• Medical Forms for School

     

    Child Health Examination Form –  Click here for Student Medical Examination FormThe school code of Illinois requires that each student entering school for the first time (preschool, kindergarten, or first grades), 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 Form or the Dental Exam WaiverStudents in kindergarten, second and sixth 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 Form or the Vision WaiverStudents entering Illinois schools for the first time (kindergarten or transfer) must submit evidence of a vision exam.

     

    Medications – Click here for the Medication Administration Form

    Prescription and non-prescription medications will be given according to the District 200 Medication Policy.  This policy states, “That students are not allowed to carry any medication during the school day unless previously approved by a physician.”  The health office staff will administer only medications necessary to maintain the student during school hours (with signed authorization from the student’s physician and parent).  Medication must be brought to the health office by a parent or guardian in the original, appropriately labeled pharmaceutical container.  Medication authorization must be renewed annually and whenever there is a change in the prescription.

     

    Emergency Action Plans

    Click here for the Food Allergy Emergency Action Plan

    Click here for the Asthma Action Plan

    Click here for the Diabetic Management Plan

    Click here for the Permission to Administer Treatment

     

    Modified PE 

    Please call the main office or email the health office with any health or PE restrictions your child may have.

    630-682-2190

    wiesbrookhealthoffice@cusd200.org

Last Modified on August 24, 2018