• Illinois Certificate of Child Health Examination

• Illinois Proof of Dental Examination

• Illinois Dental Examination Waiver

• Illinois Eye Examination Form

School District 102 and Illinois State Board of Education guidelines state that all prescription and non-prescription medication given during school hours or school-related activities must have a completed Medication Authorization form (see below) prior to the administration of any medication. Medication prescribed once, twice, or three times daily should be administered outside of school hours. No medication will be given during the school day unless absolutely necessary for the critical health and well-being of the student.

Only after a Medication Authorization form (below) has been signed by both the physician and the parent, may the nurse or a designated substitute give any medication. This includes both prescription and over the counter medications. The school health offices do not supply any medication. Only labeled prescription bottles or medication in their original, unopened packaging will be accepted.

• Authorization for Self-Administration of Medication (Epipen, Inhalers)

• Authorization for Nurse Administration of Medication

If your student has ASTHMA, submit to school: 

• a completed Asthma Action Plan

• a Authorization for Self-Administration of Medication (Epipen, Inhalers)

• an unexpired inhaler in the original box with the prescription label for your student and a spacer

If your student has a LIFE THREATENING FOOD ALLERGY, submit to school:

• a completed Illinois Food Allergy Action Plan

• a Authorization for Self-Administration of Medication (Epipen, Inhalers)

• at least one unexpired epinephrine auto-injector in the original box with the prescription label for your student. 

• If your physician has indicated an antihistamine or inhaler on the IL FAAP,  please include those medications as well (unexpired and unopened).

If your student has a SEIZURE DISORDER, submit to school: 

• a completed Seizure Action Plan

• a Authorization for Nurse Administration of Medication (above) 

• any unexpired emergency medication in the original packaging with the prescription label for your student

If your student has DIABETES, submit to school:

• a Diabetic Medical Management Plan from your student's doctor

• all necessary supplies, to include, but not limited to, insulin, lancets, needles, insulin pen, blood glucose meter,  blood glucose strips, insulin pump supplies, CGM supplies, and quick sources of carbohydrates, such as juice, candy, fruit snacks, etc.. 

• a Medication Authorization form (above) for emergency glucagon with the unexpired medication in the original packaging with the prescription label for your student