Health & Wellness

Forms

Medical

Anaphylaxis Emergency Action Plan
Students with severe allergies should have an anaphylaxis emergency plan on file with the school nurse. 
 Click here to access a blank Anaphylaxis Action Plan form that you may take to the doctor. The completed form should be presented to the school office.

Asthma Action Plan
An asthma action plan (also called a management plan) is a written plan that is developed 
with the student's doctor to help control his/her asthma. The asthma action plan gives the school district important information about the student's daily treatment, such as what kind of medicines have been prescribed and when they are taken. The plan describes how to control asthma long term AND how to handle worsening asthma, or attacks. The plan explains when to call the doctor or go to the emergency room. A completed form must be presented to the school office. Click here to access a blank Asthma Action Plan that you may take to the doctor.  

Chart of Required Immunizations for K-12 Students
Click here to access a printable chart from the Illinois Department of Public Health that details the minimum immunization requirements for students entering a child care facility or Illinois school.

Concussion Plan Document
Beginning with the 2016-2017 school year, Illinois school districts are required to implement a research-based response to concussion and head injuries.​
Click here to access the Concussion Plan and Forms

Diabetes Medical Management
Students who have been diagnosed with diabetes work with a school team to ensure a Section 504 plan is up-to-date as well as their Diabetes Medical Management Plan has been developed by the physician and shared with the school. In addition, staff interacting with a diabetic student complete diabetes training.
Sample Diabetes Section 504 Plan
Sample Diabetes Medical Management Plan

Physical Examination
All students entering Kindergarten, 6th grade, or entering an Illinois school for the first time need to have a new physical exam and the required immunizations.  Questions about these requirements can be directed to the school office and/or the school nurse.
Click here to access the Physical Examination Form

Sports Physical Examination
A sports physical is required each year for those students in grades 5-8 who want to try out for a sport.  All students trying out must have a current physical on file BEFORE trying out. 
Click here to access the Sports Physical Examination Form

Student Medical Authorization Form
This form is required when a student needs to take prescription and non-prescription medication to be taken at school.
Click here for the district's Student Medical Authorization Form

TDap Vaccine Requirement
Beginning with the 2013-2014 school year, all students entering, advancing or transferring into grades 6-8 will be required to show proof of receipt of one dose of Tdap vaccine.
Click here to read the overview from the Illinois Department of Health.

Dental

Dental Examination
All students entering Kindergarten, 2nd grade, or 6th grade must have a dental exam completed.
Click here to access Dental Examination guidelines
Click here to access the Dental Examination Form
Click here to access the Dental Waiver Form

Vision

Vision Examination
All students entering Kindergarten need to have a vision examination before October 15 of their entrance year to school.
Click here to access the Eye Examination Form

Health & Wellness Plans

Immunization Data

Per Illinois state law (097-0910), "every school shall report to the State Board of Education by November 15, in the manner which that agency shall require, the number of children who have received the necessary immunizations and the health examination (other than a dental examination or eye examination) as required, indicating, of those who have not received the immunizations and examination as required, the number of children who are exempt from health examination and immunization requirements on religious or medical grounds."  Parents may submit a request, in writing, to the Smithton school office for a copy of the annual report submitted to the Illinois State Board of Education.

Need information on immunizations, including flu shots? 
Please click here! or CDC

Need information about the meningococal disease and vaccine? 
Please click here!

Resources

Lead Testing

Results of our 2017 water testing for lead are detailed in this letter to Smithton families on February 1, 2017. More information about lead in drinking water can be obtained from the U.S. EPA's website at Drinking Water Schools and Childcare Facilities.