Health Forms
This page contains links to downloadable health forms for District 401 students.
As mandated by Board Policy 7:100, failure to submit required health forms, or to follow through on exemption rules outlined by the Illinois Department of Public Health, will result in the student's exclusion from school until the required forms are presented to the District.
If You Know Which Forms You Need
Click the expandable row located directly below titled "All District 401 Health Forms." Links inside the row are listed in alphabetical order.
If You're Not Sure Which Forms You Need
Start with the section below titled Letter to Parents About Student Health Requirements.
Then jump to the Health Form Directory, where you will see expandable rows containing links to the various forms. Click the rows that apply to your child.
Letter to Parents About Student Health Requirements
This letter provides a detailed list of all immunizations, health exams and health forms required of District 401 students from preschool through 12th grade:
For your convenience, this letter is also available to download in single languages:
Health Form Directory
For links to all necessary forms, click the rows located below that apply to your child.
Download and submit this medical information form. All students — new or returning — must fill out and submit this annually updated document:
Download and submit the following two forms. These documents are required of any student who is new to District 401 regardless of grade (except preschoolers, who do not need to submit an eye exam report):
- Illinois Certificate of Child Health Examination Form
- Illinois Eye Examination Report (not required for preschool)
If your child is new to the District and is entering kindergarten, 2nd grade or 6th grade, this document is also required:
Download and submit the following form. This document is required of any D401 student who is entering preschool:
Download and submit the following forms. These documents are required of any D401 student who is entering kindergarten:
Download and submit the following form. This document is required of any D401 student who is entering 2nd grade:
Download and submit the following forms. These documents are required of any D401 student who is entering 6th grade:
Download and submit the following form. This document is required of any D401 student entering 9th grade:
Download and submit the following form. This document is required of any student who wants to play sports for Elm Middle School:
Download and submit the following form. This document is required of any student who wants to play sports for Elmwood Park High School:
Download and submit the following form. This document is required of any D401 student who must take medication while in school. The form authorizes the school nurse or other member of the District staff to administer the medication:
Download and submit the following form. This document is required of any D401 student who needs to self administer medication while in school:
Download and submit the following form if you are returning with restrictions after an excused health-related absence. This form is optional:
Download this asthma action plan from the American Lung Association:
Download this food allergy and anaphylaxis emergency care plan from Food Allergy Research & Education (FARE):
Download this seizure action plan from the Epilepsy Foundation:
The Loyola Pediatric Mobile Medical Unit (medical bus) is primarily for those who have no or limited insurance, are homeless or have public aid and cannot find a doctor to take them or cannot get a timely appointment. Contact your child's school nurse to see if your child is eligible to use the Mobile Medical Unit.
If your child is eligible, download both of these consent forms: