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.
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Food Allergy Action Plan
![](https://www.google.com/images/icons/product/drive-32.png)
Asthma Action Plan
![](https://www.google.com/images/icons/product/drive-32.png)
Diabetes Medical Management Plan (DMMP)
![](https://www.google.com/images/icons/product/drive-32.png)
Seizure 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.
![](https://www.google.com/images/icons/product/drive-32.png)
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Religious Exemption Form
Must be signed by parent/guardian AND physician.
![](https://www.google.com/images/icons/product/drive-32.png)
![](https://www.google.com/images/icons/product/drive-32.png)
State 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.