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East Maine School District 63

 
 
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Health Forms

 

 

 

For more information, contact Robin Olson, District Nurse or your school health office.

Health Forms:
Parents Consent for Emergency Treatment  Inhaler Regulations 
IL Certificate of Child Health Examination Code Immunization Requirements
State of Illinois Child Health Examination Form Dental Examination Requirement for K, Grade 2 and Grade 6 Students
Certificado de Examen de Salud del Nino (A) Proof of School Dental Examination Form
  Formulario Comprobante Del Examen Dental Escolar
Childhood Lead Risk Assessment Questionnaire for Children in Pre-K and Kindergarten State of Illinois Eye Examination Report
Cuestionario de Asesoramiento Infantil de Riesgo por el Plomo Physician Authorization for the Administration of Medication/Treatments at School (SE-153rev8.5MDed)
High Risk Zip Codes for Pediatric Blood Lead Poisoning Parent/Guardian Authorization for Medication/Treatments at School (SE-153rev8.5ParMed)
 
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phone 847.299.1900 East Maine School District 63 10150 Dee Rd Des Plaines, IL 60016
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