Forms

Back to School Help Fair Flyer:

Back To School Fair Flyer 2023

Physical Form:

Child Health Exam Form Revised 01 31 2024 (1)

Child Health Exam With Parent Section

Forms Owh Child Health Exam Spanish 042916

SPORTS PHYSICAL FORM  (This can’t be used for the school physical)

Dental Forms:

Dental Exam Form 2022

Dental Exam Form 2021 Editsspanish Final

Dental Exam Waiver 2021 Editsspanish Final

Dental Exam Waiver 2021

Kindergarten Round up forms (Click on link)

KDG Camp Flyer 22 23 Updated

Meningococcal Form:

ACHD Consent Meningococcal

Wellness Express Forms:

ACHD School Consent 7.12.18

SIU Consent Required For All Physicals

Directions For Filling Out IDPH Forms For Wellness Express

Allergy Policy and Forms:

Guideline For Management Of Children With Life Threatening Allergies Revised 2019

Allergy Medical Management Plan (Action plan plus orders)

Physician Statement For Food Substitution

Girls Talk Outline:

Girls Talk Outline

Asthma Forms:

Asthma Medical Management Plan (Action plan and orders)

Asthma Questionnaire

Parental Authorization Request For Self Administration Of Asthma Inhaler

Seizure Forms:

Seizure Medical Management Plan (Action plan and orders.)

Seizure Questionnaire

Diabetes:

DIABETES MEDICAL MANAGEMENT PLAN 

QPS Dexcom Authorization Letter

Medication Forms:

AUTHORIZATION AND PERMISSION FOR ADMINISTRATION OF MEDICATION 

AUTHORIZATION AND PERMISSION FOR SPECIALIZED MEDICAL TREATMENT 

(For Seizure, asthma, diabetes, and allergy orders, please refer to those sections located above.)

Diabetes:

DIABETES MEDICAL MANAGEMENT PLAN 

QPS Dexcom Authorization Letter

Eye Exam Forms:

2022 Eye Examination Report

2022 Eye Examination Waiver

LEAD QUESTIONNAIRE

Other Forms:

SIU Flyer

Facts about Meningococcal Disease

Meningococcal Vaccine Form

Flu Guide For Parents Brochure

IDPH Disease Guide

Religious Exempt Form