Get State Of Illinois Eye Exam Form 2020-2025

The State Of Illinois Eye Exam Form is a crucial document that ensures children receive the necessary eye examinations required for school enrollment. This guide provides step-by-step instructions to assist users in completing this form online, ensuring a smooth and efficient process.

Follow the steps to complete the form accurately and efficiently.

1. Click ‘Get Form’ button to obtain the form and open it in your preferred editor.
2. Begin by filling in the student's name. Provide the last name, first name, and middle initial where indicated. Ensure accurate spelling for official records.
3. Enter the student's birth date in the specified format (Month/Day/Year), followed by gender and current grade level.
4. Provide the parent or guardian's name. Fill in their last name and first name, along with an area code and phone number for contact.
5. Fill in the address of the student, including number, street, city, county, and ZIP code. This information is necessary for school records.
6. Record the date the eye examination was conducted in the designated field.
7. Complete the ocular history section, marking if the history is normal or listing any positive indicators as relevant.
8. In the drug allergies section, indicate whether the child has no known drug allergies (NKDA) or detail any allergies they may have.
9. Provide medical history in a similar manner as the ocular history. Indicate if it is normal or include relevant conditions.
10. Fill out the examination section, including unaided and best-corrected visual acuity for both distance and near vision. Ensure to record the values accurately.
11. Complete additional examinations and assessments such as color vision, internal exam, and neurological integrity, checking the appropriate boxes.
12. In the diagnosis section, select the relevant conditions from the list provided. Ensure all options relevant to the examination results are checked.
13. Use the comments field to provide any additional pertinent information regarding the examination.
14. Fill in the recommendations section based on the examining doctor's suggestions, indicating if corrective lenses are needed and for which activities.
15. Complete the consent section with the parent or guardian's signature, authorizing the release of this information to the appropriate authorities.
16. Finally, print the form for your records or to submit as required. Ensure all fields are completed to prevent any delays.

Complete the State Of Illinois Eye Exam Form online today to ensure your child's school enrollment is seamless.