School Nurse Katie Dulle may be reached at (630) 243-3231, or via e-mail by clicking on her name.
- Medical Forms
- Health Examination Requirements
- Immunization Requirements
- Procedures for Administration of Medication
- Vision Screening Notification
- Alumni Medical/Immunization Records Request
- State of Illinois Child Health Examination Form
- State of Illinois Eye Examination Report
- State of Illinois Dental Examination Form
- State of Illinois Dental Examination Waiver
- IHSA Pre-Participation Medical Exam Form
- Certificate of Religious Exemption Form
- Certification of Medical Contraindication to the Use of a Face Covering Form
The Illinois School Code and Illinois Department of Public Health require that students provide the school with a completed health examination form and up-to-date immunization record. Schools are allowed to exclude students who are not in compliance with health examination and immunization requirements. Parents and guardians are advised that all required health and immunization records must be on file in the school office by the first day of school each year.
Students who are medically non-compliant after October 15 will be excluded from school until the proper documentation is provided to the school.
All students entering Lemont High School for the first time – including freshmen and in-state transfer students – must submit a complete State of Illinois Child Health Examination Form. This form must be signed by a licensed physician, advanced practice nurse (APN) or physician’s assistant (PA) in the State of Illinois.
All immunization dates since birth must be recorded (month/date/year) on the top of the Child Health Examination Form. These immunizations must meet the standards required by the Illinois Department of Public Health, with a signature from a physician or health care professional certifying their accuracy.
Parents/guardians must complete and sign the Health History section on the back of the Child Health Examination Form. If left incomplete or unsigned, the form will be returned to the parent/guardian.
Parents/guardians are strongly encouraged to keep a copy of the completed Child Health Examination Form for their records.
The Child Health Examination Form also may be used for a student’s sports physical for up to 13 months. In order to be eligible for the complete school year, the form should be dated after May 15. Parents/guardians should provide a copy of the form to the Athletics Administrative Assistant, along with the other documents required for participation in athletics. The original copy of the physical should be submitted to the School Nurse.
Freshmen may not submit a sports physical as a substitute for the required Child Health Examination Form.
Freshmen must provide a State of Illinois Dental Examination Form, completed by the student's dentist, by May 15 of their freshman year. This must be dated on or after November 15 of the student's 8th grade year.
All incoming freshmen also are encouraged to submit the State of Illinois Eye Examination Report (please see the note concerning vision screenings). Out-of-state transfer students are required to submit a State of Illinois Eye Examination Report, completed by an Illinois physician.
Lemont High School urges parents and guardians to schedule the appropriate medical appointments for their children early enough so that all immunizations and examinations are completed and documentation is on file in the Nurse’s Office in a timely manner. Child Health Examination Forms and the up-to-date immunization record are due in the Nurse’s Office by July 1.
Additionally, during the registration process, parents/guardians are urged to supply to the school any pertinent information about their children's medical history. This may be done by completing the "Medical Data Form" within the school's online registration module. If a student's medical condition changes during the school year, parents/guardians are asked to provide any updated information to the School Nurse.
- Immunizations Required for Enrollment
- Meningococcal Vaccination Requirements
- Immunization Compliance Report (2020-21 School Year)
The following immunizations are required for entry to an Illinois public high school:
- One dose of the Tetanus, Diphtheria and Pertussis (Tdap) vaccine
- One dose of the Meningococcal conjugate vaccine (with the dose having been given on or after the student's 11th birthday)
- Two doses of the Varicella (i.e., chicken pox) vaccine (with the first dose having been given on or after the student’s 1st birthday and the second dose no less than four weeks later)
- Two doses of the Measles, Mumps and Rubella (MMR) vaccine (with the first dose having been given on or after the student’s 1st birthday and the second dose no less than four weeks later)
- Three doses of the Hepatitis B vaccine (administered at the recommended intervals)
- Three or more doses of the DTP/DTap vaccine (with the last dose having been given on or after the student’s 4th birthday)
- Three or more doses of the Polio vaccine (with the most recent booster having been given on or after the student’s 4th birthday)
Any student entering the 12th grade in the State of Illinois is required to show proof of having received the proper dosage of the Meningococcal conjugate vaccine. A student must receive one dose of the vaccine on or after his/her 16th birthday; that dose may not be within eight weeks of a previous dose of the vaccine.
Parents/guardians are asked to do one of the following:
- If the student is compliant with the requirements listed above, either download the form above and ask that your student’s health care provider complete it in full, or provide a copy of your student’s immunization record from his/her health care provider showing the date(s) of the Meningococcal vaccine(s).
- If the student has not met the requirements listed above, schedule an appointment to receive the vaccine, and either download the form above and ask the health care provider to complete it in full, or provide an updated copy of the student’s immunization record showing the date(s) of the Meningococcal vaccine(s).
This documentation may be returned in person in the school’s Main Office; via fax (Attn: School Nurse) at (630) 243-7904; via e-mail; or via mail (Attn: School Nurse; c/o Lemont High School, 800 Porter Street, Lemont, IL 60439).
All incoming seniors must fulfill this requirement. Regardless of the student's grade in school, proof of having received the proper dosage of the vaccine should be submitted to the School Nurse as soon as the vaccine is given. Parents/guardians should not wait until their students are entering their senior year to provide this documentation.
Proper documentation of the vaccine should be provided to the school prior to the first day of school. Students who are medically non-compliant after October 15 will be excluded from school until the proper documentation is provided to the school.
Students who require specific medications (over the counter and/or prescription) during the regular school day or a school-related activity must fulfill these requirements and adhere to these procedures prior to the implementation of any medication in the school setting.
The appropriate Medication Authorization Form must be completed, signed and returned to the Nurse's Office. The form must be signed both by the student's physician and parent/guardian, and should be accompanied by the physician’s written order for the medication.
A physician’s written order for a specific medication (over the counter and/or prescription) a student is required to take during the regular school day or a school-related activity should include:
- Reason for medication
- Specific instructions (including precautions, possible adverse reactions and interventions)
- Duration of procedural implementation
Parents/guardians must renew the Medication Authorization Form and the physician’s written order annually. Additionally, if the physician's written order changes during the school year, a new Medical Authorization Form must be submitted to the Nurse's Office in order to replace the standing order.
Parents/guardians are responsible for immediately notifying the School Nurse of any changes in a student's medication.
Students who do not have the State of Illinois Eye Examination Report on file with the school are subject to a vision screening by the School Nurse at the mandated age/grade level. Vision screening is not a substitute for a complete eye and vision examination by an eye doctor. Students who have had an eye examination by an optometrist or ophthalmolgist within the previous 12 months are not required to undergo a vision screening.