Evergreen ParkElementary School District 124


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Health Services

Evergreen Park School District 124 recognizes the critical relationship between health and learning. "You cannot educate a child who is not healthy, and you cannot keep a child healthy who is not educated."-Jocelyn Elders MD, former Surgeon General

The health offices are staffed by a full-time Health Aide and 2 circulating District Registered Nurses. At Evergreen Park School District 124, the School Nurses and Health Aides strive to ensure students’ physical, emotional and mental health needs are met.

Health Forms

IL Child Health Exam Form
Mandated physical form to be completed by physician for entrance into Preschool, Kindergarten, 6th grade and first time entry into School District 124.

Eye Exam Report Form
Required for Kindergarten and new students to the state of Illinois.

Dental Exam Form
To be completed by a licensed Dentist for students in kindergarten, 2nd grade and 6th grade by May 15th of the school year.
Dental Exam Form (Spanish)

Medication Authorization Form
Required for all medication (including over-the-counter) to be administered during school hours per School District 124 and State of Illinois policy.

Diabetes Medical Management Plan
To be completed by physician and parent, accompanied by Medication Authorization form.

Inhaler Self Administration Form
To be completed for inhalers carried by students accompanied by a copy of the prescription label.

Asthma Action Plan
To be completed for students with Asthma, accompanied by Medication Authorization form (e.g. inhaler) and/or the Inhaler Self Administration Form.

Allergy Emergency Action Plan
To be completed for students with severe allergies, accompanied by Medication Authorization form (e.g. EpiPen)

Seizure Action Plan
To be completed for students with a seizure disorder, accompanied by Medication Authorization form.

Immunization Reports

Public Act 097-0910 requires that on or before December 1 of each year, every public school district and registered nonpublic school shall make publicly available the immunization data they are required to submit to the State Board of Education by November 15.
AED and CPR Video

On the IHSA website, a video on hands-only cardiopulmonary resuscitation and automated external defibrillators is posted. We encourage parents and staff to view it. Please click here to access the IHSA website with more information. The CPR video is below. 
Kristen Campbell
Nurse Coordinator

Mary Alice Augustinas
Central Middle School
RN Nurse
Barb Lusk
RN Nurse
Elizabeth Fitzpatrick
RN Nurse
Michelle Matt
RN Nurse