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Special Health Forms

Special Health Forms

Asthma
If your student has a history of asthma, effective January 1, 2017, Illinois Public Act 099-0843 requires schools to request an Asthma Action Plan (AAP) from parents of students with asthma. The asthma action plan must be completed by your student’s doctor, kept on file in the health office and updated annually. 

Asthma Action Plan 

 

Seizures
If your student has a history of seizures, effective July 1, 2020, Illinois Public Act 101-0050 requires a Seizure Action Plan for students who require assistance with epilepsy related care in a school setting. The seizure action plan must be completed and signed by your student’s doctor, kept on file in the health office, and updated annually.

Seizure Action Plan

 

Life Threatening Allergies (7:285)
For students who have a potential for an allergic reaction to food or other allergen requires an Allergy and Anaphylaxis Action Plan. The allergy and anaphylaxis plan must be completed and signed by your student’s doctor, kept on file in the health office, and updated annually. Students who are prescribed an Epipen are allowed by law to carry this medication during school hours.

Allergy and Anaphylaxis Action Plan

 

Diabetes
For students who have a history of diabetes, Illinois Public Act 096-1485 The Care of Students with Diabetes Act, requires a Diabetes Medical Management Plan (DMMP), or doctor’s orders which provides for the management and care of diabetes needs of your child. A DMMP must be completed by your student’s doctor, kept on file in the health office, and updated annually.

Diabetes Medical Management Plan