Health Requirement Chart

These charts show what documents are required for each particular grade level. 

It covers physicals, immunizations, vision exams, and dental exams.

Health Requirement Chart: Pre-Registered & Returning Students

Health Requirement Chart: Transfer Students (Families who recently moved into Mascoutah School District)

Physical & Immunization

PHYSICAL EXAMINATION REQUIREMENTS

All students entering Pre-K, Kindergarten, 6th, and 9th grade, new students transferring from an out of state school, and students planning to participate in sports will need a physical examination completed within the past year. Copies of the required physical examination form, ILLINOIS DEPT. OF HUMAN SERVICES, CERTIFICATE OF CHILD HEALTH EXAMINATION are available from the school office, the nurse, or linked on this page. Parents/guardians, please complete the Health History Section, sign, and date it before seeing the health care provider.  

PHYSICAL EXAMINATION FORM

IMMUNIZATION REQUIREMENTS

The state of Illinois Requirements for Immunizations include:

Every Kindergarten student must show proof of completion of Diphtheria/Tetanus/Pertussis series, Polio, MMR, Varicella after age 4 and Hepatitis B series. 

Every 6th grade student must show proof of Tdap & Meningococcal (MCV4) after age 11 and all previous grade level requirements.

Every 12th grade student must show proof of Meningococcal (MCV4) after age 16 and all previous grade level requirements.

If any series is incomplete, a schedule for completion must be obtained from your healthcare provider for your child to attend school. 

Dental

All Kindergarten, 2nd, 6th, and 9th grade students MUST have a dental examination on file by May 15 of the current school year. These can be completed within the 18 months prior to due date.

DENTAL EXAM FORM

DENTAL WAIVER FORM

vision

All Kindergarten students and students new to Illinois schools must have a vision exam on file by October 15.  If enrolling after October 15, submit proof of eye exam within 30 days of enrollment.

VISION EXAM FORM

VISION FORM WAIVER

medication

Only in the case of prescribed medication or treatment necessary for the student to remain in daily attendance or where failure to take medication or treatment could jeopardize the student's health, should medication or treatment be administered at school. Forms for requesting medication or treatment to be given at school (including prescription and over-the-counter medication) and forms for self-administration of asthma inhalers or Epi-pens are available from the school office, the health room, or below. 

Use these links to view or print Medication Administration information and forms:

MEDICATION ADMINISTRATION AND POLICY FORM 

SELF-CARRY EPINEPHRINE FORM 

ASTHMA INHALER CONSENT FORM

Board Policy 7-285 Anaphylactic Policy - Food Allergy Management Program

Influenza & MENINGOCOCCAL Disease 

Use these links to find resources on prevention and care:

Centers for Disease Control & Prevention: Influenza

Illinois Department of Public Health: Influenza 

Centers for Disease Control & Prevention: Meningococcal Disease

Illinois Department of Public Health: Meningococcal Disease

HEAD LICE INFORMATION

If your child has head lice, he or she needs to be treated with a topical over-the-counter product, such as RID, Lice-B-Gone, or any other lice-killing product. Your child should be treated when you first see the eggs or nits and again in 7-10 days to ensure that any remaining lice are killed. After the treatment, please use the comb enclosed with the package to remove any dead eggs or nits.