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Health Forms for Medical Providers

Medical providers can find the most up-to-date versions of all medical forms that may be required for students in Chicago Public Schools. 

While these forms often say physician, CPS allows for medical providers (MD, DO, APRN or PA) to complete these forms.

Once completed, forms must be sent to your student's school. At which point, the CPS staff will review the forms and may contact the medical provider to clarify services required during school hours.

Call the Healthy CPS Hotline at 773-553-KIDS (5437) for assistance with Medicaid or SNAP enrollment.

Please visit the Office of Diverse Learner Supports and Services website to learn about 504 and IEP related supports.

Does this family need help signing up for public benefits?

CPS’ Children and Family Benefits Unit (CFBU) connects CPS families to free or low-cost health insurance (Medicaid) and to food through the Supplemental Nutrition Assistance Program (SNAP). In addition to providing application and redetermination assistance, CFBU also provides parent-focused education to help families maintain and understand how to use their public benefits.

For more information, visit one of our School-Based Enrollment Sites or call the Healthy CPS Hotline at 773-553-KIDS (5437).

Forms updated for the 2019-2020 School Year.

Student Health and Wellness

773-553-KIDS (5437)

42 W. Madison St.
Chicago, IL 60602