• MEDICAL HEALTH FORMS
    State of Illinois medical forms are required to be completed, by licensed healthcare provider and parent, and returned to the Health Office, prior to the beginning of the school year. Please submit these forms as soon as possible in order to assist with processing the information and medical forms within a timely manner.
    A registered nurse is assigned to Winkelman and Field School for the administration of first aid, to maintain health records, and to maximize the health and wellness in the school environment.

    SUMMARY OF MEDICAL FORM REQUIREMENTS
    Pre-K:                                 Physical
    Kindergarten:                  Physical, Dental, and Eye
    1st grade:                          No forms required
    2nd grade:                         Dental
    3rd, 4th, & 5th grade:     No forms required
    6th grade:                          Physical (exam also covers interscholastic sports physical) and Dental
    7th & 8th grade:               No forms required

    PHYSICAL EXAM & IMMUNIZATION RECORD
    A physical exam, with an updated immunization record on the, “State of Illinois Certificate of Child Health Examination” form, is required to be completed and signed by a licensed healthcare provider and parent/guardian. Proof of exam must be submitted by October 15 upon entering Pre-K, Kindergarten and 6th grade, and/or when transferring from out of state.

    Parent/Guardian sections to complete:
    1. Top section of front page (Student’s name, birth date, grade, address, etc.)
    2. Top section of page #2 (Student’s name, etc. and entire* Health History with parent signature/date)
    *If these sections are not completed or signed by parent/guardian, form will be returned until complete.
    State of Illinois Certificate of Child Health Examination - English
    State of Illinois Certificate of Child Health Examination - Spanish

    DENTAL EXAM
    A dental exam on the, “Proof of School Dental Examination Form”, is required to be completed and signed by a licensed dentist and parent by May 15, for Kindergarten, 2nd and 6th grade students, OR a waiver needs to be submitted with the reason for exam not being done.

    Parent/Guardian section to complete:
    Top of section (Student’s name, birth date, grade, address etc.)
    State of IL Dental Exam Form
    Dental Exam Waiver Form


    EYE EXAM
    The Illinois School Code requires a vision exam to be completed on the “State of Illinois Eye Examination Report” for Kindergarten and/or all students entering the Illinois school system for the first time, by October 15. This exam can be performed by a licensed optometrist or physician that provides complete eye examinations, OR a waiver needs to be submitted with the reason for exam not being done.

    Parent/Guardian sections to complete:
    Top section of front page (Student’s name, birth date, grade, address, etc.)
    Middle section of page #2 (Consent signature/date)
    State of IL Eye Exam Form/Report
    State of IL Eye Exam Waiver Form


    PRESCRIPTION DRUGS/MEDICATION
    When a student’s licensed healthcare provider and parent/guardian believe that it is necessary for the student to take medication (prescription or over the counter) during school hours or school related activities, the Medical Authorization form needs to be completed and signed yearly by both the physician and parent/guardian. The parent/guardian and student must follow District #31 procedures for the administration of medication. No student will receive prescription or nonprescription medication, including Tylenol or Motrin, until the school has received a completed medication form. All medications must be brought to school by an adult. Prescription medications must be in originally labeled pharmacy containers. Over the counter medication must be in an unopened package/container.

    Parent/Guardian sections to complete:
    Top section page #1 (Student information)
    Bottom of page #2 (Signature, date, phone #)
    Medication Authorization Form

    ASTHMA
    All students with an Asthma diagnosis must have an, “Asthma Action Plan”, completed and signed yearly by a licensed healthcare provider and parent/guardian. There is no need for a separate medication form for the inhaler/medication when this form is used. Medication must be brought to school by an adult and must be in the originally labeled pharmacy container.

    Parent/Guardian section to complete:
    Top of form (Student’s name, date of birth, grade) and bottom of page (Signature and date)
    Asthma Action Plan Form

    FOOD ALLERGIES
    All students that require Epinephrine (EpiPen, Auvi-Q) for a possible food allergy emergency, must have an, “Allergy Emergency Action Plan and Treatment Authorization”, completed and signed yearly by a licensed healthcare provider and parent/guardian. There is no need for a separate medication form for the antihistamine or Epinephrine when this form is used. This plan also requests a recent picture of your child in the upper right corner. Medication(s) must be brought to school by an adult and must be in the originally labeled pharmacy container.

    Parent/Guardian sections to complete:
    Top of page (Student info)
    Bottom of page (contacts with phone numbers and signature/date)
    Food Allergy Emergency Action Plan and Treatment Authorization
    Family Allergy Health History Form
    *In order to further understand your student’s food allergy, District #31 requests that a parent/guardian fill out a Family Allergy Health History questionnaire yearly to be kept on file and returned with the Food Allergy Action Plan. This is a parent/guardian form only.

    UNDESIGNATED EPIPEN
    The health office has an undesignated EpiPen available for use in case of a suspected anaphylactic reaction. As permitted by law, the EpiPen may be administered to a student exhibiting signs of anaphylaxis by staff trained to recognize the signs and symptoms of a severe allergic reaction. When the lawfully prescribed medication is so administered, parents/guardians waive any claims they might have against the District, its employees, and agents arising out of the administration of the said medicine. In addition, parents/guardians agree to hold harmless and indemnify the District, its employees, and agents, either jointly or severally, from and against any and all claims, damages, caused by actions or injuries incurred or resulting from the administration or attempts of administration of said medication. *If you do not want your child to have epinephrine administered under any circumstances, you must submit a written request to the school, and the nurse and trained personnel will be informed.

    PHYSICAL EDUCATION EXEMPTIONS
    A student may be exempt from some or all of physical activities when the appropriate reasons/excuses are submitted to the school by parents/guardians (1-3 days) or by a licensed healthcare provider under the Medical Practice Act. If a student needs to be exempt from Physical Education or recess for more than three (3) days, a medical note is required.

    From time to time, students may need to use a piece of medical or adaptive equipment (such as a brace or protective eyewear) in order to participate in Physical Education classes. A student must have a note from a physician indicating the type of equipment that the student requires, the duration for which the equipment is to be worn, as well as any restrictions on movement or activity that the injury equipment requires. Once the note is on file, students who do not have, or choose not to wear equipment will not be permitted to participate in the physical education class. Students who do not have a doctor’s note on file will not be permitted to wear any equipment beyond that which is worn by the rest of the class or as required for the class activity.