The CH-14 Universal Child Health Record is New Jersey’s standard medical clearance form for childcare, preschool, and K–12 enrollment, and completing it is a two-part job: you fill in the top section with your family and insurance details, your child’s healthcare provider completes the physical exam and health history below, and you submit the signed form with an immunization record attached to your child’s school or center.1New Jersey Department of Health. CH-14, Universal Child Health Record A blank copy is available at nj.gov/health/forms/ch-14.pdf, and school offices usually keep hard copies on hand.
What You Fill Out Before the Appointment
Section I is the parent or guardian’s part. Finish it at home so the appointment can focus on the exam. The fields are short:1New Jersey Department of Health. CH-14, Universal Child Health Record
- Child’s full legal name, gender, and date of birth, matching enrollment paperwork.
- Names and phone numbers for up to two parents or guardians, with home and work or cell lines.
- Health insurance status and, if covered, the carrier’s name.
- Your signature and the date on the consent line, which authorizes the provider and the school nurse to discuss the information on the form.
- The WIC release box, checked only if the form is going to a WIC office as well.
Bring the completed Section I, your insurance card, and the exact name of the school or center to the visit.
What the Provider Fills Out at the Appointment
Section II has to be completed by a licensed physician, physician assistant, or advanced practice registered nurse.2Connecticut General Assembly. Universal Child Health Forms The provider examines your child and writes the findings directly on the form.
Physical Exam
The provider records weight, height, and head circumference for children under two. Blood pressure is taken from age three.1New Jersey Department of Health. CH-14, Universal Child Health Record If the form is also going to WIC, the weight and height must have been measured within the previous 30 days. A head-to-toe check of eyes, ears, heart, lungs, abdomen, and other body systems follows, with any abnormalities and recommended treatment noted on the form.
Screenings
A screening row covers lead (capillary or venous), hearing, vision, tuberculosis in millimeters of induration, dental, developmental, and scoliosis.1New Jersey Department of Health. CH-14, Universal Child Health Record The provider completes only the ones appropriate for your child’s age.
Conditions, Medications, and Activity Limits
The provider lists ongoing conditions that could affect your child during the school day, such as asthma, seizure disorders, or severe allergies, along with long-term medications, including ones given at home that could still matter at school (cardiac drugs, seizure medications, daily inhalers). Short-term prescriptions like a course of antibiotics do not need to go on the form. A condition that needs a detailed management plan calls for a separate Special Care Plan (form CH-15), attached to the CH-14.1New Jersey Department of Health. CH-14, Universal Child Health Record
If your child has an activity restriction, say a healing fracture, the provider notes what is off-limits and for how long. Equipment like glasses or orthotics is recorded in the same area.
Signature
At the bottom of Section II, the provider prints their name, signs, and dates the form. The signature certifies that the child has been examined and is “medically cleared to participate fully in all child care/school activities, including physical education and competitive contact sports,” subject to any restrictions written above.1New Jersey Department of Health. CH-14, Universal Child Health Record Schools reject the form if this signature is missing.
Attaching the Immunization Record
The CH-14 is not valid on its own. An immunization record has to be attached, and a copy of the one your provider already keeps is acceptable; the provider does not need to recopy every date onto the CH-14.1New Jersey Department of Health. CH-14, Universal Child Health Record Required vaccines are set by grade under N.J.A.C. 8:57-4 and include DTaP, polio, MMR, varicella, and hepatitis B for kindergarten entry, with Tdap and meningococcal (MenACWY) added at sixth grade.3New Jersey Department of Health. New Jersey Immunization Requirements Ask your provider to confirm your child’s record meets the dose counts and minimum-age rules for the grade being entered, since doses given too early or too close together will not count.
A note on exemptions: New Jersey allows medical and religious exemptions from vaccine requirements, but not philosophical or personal-belief exemptions.4Legal Information Institute. New Jersey Code 8:57-4.4 – Religious Exemptions Those exemptions apply to the vaccination requirement, not to the CH-14 itself; the form still needs to be completed and signed. A medical exemption requires a written statement from the provider explaining the contraindication and its expected duration, and a religious exemption requires a signed statement from the parent that immunization interferes with the free exercise of the child’s religious beliefs.5Legal Information Institute. New Jersey Code 3A:52-7.3 – Health and Immunization Requirements for Children
How Recent the Physical Has To Be
The exam on the CH-14 has a shelf life. For childcare enrollment of a child two-and-a-half years old or younger, the exam must have been performed within six months before admission. For a child older than two-and-a-half, it must have been performed within one year before admission.5Legal Information Institute. New Jersey Code 3A:52-7.3 – Health and Immunization Requirements for Children Scheduling the appointment a few months before enrollment leaves a buffer.
Submitting the Form
Once Section II is signed and the immunization record is attached, deliver the packet to the school’s administrative office or registrar. Most schools accept a hand-delivered hard copy, and many now offer a secure digital upload portal for student health documents. Certified mail works if you want proof of receipt.
A school nurse or facility director reviews the form to confirm both sections are complete, the provider’s signature and exam date are present, and the immunization record is attached. Anything missing sends it back to you. Once the form is accepted, you typically receive written or electronic confirmation that your child is cleared for attendance.
When To Update It
Childcare centers that are not part of a public or private school must keep a current CH-14 on file and update it annually, which means a fresh physical and a new form every year for preschool or daycare.5Legal Information Institute. New Jersey Code 3A:52-7.3 – Health and Immunization Requirements for Children For K–12, the CH-14 covers school entry and athletic participation, but update cycles vary by district: some require a new physical at each transition point (kindergarten, middle school, high school), others follow the annual model.2Connecticut General Assembly. Universal Child Health Forms Ask your school directly.
A move to a new district, a new diagnosis, surgery, or a medication change are all reasons to have the form redone outside the normal cycle. If an updated record is not provided within the required timeframe, the school can exclude the child until the documentation is in hand.
Cost
Most private insurance and Medicaid cover well-child visits, including the exam needed for the CH-14, at no out-of-pocket cost under preventive care benefits. For an uninsured child, a pediatric physical generally runs about $30 to $145 depending on the provider. Community health centers and local health departments sometimes offer reduced-cost school physicals in late summer. Call the office to confirm pricing before booking.