District Medical Forms
Illinois dental form: 2020_dental.pdf
Illinois dental form Sp: 2020_sp_dental.pdf
Illinois dental waiver: dentalexamwaive.pdf
Illinois dental waiver Sp.:dentalexamwaiver_sp.pdf
Illinois dental form Sp: 2020_sp_dental.pdf
Illinois dental waiver: dentalexamwaive.pdf
Illinois dental waiver Sp.:dentalexamwaiver_sp.pdf
Illinois State Eye Exam Form: eyeexamreport.pdf
Eye exam waiver: eye-examination-waiver-050216__1_.pdf
Eye exam waiver: eye-examination-waiver-050216__1_.pdf
Illinois Elementary School Athletic Form: elementary_sports_physical.pdf
6th grade Illinois State Childhood Examination and Immunization form: child-health-exam-form-revised-01-31-2024.pdf
Kindergarten Illinois State Childhood Examination and Immunization form: child-health-exam-form-revised-01-31-2024.pdf
Lead level questionnaire: lead_questionare.pdf Spanish version: lead_lraq_spanish_9-07__1_.pdf
6th grade Illinois State Childhood Examination and Immunization form: child-health-exam-form-revised-01-31-2024.pdf
Kindergarten Illinois State Childhood Examination and Immunization form: child-health-exam-form-revised-01-31-2024.pdf
Lead level questionnaire: lead_questionare.pdf Spanish version: lead_lraq_spanish_9-07__1_.pdf
Required Vaccine Information:
Pneumococcal Conjugate:
www.immunize.org/wp-content/uploads/vis/pcv.pdf
www.immunize.org/wp-content/uploads/vis/spanish_pcv.pdf
DTap:
www.immunize.org/wp-content/uploads/vis/dtap.pdf
www.immunize.org/wp-content/uploads/vis/spanish_dtap.pdf
IPV:
www.immunize.org/wp-content/uploads/vis/polio_ipv.pdf
www.immunize.org/wp-content/uploads/vis/spanish_polio_ipv.pdf
HIB:
www.immunize.org/wp-content/uploads/vis/hib.pdf
www.immunize.org/wp-content/uploads/vis/spanish_hib.pdf
HepB:
www.immunize.org/wp-content/uploads/vis/hepatitis_b.pdf
www.immunize.org/wp-content/uploads/vis/spanish_hepatitis_b.pdf
Varicella:
www.immunize.org/wp-content/uploads/vis/varicella.pdf
www.immunize.org/wp-content/uploads/vis/spanish_varicella.pdf
MMR (Measles Mumps Rubella):
www.cdc.gov/vaccines/hcp/vis/vis-statements/mmr.pdf
www.immunize.org/wp-content/uploads/vis/spanish_mmr.pdf
MMRV (Measles Mumps Rubella Varicella):
www.immunize.org/wp-content/uploads/vis/mmrv.pdf
www.immunize.org/wp-content/uploads/vis/spanish_mmrv.pdf
Meningococcal:
www.immunize.org/wp-content/uploads/vis/meningococcal_acwy.pdf
www.immunize.org/wp-content/uploads/vis/spanish_meningococcal.pdf
Tdap:
www.immunize.org/wp-content/uploads/vis/tdap.pdf
www.immunize.org/wp-content/uploads/vis/spanish_tdap.pdf
Pneumococcal Conjugate:
www.immunize.org/wp-content/uploads/vis/pcv.pdf
www.immunize.org/wp-content/uploads/vis/spanish_pcv.pdf
DTap:
www.immunize.org/wp-content/uploads/vis/dtap.pdf
www.immunize.org/wp-content/uploads/vis/spanish_dtap.pdf
IPV:
www.immunize.org/wp-content/uploads/vis/polio_ipv.pdf
www.immunize.org/wp-content/uploads/vis/spanish_polio_ipv.pdf
HIB:
www.immunize.org/wp-content/uploads/vis/hib.pdf
www.immunize.org/wp-content/uploads/vis/spanish_hib.pdf
HepB:
www.immunize.org/wp-content/uploads/vis/hepatitis_b.pdf
www.immunize.org/wp-content/uploads/vis/spanish_hepatitis_b.pdf
Varicella:
www.immunize.org/wp-content/uploads/vis/varicella.pdf
www.immunize.org/wp-content/uploads/vis/spanish_varicella.pdf
MMR (Measles Mumps Rubella):
www.cdc.gov/vaccines/hcp/vis/vis-statements/mmr.pdf
www.immunize.org/wp-content/uploads/vis/spanish_mmr.pdf
MMRV (Measles Mumps Rubella Varicella):
www.immunize.org/wp-content/uploads/vis/mmrv.pdf
www.immunize.org/wp-content/uploads/vis/spanish_mmrv.pdf
Meningococcal:
www.immunize.org/wp-content/uploads/vis/meningococcal_acwy.pdf
www.immunize.org/wp-content/uploads/vis/spanish_meningococcal.pdf
Tdap:
www.immunize.org/wp-content/uploads/vis/tdap.pdf
www.immunize.org/wp-content/uploads/vis/spanish_tdap.pdf
Recommended Vaccines:
HPV (Human Papillomavirus):
www.immunize.org/wp-content/uploads/vis/hpv.pdf
www.immunize.org/wp-content/uploads/vis/spanish_hpv.pdf
Hepatitis A (Hep A):
www.immunize.org/wp-content/uploads/vis/hepatitis_a.pdf
www.immunize.org/wp-content/uploads/vis/spanish_hepatitis_a.pdf
HPV (Human Papillomavirus):
www.immunize.org/wp-content/uploads/vis/hpv.pdf
www.immunize.org/wp-content/uploads/vis/spanish_hpv.pdf
Hepatitis A (Hep A):
www.immunize.org/wp-content/uploads/vis/hepatitis_a.pdf
www.immunize.org/wp-content/uploads/vis/spanish_hepatitis_a.pdf
Asthma Packet (download):
Asthma assessment form: asthma_assessment_2018.pdf
Asthma assessment form Spanish: asthma_assessment_2016_spanish.pdf
Medication authorization medicauthorization2018gside_1_copy.pdf
Medication self-administer form: medauthpg2selfadm_2018.pdf
Asthma action plan: asthmaactionplan-jul2008-high-res.pdf
Asthma assessment form: asthma_assessment_2018.pdf
Asthma assessment form Spanish: asthma_assessment_2016_spanish.pdf
Medication authorization medicauthorization2018gside_1_copy.pdf
Medication self-administer form: medauthpg2selfadm_2018.pdf
Asthma action plan: asthmaactionplan-jul2008-high-res.pdf
Allergy Packet (download):
Allergy assessment form: annlallxassessform2018.pdf
Allergy assessment form Spanish: allergy_assess_span_2018.pdf
Anaphylaxis Plan: revised_anaphylaxis_plan_2011.pdf
Medication authorization: medicauthorization2018gside_1_copy.pdf
Medication self-administration form: medauthpg2selfadm_2018.pdf
Allergy assessment form: annlallxassessform2018.pdf
Allergy assessment form Spanish: allergy_assess_span_2018.pdf
Anaphylaxis Plan: revised_anaphylaxis_plan_2011.pdf
Medication authorization: medicauthorization2018gside_1_copy.pdf
Medication self-administration form: medauthpg2selfadm_2018.pdf
Diabetes Packet (download):
Diabetes questionnaire:_sample-diabetes-medical-management-plan-508.pdf
Diabetic Eye Exam:_ eyeexamreport.pdf
Diabetic Medication Authorization: diabmedform2018.pdf
Diabetes questionnaire:_sample-diabetes-medical-management-plan-508.pdf
Diabetic Eye Exam:_ eyeexamreport.pdf
Diabetic Medication Authorization: diabmedform2018.pdf
Seizure Packet (download):
Parent letter: seizure_parent_letter_.pdf
Parent letter Spanish: spanishseizure_letter_2018.pdf
Parent questionnaire: seizure_quest.__2017.pdf
Parent questionnaire Spanish: spanish_seizure_questionnaire_2018.pdf
Seizure plan: seizure-action-plan.pdf
Medication authorization form: medicauthorization2018gside_1_copy.pdf
Parent letter: seizure_parent_letter_.pdf
Parent letter Spanish: spanishseizure_letter_2018.pdf
Parent questionnaire: seizure_quest.__2017.pdf
Parent questionnaire Spanish: spanish_seizure_questionnaire_2018.pdf
Seizure plan: seizure-action-plan.pdf
Medication authorization form: medicauthorization2018gside_1_copy.pdf
Medication authorization form (download): medicauthorization2018gside_1_copy.pdf
Medication self administration form: medauthpg2selfadm_2018.pdf
Medication self administration form: medauthpg2selfadm_2018.pdf