District Information
District Health Check Off Forms
- 12th grade health req check off 2018-19.pdf
- All Health Requirements 2018-19.pdf
- 9th grade health req check off 2018-19.pdf
- 6th grade health req check off 2018-19.pdf
- 2nd grade health req check off 2019.pdf
- New Student health req check off 2018-19.pdf
- PreK Health Req check off 2018-19.pdf
- Kindergarten Health Req check off 2018-19.pdf
District Health Action Plans
- Asthma Action Plan.pdf
- Bee Sting Allergy Action Plan.pdf
- Food Allergy Action Plan.pdf
- Seizure Action Plan.pdf
Illinois Health Forms
- Child Health Exam11_15.pdf
- IL dental exam form.pdf
- IL dental exam waiver form.pdf
- IL eye exam form.pdf
- IL eye exam waiver form.pdf
- IL sports physical form.pdf
- ILCertificateofReligiousExemptionform.pdf
- Spanish Child Health Exam11_15.pdf
Medication Authorization
Peanut Allergy Resources
Asthma Protocol
Western CUSD 12 is formally requesting parent/guardians of a student with an asthma diagnosis to submit an Asthma Action Plan completed by student’s health care provider to the Health Office. This plan is written and developed by a student’s medical provider to help control the student’s asthma and gives detailed instructions on how to treat Asthma symptoms. Here is an example of an Asthma Action Plan. This request is stemming from Illinois Public Act 099-0843, which requires schools to request this information on all students with a diagnosis of Asthma. Illinois Public Act 099-0843 also required School Districts in Illinois to develop an “Asthma Episode Emergency Response Protocol,” which are the procedures to provide assistance to a student experiencing symptoms of wheezing, coughing, shortness of breath, chest tightness, or breathing difficulty. More information on Illinois Public Act 099-0843 can be located on the Illinois General Assembly website. If questions arise regarding this, please contact the School Nurse at 217-335-2323 or contact your student’s building administrator.