Medical Forms

  • Child Health Examination - Click here for the Child Health Examination Form or here for the Child Health Examination Form in Spanish
    The school code of Illinois requires that each student entering school for the first time (preschool, kindergarten, or first grade), students entering sixth and ninth grades, and transfer students must submit evidence of a physical examination done by a licensed physician, advanced practice nurse or examining physician assistant and a complete record of immunizations.
    Dental Exam - Click here for the Dental Exam / Dental Exam - Spanish or the Dental Exam Waiver / Dental Exam Waiver - Spanish
    Students in kindergarten, second, sixth, and ninth grades must submit evidence of a dental examination by May 15th of that school year.  Dental exams must be completed within eighteen (18) months prior to May 15th.
    Vision Exam - Click here for the Vision Exam / Vision Exam - Spanish or the Vision Exam Waiver.
    Students entering Illinois schools for the first time (kindergarten or transfer) must submit evidence of a vision exam.
    Parent(s)/guardian(s) are responsible for administering medication to their children.  Administering medication during school hours or during school-related activities is discouraged unless it is necessary for the educational benefit and/or critical health and well-being of the student.  If medication must be administered during the school day, the District may administer the medication.  If a nurse is unavailable to administer the medication, a building administrator or a designee who volunteers to administer the medication will either: a) supervise the self-administration of the medication; or b) administer the medication to the student.
    Parents/guardians are encouraged to be present and to administer required medications (e.g., insulin, inhalers, epinephrine, etc.) to their children during school-sponsored field trips and extracurricular activities (e.g., athletic events, musical concerts, performances, etc.) when their child has not yet been approved to independently self administer their medication.  In the event that a parent/guardian will not be present to administer their child's required medication during a school-sponsored field trip or extracurricular activity, the parent/guardian must notify the Principal at least five (5) days prior to the scheduled event so that District 200 may appoint another party to serve the child in this capacity.  Doctors, parents, and school staff will discuss when a student is able to independently administer medication and no longer needs the assistance of a parent or school staff member designated to assist in the care of medical needs (i.e., delegated care aide).
    Students in possession of prescription or nonprescription medications in violation of these procedures may be subject to disciplinary action.
    Student Health History - Click here for the Student Health History/Update.
    Emergency Action Plans
    Click here for the Asthma Action Plan
    Click here for the Diabetic Care Plan
    Click here for the Seizure Action Plan 
    Modified PE Forms
    Please refer to the school for the school's modified PE form.
    Athletic Physical Exams - Click here for the Illinois High School Association (IHSA) Physical Form.
    A sports physical exam is required for students participating in interscholastic athletics and is valid for 395 days.  The school health required physical examination form can be used for athletics, but a separate copy must be provided to the athletic office.
Last Modified on March 8, 2023