than a physician, APN or PA performs any part of a health examination, then a physician must review and sign all required forms.
If the "Certificate of Child Health Examination" form has a physician stamp instead of an actual signature, is this acceptable?
Yes - if a physician signature stamp is used.
Will the State Board of Education "cite" a school if the parent does not sign the health history section of the "Certificate of Child Health Examination" form?
It is possible. The health history section is a required part of the "Certificate of Child Health Examination."
If the parent does not complete the health history section of the form, can I ask them to complete one and attach it to the physical?
Yes - a health history can be completed, dated and signed by the parent and attached to the physical examination form.
Who can sign the Immunization History portion of the "Certificate of Child Health Examination" form?
The immunization history portion of the form can be signed by a physician, nurse in physician's office, school nurse, record keeper in schools, local health agency, etc. The date of verification must be included.
Is a local health department stamp acceptable?
Yes. A local health department stamp is acceptable for verifying the immunization history portion of the health form. The date of verification must be included.

IMMUNIZATIONS

Can the school require the physician conducting the physical exam to complete the immunization history section of the Certificate of Child Health Examination form?
No, a physician may not always have knowledge of child's immunization history.
Is it acceptable to attach an immunization record (i.e., immunization record from a local health department, Cornerstone report) to the "Certificate of Child Health Examination" and indicate in the Immunization "Comments" section of the form to "see attached immunization history documentation"? (Some schools are hesitant about transferring immunization dates from another health record to the Certificate of Child Health Examination form.)
Yes - if there is a notation in the immunization section of the form that refers to the attached documentation. The attached immunization record must be signed and dated by the health care provider or local health department or their employee.
Who is responsible for reviewing physician immunization notes?
Physician notes which state that a child has a medical contraindication to immunization, is "adequately immunized" or which indicate "no additional vaccine is needed" must be sent to regional IDPH Immunization Program staff.

IDPH rules and regulations do not acknowledge the "4-day grace period" that some providers wish to apply. When physicians administer vaccinations "off schedule," they will need to submit notes outlining these circumstances that must then be submitted to IDPH for review.

During the time physician notes are under review by IDPH staff, students will be considered "In Compliance, but Unprotected."
Are children entering kindergarten required to be vaccinated against hepatitis B?
No, hepatitis B vaccination is not required for K-4. It is required for children attending preschool and all children entering grades 5 through 12. Any student who transfers in from an out-of-state school that would be entering preschool or grades 5 through 12 must also be vaccinated against hepatitis B.
Is the varicella vaccination requirement progressive?
Yes, the varicella vaccine requirement is a progressive requirement and grades will continue to be added until 2014, when all students enrolling will be expected to have protection. Varicella vaccination requirements for school year 2013-14 will include children who attend Preschool, Kindergarten, 1st, 2nd, 3rd, 4th, 5th, 6th, 7th, 8th, 9th, 10th and 11th grades. Any student who transfers in from out-of-state in any of those grades is required to comply with varicella vaccination requirements.

When counting intervals for all vaccines, especially hepatitis B, day one is the day after the vaccine was administered. The day vaccine was administered is considered day zero; begin counting from the next day, and day 28 is the earliest the next dose can be given.
If a non-immunized child is excluded from school because of a measles outbreak, does the school district have to provide homebound tutoring?
If the child is unprotected because of a medical objection (not a religious objection), they may be eligible for homebound tutoring. Check with your special education director.
Who is required to receive Tdap?
September 27, 2011 the Child Health Examination Code Part 665 was amended requiring all incoming 6th graders to show proof of receiving a Tdap booster. The requirement also included students entering grades 7 through 12 who have not already received a dose of Tdap.
What type of documentation of Tdap vaccination is needed to meet the requirements?
The following documents will be accepted:
1. Note or letter, signed by health care provider and identifying the vaccine (Tdap) and date (month, day, and year) administered
2. Print-out from provider's electronic medical records system that identifies Tdap vaccination(s) and date administered for student in question
3. Current Certificate of Child Health Examination, specifying Tdap and date (Month, day, and year) administered.
Instead of getting a dose of Tdap, can there be other proof of immunity?
Pertussis disease history is not considered proof of immunity, any immunity that developed after disease wanes after time. Serological testing for pertussis immunity is not reliable and WILL NOT MEET THE REQUIREMENT.
What if a 6th through 12th grade student does not have proof of receipt of a Tdap vaccine before school starts?
If a student in 6th through 12th grade does not have proof of receipt of a Tdap vaccine since the product was licensed in 2005 before the start of school, unless medical or religious exemptions have been approved for Tdap, or the student has an appointment during the school year, the student is subject to exclusion from school on or before 10/15/2013.
What is the requirement for a 10 year Td booster?
Another change to section 665.240a was the removal of the requirement that stated... "If 10 years have elapsed since the last booster, an additional Td or Tdap booster is required. The reasoning regarding the removal of this requirement was since students were going to be required to show proof of a dose of Tdap (6th-12th grade) there was not a need to have the 10 year requirement in the Child Health Examination Code. Receipt of Tetanus Toxoid (T.T.) Vaccine is not acceptable in fulfilling this requirement."

RECORD MAINTENANCE

When a school transfers a record to another school, should they keep the original record or keep a copy?
ISBE does not have an official position. It is recommended that the original stay with or follow the student's school attendance location and the previous school keep a legible copy for the required duration.
Who is responsible for maintaining the "Certificate of Child Health Examination" form for students attending out-of-district classes (i.e. special education students)?
Both districts. The original should be maintained by the child's home district (district of residence). A copy should be kept by the school where the child attends out-of-district classes. Questions should be directed to the ISBE Division of Special Education, Office of Health/Homeless/Compliance at (312) 814-5560.
Can a school the student is transferring from refuse to send a copy of a physical and immunization record to a new school if there are outstanding fees due?
ISBE considers the school physical to be the personal property of the parent. Therefore, the school may not withhold it, although the school must maintain a legible copy.
For record keeping purposes, are medical records (containing physical exam and immunization information) part of the student's "permanent record"?
Yes - The Certificate of Child Health Examination form is part of the permanent record and must be kept for a period of 60 years.
Can Immunization Program staff recommend that schools keep the medical record (containing the student's immunization history) separate from the student's cumulative record?
Staff can recommend it be kept separate, but can't require it.

LEAD SCREENING

Who is required to be screened for lead?
Children six months through six years of age entering day care, preschool or kindergarten shall provide a statement from a physician or health care provider that the child has been screened or assessed for lead poisoning. A doctor or nurse must administer and sign the IDPH, Lead Risk Assessment Questionnaire. The IDPH, Lead Poisoning Prevention Code and Lead Risk Assessment Questionnaire may be found on the IDPH website, www.idph.state.il.us.Questions should be addressed to the IDPH, Lead Program at (217) 782-3517.
Is lead screening required?
Per 77 Illinois Administrative Code 665, (Child Health Examination Code) lead screening is a required part of the health examination for children age six years or younger prior to admission to kindergarten or first grade.
The health care provider must complete the section of the Certificate of Child Health Examination indicating that the child has been risk-assessed using the Lead Risk Assessment Questionnaire if the child resides in an area defined as low risk by the Department (IDPH), or screened (Blood Lead Tested) for lead poisoning if the child resides in an area defined as high risk. (Section 7.1 of the Lead Poisoning Prevention Act).
What is the Lead Program's expectation for completion of the lead section on the health exam form?
1. Completion of the section: "Blood Test Indicated? Yes or No." If the lead section of the form is not completed by the child's health care provider, a nurse can administer the questionnaire and mark that section "yes or no", inform the parent of the need for the blood test if indicated, and note the date of the referral on the form.
2. There is no requirement that the school obtain the actual blood test results.
3. If the lead section of the health examination is not completed by the health care provider or nurse, the form is incomplete and cannot be accepted for school enrollment.

TB TESTING

Do students need to have a TB skin test?
IDPH rules (77 Illinois Administrative Code) do not require initial or routine skin testing of school children for TB. However, the local health department, TB board, or IDPH may, after considering community factors, institute routine, periodic testing when a community, school, or school district has a higher than expected prevalence of infection.

The TB Control Program recommends that children be assessed individually and skin tested by the Mantoux method if they are:
1. in a high risk group such as children who are immunosuppressed due to HIV infection or other conditions,
2. recent immigrants from high prevalence countries (see CDC Travelers Health Yellow Book on website), or
3. exposed to adults in high-risk categories (see CDC guidelines).
Can a school district require TB skin testing?
Some school districts require TB skin testing as part of the school health examination and the Illinois Department of Children and Family Services requires that children in licensed day care centers receive a Mantoux skin test if the child is in a high-risk group as determined by the examining physician.

TB skin testing requirements for federal Head Start programs are decided by local Health Services Advisory Committees.

Additional questions should be directed to the TB Control Program at (217) 785-5371.

DIABETES SCREENING

Is diabetes risk assessment a required component of the physical examination?
Yes. Public Act 93-0530 requires that diabetes screening shall be completed as a required part of each mandated health examination. The Consensus Panel of the American Diabetes Association (ADA) suggests that if an individual is overweight and has any two of the risk factors listed below, they are at risk of developing type 2 diabetes.
1. Overweight in children is defined as BMI greater than 85th percentile for age and sex.
2. Risk Factors:
  1. Family history of type 2 diabetes in first/second-degree relatives.
  2. Belonging to certain race/ethnic groups including American Indians, African Americans, Hispanic Americans, Asian/South Pacific Islanders.
  3. Showing signs of insulin resistance or conditions associated with insulin resistance including: acanthosis nigricans, hypertension, dyslipidemia, polycystic ovarian syndrome.

Results of the diabetes risk assessment must be documented on the Certificate of Child Health Examination form. Beginning school year 2006-07, schools will be cited if risk assessment is not documented on mandated school physicals. Questions about the diabetes risk assessment should be directed to Vyki Jackson, (217)785-4525 or victoria.jackson@illinois.gov.

VISION AND HEARING

What are the mandated grades/age for vision and hearing screening?
Vision and hearing screening are required annually beginning at age 3 in all licensed daycare/preschool programs. Once a child begins school, vision screening is required at grades K, 2 and 8. Hearing screening is required at grades K, 1, 2, and 3. Screening for both vision and hearing must be completed annually on ALL children in special education, children new to the district, and teacher referrals. Screening performed by the doctor's office as part of the school physical does not fulfill the mandate. If there is documentation in the child's file of an eye examination having been completed by an optometrist or ophthalmologist within the last 12 months, the child does not have to be screened.
Who can provide mandated vision and hearing screening?
Screeners who are trained and certified by the IDPH may perform mandated screening.
Which students are required to have an eye examination?
Any child entering the Illinois school system at the kindergarten level or higher for the first time is required to have the eye examination regardless of grade level. If a child transfers in from another school in Illinois, it would not be first entry into the Illinois school system. If they transfer in from out-of-state, out-of-country, or from home schooling, and have never before been in the Illinois school system, then the eye examination would be required.
Does the new vision examination requirement apply to early childhood classes?
No, the law does not apply to children in Early Childhood Education (school or special education prior to kindergarten). The law applies to children entering Illinois schools for the first time at kindergarten or after. If a child came from another state or was home schooled and entered the Illinois school system in grade 3 (or any other grade), then the eye examination requirement would apply to that child.
How are children who receive the eye exam counted on the vision conservation annual report?
The children receiving the mandated eye examination are NOT included on the IDPH vision conservation annual report of screening activity. Children who are non-compliant with the eye examination requirement would still be screened and counted on the vision conservation annual report to DPH.
Does the vision examination law change the Vision screening requirements?
The eye examination law does not change the requirements of the Illinois Child Vision and Hearing Test Act. The law does not apply to pre-kindergarten. For kindergarten children, the same rules apply as before. If there is documentation of an eye examination having been done within the last 12 months in the child's file, he/she does not have to be screened.
What do I do if I receive an eye examination form that has not been completed in its entirety?
According to ISBE, you should ask for another form that has all required information completed.
Who should I contact if I have vision and hearing screening questions?
Questions should be directed to the IDPH Division of Health Assessment & Screening at (217) 782-4733. Vision and hearing questions can also be sent to the DPH.VisionandHearing@ILLINOIS.GOV mailbox. You can add your contact information for the listserv by sending an email to the address given above with a request to be added to the listserv.

EXCLUSION FOR NON-COMPLIANCE WITH HEALTH REQUIREMENTS

When should a child be excluded from school for noncompliance with physical examination and immunization requirements?

If a child does not comply by October 15 of the current school year, or by the earlier date established by a school district, with all of the physical examination and immunization requirements, then the local school authority shall exclude that child from school until such time as the child presents proof of having had the health examination as required and presents proof of having received those required immunizations which are medically possible to receive.
(To establish a date before October 15 of the current school year, a school district must give notice of the requirements of Section 27-8.1 of the School Code 60 days prior to the earlier established date.)
Required components of the health examination include: health history, diabetes screening, lead risk assessment or testing, and complete physical examination.
Must an out-of-state transfer student be given additional time to provide health records?
Until June 30, 2015, if the student is an out-of-state transfer student and does not have the proof required under subsection (5) before October 15 of the current year or whatever date is set by the school district, then he or she may only attend classes if he or she has proof that an appointment for the required vaccinations has been scheduled with a party authorized to submit proof of the required vaccinations. If the proof of vaccination required under this subsection (5) is not submitted within 30 days after the student is permitted to attend classes, then the student is not to be permitted to attend classes until proof of the vaccinations has been properly submitted.
Must students who are receiving special education services be excluded from school for noncompliance with health examination and immunization requirements?
The requirements for health examinations and immunizations apply to all children except those who have been granted an exemption due to religious convictions or medical concerns. If an exemption has not been sought and granted, the district shall exclude a special education student in the same manner as a regular education student.
If a child receiving special education services is excluded, does the school have to provide homebound tutoring?
A district would only have to provide homebound tutoring to a child enrolled in special education who is excluded if they extended that service to a child enrolled in regular education.
Is there a penalty for parents who do not comply with examination or immunization requirements (other than medical or religious exemption)?
Parents/guardians whose children are not attending school related to their failure to obtain the necessary immunizations and/or physical exams are subject to state compulsory attendance laws. "Section 26-10 of the School Code states that any person having custody or control of a child subject to the provisions of this Article to whom notice has been given of the child's truancy and who knowingly and willfully permits such a child to persist in his truancy within the school year, upon conviction thereof shall be guilty of a Class C misdemeanor and shall be subject to not more than 30 days imprisonment and/or a fine of up to $500.
Can a student who is "homeless" be excluded from school for failure to comply with physical examination and immunization requirements?
The McKinney-Vento Homeless Assistance Act requires that schools provide support to homeless children in need of physicals and immunizations for school enrollment. The enrolling school must immediately refer the parent or guardian to the LEA homeless liaison, who must assist in obtaining the immunizations or records by helping to enroll the child in AllKids, arranging appointments for physicals and immunizations and providing transportation if necessary. If, after exhausting all efforts, the parent fails to keep appointments or complete paperwork such as that needed for AllKids enrollment, the child may be excluded. Contact Sharon Neely at ISBE: saneely@isbe.net or (217) 782-5589.

DENTAL EXAMINATION

Is dental examination required?
Before May 15 of the school year, each child in kindergarten and the second and sixth grades shall present to the school proof of having been examined by a dentist in accordance with Section 27-8.1(1.5) of the School Code.
Where can I find the most current dental examination report form?
The form is available on IDPH website at www.idph.state.il.us or the ISBE website: http://www.isbe.net/school_health.htm
What are the consequences for failure to provide a report of dental examination?
If a child in kindergarten, second or sixth grade fails to present proof of having been examined by a dentist by May 15, the school may hold the child's report card until one of the following occurs:
1. the child presents proof of a completed dental examination. (Section 27-8.1(1.5) of the School Code) Submission of a completed examination form, in accordance with subsection (b), constitutes proof of a completed dental examination
2. the child presents proof that a dental examination will take place within 60 days after May 15. (Section 27-8.1(1.5) of the School Code) A written statement or appointment card, prepared by a dentist, dental hygienist, or his or her designee and signed by the child's parent or guardian, indicating the name of the child and the date and time of the scheduled dental examination, constitutes proof that a dental examination will take place. The child must present proof of a completed dental examination at the beginning of the following school year; Or
3. the child presents a dental examination waiver form, in accordance with Section 665.450.

Revised 4-25-13 SHP

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