Infant Jesus of Prague School Student Health Services
Procedure and forms needed for medication administration during school hours
Procedure for Medication Administration
All of these are the forms needed for Medication Administration:
Medical Information and Emergency Notification Form
Medication Authorization Form (Physician)
Physician Request for Self-Administration of Medication (Physician must fill out)
Parent/Guardian Permission and Authorization
All students: Health/Emergency Information Form (included in Registration Packet)
Preschool: Physical Exam and Immunizations
Kindergarten or first grade: Physical Exam, Immunizations, Dental Exam and Professional Eye Exam
Second grade: Dental Examination
Sixth grade: Physical Exam, Immunizations and Dental Exam
Transfer students: Physical Exam, Immunizations, Dental Exam, Professional Eye Exam and records from previous school
Health/Emergency Information
The Health/Emergency Information form for each child must be turned in at registration to be kept on file in the health office prior to the start of school. This is needed in order to share pertinent health information with school personnel on an as needed basis.
Dental Exam Required by the State of Illinois
Forms: Dental Exam Form Dental Exam Waiver Form
State law requires a dental examination be conducted for students entering kindergarten, grade 2, grade 6, and for all out-of-state or out-of-country transfer students. The examination must be documented on the Dental Examination form and must have taken place within 18 months prior to May 15th of the school year. For the 2008-2009 school year the exam must be performed sometime after November 15, 2007, and before May 15, 2009. If a child in grade 2, or grade 6 fails to present proof of dental examination by May 15 of the school year, the school may hold the child’s report card until one of the following occurs: 1) the child presents proof of a completed dental examination; 2) the child presents proof that a dental examination will take place within 60 days after May 15; or 3) the parents obtain a Dental Examination Waiver from the Department of Public Health or provide objection to the dental examination on religious grounds.
Vision Examinations Required by the State of Illinois
Forms: Eye Examination Report Eye Examination Waiver Form
As of January 1, 2008, the State of Illinois has required that all students entering kindergarten or entering school for the first time from out of state shall have an eye examination by an optometrist or ophthalmologist before October 15th of the school year.
Physical Examinations Required by the State of Illinois
Forms: IL Certificate of Child Health Exam (form is also available at your doctor’s office)
A physical examination including immunizations is required by state law (Title 77, Chapter 1, Part 665). The law applies to students entering the preschool program, kindergarten or first grade, sixth grade, and all first-time students in the state of Illinois. The exam shall be conducted within one year prior to the date of entering school. The examiner records the results of the health examination and immunizations on the Certificate of Child Health Examination form. The Health History section of the form shall be completed and signed by the student's parent/legal guardian and verified by the physician. The completed form shall be presented to the school nurse prior to the first day of attendance or the student will be excluded from school. If you object to a health examination due to religious beliefs, you may file a written statement to that effect with the school principal.
At the beginning of the 2007-08 school year, the State of Illinois enacted Public Act 095-0422 which changed the year of the required physical examination for students from “prior to entering 5th grade” to “prior to entering 6th grade.” This means that 4th graders are NO LONGER required to have a physical before entering 5th grade. They will, however, need one the following year when they enter 6th grade.
According to the Illinois Department of Public Health, students in 5th grade during the 2007-08 school year who had a physical examination that was compliant for starting the current school year will be “accepted and grandfathered for the 2008-09 school year” for their physical examination. This means that for one year only, students entering 6th grade will not be required to have a repeat physical exam to start school in the fall, unless they are new to the District from out of state.
Immunization Requirements for Preschool
Diphtheria, Pertussis, Tetanus: 4 doses of DTP/DtaP
Polio: minimum of 3 doses of IPV
Measles: 1 dose received on or after the 1st birthday (usually given as MMR)
Mumps: 1 dose received on or after the 1st birthday (usually given as MMR)
Rubella: 1 dose received on or after the 1st birthday (usually given as MMR)
Hepatitis B: 3 doses received at proper intervals
Haemophilus Influenza B: HIB vaccine appropriate to age
Chicken Pox: As of July 1, 2002 varicella immunization prior entrance to preschool: 1 dose on or after the 1st birthday, or physician’s statement verifying disease history, or laboratory evidence of varicella immunity.
Immunization Requirements for Kindergarten
Diphtheria, Pertussis, Tetanus: 4 or more doses of DTP/DtaP with the last dose qualifying as a booster and received on or after the 4th birthday
Polio: 4 or more doses of IPV with the last dose qualifying as a booster and received on or after the 4th birthday
Measles: 2 doses: the first dose received on or after the 1st birthday; second dose no less than 28 days later (usually given as MMR)
Mumps:1 dose received on or after the 1st birthday (usually given as MMR)
Rubella: 1 dose received on or after the 1st birthday (usually given as MMR)
Hepatitis B: 3 doses received at proper intervals
Haemophilus Influenza B: Hib immunization not required after 5th birthday
Chicken Pox: As of July 1, 2002 varicella immunization prior entrance to kindergarten: 1 dose on or after the 1st birthday, or physician’s statement verifying disease history, or laboratory evidence of varicella immunity.
Immunization Requirements for 1st – 8th
Diphtheria, Pertussis, Tetanus: 3 or more doses of DTP/DtaP or Td with the last dose qualifying as a booster and received on or after the 4th birthday
Polio: 3 doses or more of IPV with the last dose qualifying as a booster and received on or after the 4th birthday
Measles: 2 doses: the first dose received on or after the 1st birthday; second dose no less than 28 days later (usually given as MMR)
Mumps: 1 dose received on or after the 1st birthday (usually given as MMR)
Rubella: 1 dose received on or after the 1st birthday (usually given as MMR)
Hepatitis B: 3 doses received at proper intervals
Chicken Pox: As of July 1, 2002 varicella immunization prior entrance to kindergarten: 1 dose on or after the 1st birthday, or physician’s statement verifying disease history, or laboratory evidence of varicella immunity.