Springfield Public Schools - Home

Health Services

School Health Requirements
Physical Exams, Immunizations, Dental, EyePreschool Health Requirements
K-12 Health Requirements 2020-2021 (2)
Varicella VaccineChickenpox (varicella) Vaccine Requirements
Meningococcal Vaccine RequirementMeningococcal Vaccine Requirement
Certificate of Religious ExemptionCertificate of Religious Exemption
Polio Vaccine RequirementProgression of Polio Vaccine Requirement
Physical Examinations
Required upon first entry into school and grades K, 6, and 9Illinois Certificate of Child Health Examination
Spanish Version
IHSA/IESA Sports ExamPre-Participation Exam - sports
SIU Mobile Clinic Permission Form
SIU Medicine Mobile Health Care Registration FormRegistration Form
SIU Consent FormConsent Form
Information Sharing
Authorization for Release of InformationWhy a Release?
The Release Form
Allergies & Epi-Pens
AllergyAllergy Action Plan ~ Food/Bee Sting/Other
Epi-Pen - Severe Allergy Epipen AuthorizationParent & Student EpiPen Agreement
School Discussion GuideFood Allergy School Discussion Guide
Self-Administration of Asthma MedicationPhysician Request and Parent Agreement
Planning for CareQuestionnaire for Parent
Parent Letter - Asthma ManagementHome / School Asthma Plan of Care
Asthma Emergency Response ProtocolAsthma Emergency Response Protocol
Dental Exams
Oral health exam by a licensed dentist required for K, 2, and 6Dental Exam Waiver
Waiver as above, in Spanish
Dental Exam Form
Dental Exam Form, in Spanish
Medical Management PlanADA School Plan - Parent & MD
Parent Letter - Transitioning SafelyTransitioning Safely to Middle or High School
Eye Exams
Complete eye exam required for Kindergarten and students new to Illinois public schoolEye Exam Report -revised June '09
Eye Exam Waiver - revised June '09
Daily or PRNAuthorization from Parent & MD
Disposing of Unused Medications
Planning for CareSeizure information ~ Parent
Seizure Action Plan ~ Parent & MD
Seizure Observation Record ~ Staff
Basic Seizure First AidSeizure First Aid - Basic
Seizure ProtocolSeizure Protocol