Bloomingdale School District 13 Health Office

Staff
Debbie English, RN
Michelle LaFontaine, RN
Michelle Lents, RN, CS

Health Office Website

DuPage County Health Department Pertussis Letter

District Medication Policy
Medications, either nonprescriptive or prescriptive, may be administered at school, but there are limitations that we place on procedures and practices.

Students may not carry any medication, with the exception of inhalers or Epi-Pens with the proper forms on file, including cough drops or lozenges, nor keep medication in their lockers. Medications (prescriptive or nonprescriptive) must be sent to the school office for safekeeping. We require:

1. All medications given in school, including non-prescription drugs, shall be prescribed by a licensed prescriber on an individual basis as determined by the student’s health status. Such written documentation must be maintained in the student’s individual medication record.
2. A written order for prescription and non-prescription medications must be obtained from the student’s licensed prescriber. The order includes:
• Student’s Name, Date of Birth, Licensed Prescriber, Signature and Date,
• Licensed Prescriber Phone and Emergency Number(s),
• Name of Medication—dosage, route of administration, frequency and time of Administration,
• Diagnosis Requiring Medication,
• Intended Effect of the Medication/Possible Side Effects,
• Other Medications Student is Receiving,
• Time Interval for Re-Evaluation,
• Approval for Self-Administration,
• Approval for students to carry emergency medication on their person (i.e. inhaler, Epi-Pen)
3. Prescription medication must be brought to school in a container, labeled appropriately by the pharmacist or licensed prescriber.
4. Over the Counter Medication (non-prescription) medication shall be brought in with the manufacturer’s original label with the ingredients listed and the child’s name affixed to the container.
5. In addition to the licensed prescriber’s order, a written request shall be obtained from the parent(s) or guardian requesting that medication be given during school hours. The request must include the name of the student, the parent(s) or guardian’s name and phone number in case of emergency. It is the parent(s) or guardian’s responsibility to ensure that the licensed prescriber’s order, written request and medication are brought to the school.
6. Students should be evaluated on an individual basis regarding the need to carry emergency medication. A written statement signed by the student’s physician and parent or guardian verifying the necessity and student’s ability to self-administer the medication appropriately should be on file in the health office.

Medication Permission Forms
Medication permission forms may be printed and completed by parent and physician (when necessary). Please turn in these forms to your school office. If your child carries his/her inhaler, proper documentation must be on file in the office.

Click here for a copy of the Authorization and Permission for Administration of Medication Form.

Certificate of Child Health Examination Form
The state of Illinois recently revised the Certificate of Child Health Examination form. This is the form your physician must use to record the required preschool, kindergarten and 6th grade physicals. It may also be used for sports physicals.

Click here for a copy of the Certificate of Child Health Examination Form.

Dental Examination Record Form
Dental forms are required for students entering Kindergarten, Second Grade and Sixth Grade.

Click here for a copy of the Dental Examination Record Form.

Eye Examination Form
Illinois School Code requires that all children enrolling in kindergarten in a public, private or parochial school and any student enrolling for the first time in a public, private or parochial school shall have an eye examination.

Each such child is to present proof of having been examined by a physician licensed to practice medicine in all its branches or a licensed optometrist within the previous year before October 15 of the school year. If the child fails to present proof by October 15, the school may hold the child's report card until either (a) the child presents proof of a completed eye examination or (ii) the child presents proof that any eye examination will take place within 60 days after October 15.

This requirement may be waived for children who show an undue burden or a lack of access to a physician licensed to practice medicine in all its branches who provides eye examinations or to a licensed optometrist. Moreover, parents or legal guardians who object to eye examinations on religious grounds shall not be required to submit their children to the examination if such parents or legal guardians present to the appropriate local school authority a signed statement of objection, detailing the grounds for the objection.

Each public, private and parochial school is required to give notice of this eye examination requirement to the parents and guardians of students. Every school shall report to the State Board of Education by June 30 the number of children who have received the required eye examination, indicating, of those who have not received the required eye examination, the number of children who are exempt from the eye examination on religious grounds, the number of children who have received a waiver, and the total number of children in noncompliance with the eye examination requirement.

Click here for a copy of the Eye Examination Record Form.

Sports Physicals
By law, students who wish to try out (including clinics) for any sport including cheerleading and poms, must have a yearly sports physical on file in the office.

Click here for a copy of the IHSA/IESA Sports Physical Form.