Required Medical Forms for 2024-25 SY

PRESCHOOL FAMILIES:

Early Childhood Health Requirements (Ages 3-5) [ ENGLISH ]

RETURNING FAMILIES ONLY:

Submit required forms listed in the school forms booklet below. Submit Updated Medical Records and/or Eye and Dental Records- Read pages 9-10

Health Clinics:

Families refer to https://findahealthcenter.hrsa.gov/ to locate a Medical Home or to a CPS School Based Health Center. See https://schoolinfo.cps.edu/HealthCenters/

Student Health & School Forms Booklet

Read through the Student Health & School Forms Booklet carefully for information about CPS health requirements and services for SY24-25. All parents and guardians must submit the following forms to their school clerk on the first day of school:

• Student Medical Information
• Request for Emergency and Health Information
• School Messaging Consent Form
• Media Consent Form and Release
• Family Income Information Form

ENGLISH SPANISH

NEW FAMILIES ONLY: 

Eye, Dental and Medical records are due before October 1, 2024

Read pages 9, 10, 15, and 22 in the school forms booklet.

• Illinois Certificate of Child Health Examination [ ENGLISH ]
• Students in Kindergarten, 2nd, 6th, and 9th grades must show proof of a dental examination. 
• State of Illinois Vision Examination Report [ ENGLISH | SPANISH ]
• State of Illinois Proof of Dental Examination Form [ ENGLISH | SPANISH ]

ADDITIONAL RESOURCES:Medication Administration

The following forms allow students to receive their medication under adult supervision at school. With the appropriate forms, students are permitted to carry and self-administer asthma, diabetes, seizure, or allergy medication.

• Physician Request for Self-Administration of Medication [ ENGLISH ]
• Parent Request for Self-Administration of Medication [ ENGLISH | SPANISH ]
• Physician Request for Administration of Medication [ ENGLISH ]
• Parent Request for Administration of Medication to a Student [ ENGLISH | SPANISH ]

Allergies

Documenting your student’s allergies at school ensures proper support is provided for your student. A health care provider should complete these forms and any needed Medication Administration forms.

• Physician Report on Child with Allergies [ ENGLISH ]
• Food Allergy Action Plan [ ENGLISH |  SPANISH ]
• Physician Statement for Food Substitution [ ENGLISH | SPANISH ]
• Physician’s Request for Student to Carry an EpiPen [ ENGLISH ]

Documenting your student’s allergies at school ensures proper support is provided for your student. A health care provider should complete these forms and any needed Medication Administration forms.

• Physician Report on Child with Allergies [ ENGLISH ]
• Food Allergy Action Plan [ ENGLISH |  SPANISH ]
• Physician Statement for Food Substitution [ ENGLISH | SPANISH ]
• Physician’s Request for Student to Carry an EpiPen [ ENGLISH ]

Asthma

Documenting your student’s asthma at school ensures proper support is provided for your student. A healthcare provider should complete these forms and any needed Medication Administration forms.

• Physician Report on Child with Asthma [ ENGLISH ]
• Asthma Action Plan [ ENGLISH ]

Diabetes

Documenting your student’s diabetes at school ensures they are given the proper support. A healthcare provider should complete this form and any needed Medication Administration forms.

• Physician Report on Child with Diabetes [ ENGLISH ]

Seizures

Documenting your student’s seizure at school ensures they are given the proper support. A healthcare provider should complete these forms and any needed Medication Administration forms

• Physician Report on Child with a Neurological Disorder [ ENGLISH ]
• Seizure Action Plan [ ENGLISH ]