Action Plans and Health Forms
Health Concerns
Parent/guardian must notify the school's nurse of any health conditions such as diabetes, seizures, asthma, or allergies
Parent/guardian are responsible for completing and returning required health forms and/or action plans.
Parent/guardian are responsible for communicating any updated health information to the school's nurse.
If your child has Food Allergies, Asthma, Diabetes and/or a Seizure disorder, please complete and return the below action plan(s), as applicable. A parent/guardian signature and physician signature are required. Action plans may also be obtained from your physician's office.
Food allergy action plan.pdfFood Allergy Action Plan
Asthma action plan.pdfAsthma Action Plan
Diabetes-Medical-Management-Plan-6-2015-Option-2 (1).pdfDiabetes Medical Management Plan (DMMP)
Seizure Action Plan.pdfSeizure Action Plan
Consent Forms
In order for the nursing staff to exchange information and obtain needed forms with the healthcare provider(s), the FERPA/HIPAA consent form and the Authorization to Exchange of Student Health Records will need to be completed and returned to the school nurse.
FERPA HIPAA Consent Form 2023.docxExchange of Education material.pdfReligious Exemption Form
Must be signed by parent/guardian AND physician.
Religious Exemption Form.pdfchild-health-exam-form-revised-01-31-2024.pdfState of Illinois Child Health Exam Form
Must be completed and signed by physician prior to entry into Pre-K, K, 6th, and 9th grades. Parent/guardian must also sign.