Mrs. Donna Kirk R.N.
Elm Place School Nurse
phone:(847)432-8490
Physical Exam Requirements
A physical exam form (Certificate of Health Examination) is required for all students entering 6th grade and 9th grade. This form is also required for any student entering an Illinois school for the first time.
Both sides of the form must be completed, and turned into the school before the first day of school.
This form is adequate for participation in interscholastic/intramural sports also.
Interscholastic/Intramural Medical Form
An Interscholastic/Intramural Medical form is required yearly for any students participating in after school sports. The form is valid for one year from the date of the physical exam. It must be in the office before the student may try-out.
A dental exam must be on file in the health office for all 6th grade students by May 15th of their 6th grade year.
Medication Administration Form
A District 112 medication form must be completed yearly, for any medication administered at school (including Tylenol, Advil, cough medication, inhalers, etc.) The medication form must be signed by the prescribing physician and the parent.
If a student must carry an inhaler or epi-pen on themselves, a separate, self-administration form must be completed by the physician.
No medications can be given by school district personnel without these forms being completed.
Medication must be in it's original container, with the student's name on it.