May 17  • A Few Clouds 81.0°  •  

Nurse Manual


Illinois Department of Public Health (IDPH)

Health Manual Table of Contents

The Diabetes Medical Management Plan

Section 1: Illinois State Board of Education and Illinois Department of Public  

           Health: Management of Chronic Infectious Diseases in School Children


Section 2: Illinois Department of Public Health: Communicable Disease Guide


Section 3: Health Service Forms and Written Communication

          Authorization for Exchange of Confidential Education & Health Information

          Authorization for Release of Information

          Child, Il State law Requires letter for Parent

          Child Health Exam ILL 444-4737

          Child Health Exam IL 444-4735 – Spanish

          Contact with Parent letter – Absence 3 days

          Dental Exam Waiver

          Dental Examination Requirement

          Dental Ill Proof of Examination

          Dental Ill Proof of Examination – Spanish

          Dental, Smile, IL Mobile Save the Date

          Determination for 1-1 Paraprofessional  

          Health Plan

          Health Plan Criteria Guidelines

          Hearing letter – did not pass annual school screening

          Hearing letter – unable to be conditioned

          Hearing Screening Follow-up

          Intake IEP Information

          Parent Letter - Upcoming case study

          Parent Letter Ill Law – Immunizations/physical examination

          Parent Letter – School Nurse Visit

          Parent Letter – Physical Exam history requirement

          Post surgical hospital report

          Request for Physicians orders for 1-1 nursing services

          Second Request for medical follow-up

          Seizure Action Plan

          Seizure Questionnaire for parent

          Student Report of Accident Form

Section 3: Health Service Forms and Written Communication (continued)

          Student Accident Claim Form

          Student Incident Report

          Student Participation Emergency Form

          Treating Physician’s Report

          Vision Exam Report State of Ill –Eye Exam Report

          Vision Exam Report State of Ill

          Vision Exam Waiver

          Vision Hearing Screening results

Section 4: Parent/Guardian Letters Re. Communicable Diseases

   Chicken Pox

   Chicken Pox - Spanish

          Conjunctivitis (Pink eye)

          Conjunctivitis (Pink eye) - Spanish

          Fifth Disease

          Fifth Disease - Spanish

          Hand-Foot-Mouth Disease

   Herpanginga (Viral Sores in Throat)


          Lice – Spanish


          Ringworm - Spanish


          Scabies - Spanish

          Scarlet Fever

          Scarlet Fever - Spanish

          Strep Throat

          Strep Throat - Spanish


Section 5: Procedure Guidelines  

  Medical Procedure Authorization Form

  Medical Procedure Authorization Form G-Tubes

  Medical Procedure Log

  Medication Authorization Form

  Medication Log

Medication Medical Procedure Request

  Medication Procedure Guidelines

Parent Letter for G Tube Supplies         

  Parent Letter Procedure Plan

Procedure Log       

Voluntary Agreement Plan

Section 6: Staff Inservice and Handout Materials

          Allergy  Action Plan

          DCFS Forms for Reporting Abuse/Neglect

          Diabetes Health Plan

          Employee Worker’s Compensation Guidelines

          Epi Pen

          In Service Training Record

          Menstrual record

          Seizure Action Plan

          Seizure Observation record

          Skin-Level Gastrosomy Indwelling Feeding Device

Section 7: Staff Injury/Bloodborne Pathogen Exposure

          Bloodborne Pathogen Inservice Attendance Log        

          Employee Authorization for Medical Records Report

          Employee Exposure Testing

          Employee First Report of Injury

          Employee Injury Report

          Employee Injury Report by Witness

          Employee Supervisor’s Report

          SPEED Employee Injury Report

          Student Bloodborne with Student Accident Claim Form

          Student Bloodborne without Student Accident Claim Form

          Universal Precautions and Work Practice Controls

Section 8: Additional Materials

   General Guidelines for Agency/1:1 Nurses Working in a SPEED Program

   SPEED Job Description: Nurse

          Health Requirements from State of Il









Schools / Programs

Program for Adaptive Learning
Independence School
Early Learning Center

Special Education Joint Agreement School District #802
1125 Division Street
Chicago Heights, IL 60411
Phone: 708/481-6100
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