Christian Liberty Academy

Health Information

School Nurse: Mrs. Nancy Kramer, R.N., B.S.N.
Email:  This email address is being protected from spambots. You need JavaScript enabled to view it. 

Nurse's Office Hours: 8:30am to 3:30pm

Nurse's Blog:  Healthtalk

Welcome to Christian Liberty Academy! The goal of the Christian Liberty Academy Nurse's Office is to promote the optimum health of all students so that they may receive maximum benefit from their educational experience.  In order to make sure your child stays safe and healthy while in school, we require the following information to be submitted. In addition, if your child has a chronic health condition, such as asthma, diabetes, seizures, etc., please notify your school nurse immediately, as additional information will be required as described below.

Nurse's Office

Please notify the clinic of any medical changes in your student (i.e. surgery, major injuries, changes in medication, etc.) and maintain up-to-date address and phone number information with the registrar (847) 385 - 2011. If your student has surgery, please notify me. You will need to provide me with a doctor's release to return to school. Any doctor's note with medical information needs to be turned in to the clinic.

Required Medical Forms

Please click here to see all medicals forms.

Online Health and Contact Forms & Required Exams:

Every parent must have a ParentsWeb Account in order to complete the online Family Demographics and Health Forms. Click here to view the tutorial: http://www.christianlibertyacademy.com/images/documents/renWebTutorial.pdf

Every student must have yearly updated online Family Demographics and Health Forms.  Please complete these forms on the ParentsWeb under the section called “Web Forms” by August 1st, or immediately upon registration, if you come in and register later than that. Please note: this must be done in order to receive report cards or progress reports. 

View ParentsWebVideo

Required Exams: The physical, dental, and eye exams are regular forms will be emailed to you to download.  Once completed by the doctors, return the forms through an email attachment, fax, or bring them in to the office. You may also find them on this website:  Click Here to download forms: http://www.christianlibertyacademy.com/admissions/documents-and-forms.html#medical-forms

Medical Enrollment Requirements:

REQUIRED MEDICAL FORMS

FORM PS JK SK1 SK2 1 2 3 4 5 6 7 8 9 10 11 12

Online ParentsWeb

Family Demographics

 

X

 

X

 

X

 

X

 

X

 

X

 

X

 

X

 

X

 

X

 

X

 

X

 

X

 

X

 

X

 

X

**Certificate of Child

Health

Examination

X

X

X

X

         

X

   

X

     

Dental Examination

   

X

X

 

X

     

X

           

Vision Examination

   

X

X

                       
Sports Physical                 X X X X X X X X

** A sports physical will NOT be accepted for the Certificate of Child Health Examination, as it is not recognized as a complete exam by the State of Illinois Department of Public Health.

STUDENTS WITH MEDICAL CONDITIONS

 

FORM Care Plan Medication Authorization Form (this form also includes the permission to carry the medication if the student requires this)
Severe Food Allergies requiring EpiPen administration X X
Asthma X X
ADHD X X
Diabetes X X
Seizures X X
Concussions X X
Other Conditions X X

 

TRANSFER STUDENTS

FORM OUT-OF-STATE TRANSFER IN-STATE TRANSFER

Online ParentsWeb

Family Demographics

 

All Students

 

All Students

**Certificate of Child

Health

Examination

All Students

Copy of most recent required physical depending on grade level

Dental Examination

Grades SK, 2, & 6

Grades SK, 2, & 6

Vision Examination

All Students

Grade SK

Sports Physical Grades 5-12 done yearly for all athletes participating in a team sport Grades 5-12 done yearly for all athletes participating in a team sport

**A sports physical will NOT be accepted for the Certificate of Child Health Examination, as it is not recognized as a complete exam by the State of Illinois Department of Public Health.

SUMMARY OF MEDICAL FORMS FOR 2017-2018:

ALL STUDENTS:

Online Family Demographics Forms – all parents must go online to ParentsWeb and complete these forms by August 1st.  Please note this must be done in order to receive progress & report cards including preschool progress reports.

FORMS THAT MUST BE SUBMITTED TO THE HEALTH OFFICE – YOU MAY EMAIL THEM TO THE NURSE (This email address is being protected from spambots. You need JavaScript enabled to view it.), fax them (847-385-2062), or bring in the actual form.  These are due by the first day of school:

All SENIORS  (12TH Grade)

Meningococcal Vaccination Documentation (our form or the doctor’s form – must be signed by the doctor)

ALL 6TH GRADE

Tdap & Meningococcal Vaccination given at the 6th grade physical examination and documented on the physical exam.

PRESCHOOL, JUNIOR KINDERGARTEN, SENIOR KINDERGARTEN 1 & 2  (ALL KINDERGARTENERS, BOTH JUNIOR & SENIOR, MUST HAVE A NEW CCHE DUE TO VACCINES REQUIREMENTS AT AGE 4 & 5),
GRADE 6, GRADE 9, AND ALL NEW STUDENTS:
Physical Exam form from the State of Illinois called the “Certificate of Child Health Examination”
**A sports physical will NOT be accepted for the Certificate of Child Health Examination, as it is not recognized as a complete exam by the State of Illinois Department of Public Health.

SENIOR KINDERGARTEN 1 & 2, GRADE 2,  GRADE 6 and ALL NEW STUDENTS through Grade 8:

Dental Exam

SENIOR KINDERGARTEN 1 & 2, and ALL NEW STUDENTS through Grade 8 :

Eye Exam

STUDENTS WITH EPIPEN/SEVERE FOOD ALLERGIES:

Food Allergy/Anaphylaxis Care Plan & Medication Authorization if child is carrying an EpiPen & if the nurse needs to give Benadryl orally

STUDENTS WITH ASTHMA:

Asthma Action Plan & Medication Authorization if the student carries an inhaler and/or nurse gives medication.

STUDENTS WITH ADHD

ADHD Care Plan & Medication Authorization if nurse is giving medication at school

STUDENTS WITH DIABETES, SEIZURES, CONCUSSIONS, OR OTHER MEDICAL PROBLEMS:

Diabetes Care Plan, Seizure Action Plan, Concussion Care Plan, Individual Care Plan (for other conditions not mentioned) & also the Medication Authorization as needed

REQUIRED VACCINE INFORMATION:

The State of Illinois Certificate of Child Health Examination must be completed by your health care provider with the month, day, and year of every dose of vaccine administered.  The following are the current required vaccine doses by grade:

REQUIRED VACCINE DOSES BY GRADE

FORM PS JK SK 1 2 3 4 5 6 7 8 9 10 11 12

DTP/DTaP

3 3 4 4 4 4 4 4 4 4 4 4 4 4 4

Tdap

                1 1 1 1 1 1 1

OPV/IPV

3 3 3 3 3 3 3 3 3 3 3 3 3 3 3

HIB

series series                          

HepB

3 3             3 3 3 3 3 3 3

Varicella

(Chickenpox)

1 1 2 2 2 2 1 1 2 2 2 2 2 2 2

MMR

1 1 2 2 2 2 2 2 2 2 2 2 2 2 2

PCV

(Pneumonia)

series series                          

MCV4

(Meningococcal)

                1 1 1 0 0 0 2

PLEASE NOTE:  We do not force anyone to have immunizations that they object to.  We believe that the health of the child is the responsibility of the parent.  You may write and submit a religious exemption letter – see the detailed information below under “Physical Form and Immunizations” section.  We must have some kind of paperwork on file for accreditation purposes:  the record of vaccinations, a medical exemption letter from a physician, or the State of Illinois Certificate of Religious Exemption to Required Immunizations.

Recent Immunization Changes:

MENINGOCOCCAL CONJUGATE VACCINE (MCV4)
Applies to students entering grades 6 & 12 grades beginning with the 2015-2016 school year.
All students entering grade 6 must show proof of receiving one dose of meningococcal conjugate vaccine (MCV4) on or after 11 years of age.
**All students entering grade 12 must show proof of receiving two doses of meningococcal conjugate vaccine. If the first dose of MCV4 was administered after 16 years of age, then only 1 dose of MCV4 is required at grade 12 entrance.

VARICELLA (CHICKENPOX) VACCINE:
Progression of 2 Dose Varicella Vaccine Requirement for Completion by All grades (K-12) by 2019 (Underlined Grade Level Indicates 2 doses required)

2017-2018   K 1 2 3 4 5 6 7 8 9 10 11 12
2018-2019   K 1 2 3 4 5 6 7 8 9 10 11 12
2019-2020   K 1 2 3 4 5 6 7 8 9 10 11 12

Tdap VACCINE:
Illinois Department of Public Health rules adopted in September 2011 now mandate that all students currently enrolled in grades 6 through 12, shall show proof of receiving one dose of Tdap (defined as tetanus, diphtheria, acellular pertussis) vaccine regardless of the interval since the last Dtap, DT or Td dose.

Physical Forms and Immunizations

Physical Exam Forms Grades Preschool, K, 6 and 9
Child Health Examination forms and required immunizations must be submitted prior to the first day of school for students in grades Preschool, JK, SK, 6 and 9.

  1. The physical exam must be completed within one calendar year prior to the start of school and must fulfill all Illinois State Board of Education and Illinois Department of Public Health requirements.
  2. If you cannot see your doctor, there are a number of places that offer these services including immediate care centers and drug stores with clinics.  See the table provided on the next page.
  3. Students who are new to CLA and IL schools must submit health records upon entry into school.  Transferred health records will be reviewed by the school nurse for compliance with Illinois school health requirements.
  4. **Students who have not received immunizations due to religious beliefs should present a written note explaining their personal religious objections.
  5. **Students who have not received immunizations due to medical objections should present a note from the physician stating the medical condition that contraindicates the immunization.
  6. A sports physical will NOT be accepted for the Certificate of Child Health Examination, as it is not recognized as a complete exam by the State of Illinois Department of Public Health.

**According to state law 105 ILCS 5/27-8.1(8) Parents or legal guardians who object to health, dental, or eye examinations or any part thereof, or to immunizations, on religious grounds shall not be required to submit their children or wards to the examinations or immunizations to which they so object if such parents or legal guardians present to the appropriate local school authority a signed statement of objection, detailing the grounds for the objection. If the physical condition of the child is such that any one or more of the immunizing agents should not be administered, the examining physician, advanced practice nurse, or physician assistant responsible for the performance of the health examination shall endorse that fact upon the health examination form. Exempting a child from the health, dental, or eye examination does not exempt the child from participation in the program of physical education training provided in Sections 27-5 through 27-7 of this Code [105 ILCS 5/27-5 through 105 ILCS 5/27-7].

How to complete the Certificate of Religious Exemption to Required Immunizations and/or Examinations Form:
• Complete the Parent/Guardian sections, which include key information about the student and the school the student will be entering, and the immunizations or examinations for which religious exemption is being requested. Provide a statement of religious belief(s) for each vaccination/examination requested.
• The form must be signed by the child’s parent or legal guardian AND the child’s health care provider* responsible for performing the child’s health examination
• Submit the completed form to local school authority prior to the first day of the school year.

Dental Forms
Illinois State law mandates that all SK, 2 and 6 grade students, and new students up to grade 8 including homeschool transfers, and out of state transfers must present proof of a dental examination prior to May 15 of that school year and must be completed within 18 months prior to the required date. 

A waiver has been established by the Illinois Department of Public Health for students who show undue burden or lack of access to a dentist.

Kindergarten Vision Examination Forms
Illinois State law mandates that all incoming grade SK, and new students up to grade 8 including homeschool transfers, and out of state transfers must present a vision exam report conducted by a physician who provides a complete eye exam or a licensed optometrist.

This report must be submitted to the school by October 15 of the school year and must be completed within one year prior to the required date.

A waiver has been established by the Illinois Department of Public Health for students who show undue burden or lack of access to an ophthalmologist or optometrist.

Sports Exam
IHSA member schools are required to keep a signed Concussion Acknowledgement and Consent form and a current Pre-participation Physical Examination on file for all student athletes participating on sports teams.  Religious exemptions are not accepted in place of the exam, only the vaccinations.  For students in 6th and 9th grades, the State of Illinois Certificate of Child Health Examination Form (CCHE) will serve as the physical exam section of the sports physical.  Sport physicals deadline dates for 5th through 12th grade athletes are the first day of practice for the sport the student is participating in. There cannot be any exceptions.

The following forms may be applicable to your child

Please Note:If you are going to the doctor and your child has any of the conditions or medication needs listed below, please read this section and download the forms from our website that the doctor must complete or obtain them from the School Nurse before your appointment. 

  1. Special Health Care Plans: If your child has one of the conditions listed below that requires nursing care at school, please obtain the appropriate form and take it to your doctor for completion. These conditions require a special health care plan: ADD/ADHD, food allergy, asthma, diabetes, seizure disorder, acute concussion care plan.  Also, an Individual Health Care Plan is available for all other conditions that may require the nurse to assist your child at school.
  2. Medications: Illinois state law mandates that a permission form needs to be signed for ALL medication given, prescription or non-prescription signed by the doctor and the parent/guardians. Should your child need to take medication at school and the nurse must administer or oversee the administration of that medication, please submit aMedication Authorization form.
  3. Should your child need to carry an asthma inhaler or EpiPen, you must have a Medication Authorization form completed and signed by your physician and the parent/guardian before the first day of school.

Area School Physical and Immunization Providers:

Please Note:  This list is provided for your convenience and information, however we do not make recommendations or assume responsibility for the quality of services provided.  IMPORTANT:  Immunizations will not be given at these establishments unless you bring your immunization records with you.  Please bring the appropriate physical exam form with you as they do not always have the correct form. 

            Updated March 2017 - Please call before going for updated information.

Name

Address

Phone Appointment Needed Dates / Times Immunizations Physical Exam

Village of Arlington Heights

33 S. Arlington Hts. Rd., Arlington Hts., IL

847-368-5760 Call – You must submit Immunization Record at least 2 weeks before and nurse will call you back.

2nd Monday of the Month

5 – 7 pm

$10 per shot

Low Cost

N/A

Family Practice Center

371 NW Hwy.

Palatine, IL 60067

847-776-7800 Appointment or Walk-in

M-F 9am – 9pm

Sat./Sun 10am – 8pm

N/A except flu shot

School $49

Sports $49

Emery Medical Center

2380 S. Elmhurst Rd.

Mt Prospect, IL 60056

847-228-5557

Walk-in

Sat. by appt. only

M-F  9am – 5pm

Sat. 9am – 2pm

No

School $50

Sports $50

Children’s Care Hoffman Estates

Hoffman Estates Village Hall

1900 Hassell Road

847-781-4850 No

1st Monday of the Month

3:30pm to 6:00pm

(also 3rd Mon. in August) (No clinic in July, Sept – changed to 2nd Monday)

$8 per shot

For residents;

$10 per shot for non-residents;

Free with AllKids

N/A

Walgreens Health Care Clinic

3 East Golf Rd., Arl. Hts. Or

375 E. Dundee, Palatine

Arlington Hts.:

847-593-6650

Palatine:

847-934-5741

Walk-In

M-F 9am -7 pm

Sat./Sun 9am- 4pm

Varies

School $148 * *without ins.

Sports $60

CVS Minute Clinics:

2045 Plum Grove Rd, Rolling Mdws.

1801 Golf Rd, Schaumburg

1855 W. Irving Pk. Rd. Schaumburg

101 S. NW Hwy, Barrington

1305 Randall Rd, Crystal Lake

Rolling Mdws.:

847-303-2451

Schaumburg:

Golf Rd.: 847-885-1326

Irving Pk. Rd: 630-893-5570

Barrington:

847-381-4105

Crystal Lake:

815-356-0386

Walk-In

Important information:
Clinic closing times may vary due to the number of patients waiting to be seen. Additional patients may not be able to sign in when the wait time extends past the posted clinic closing time.

M-F  8:30am – 7:30pm

Sat.  9am – 5:30pm

Sun. 9am – 4:30pm

Varies

Sports $69

General Medical Exam $89

Message from the Nurse

"Hello, my name is Nancy Kramer and I have been the School Nurse for Christian Liberty Academy since 1996. I have experience in Hospital, Community Health, and Agency Nursing. I have loved all aspects of nursing, but I must say I have really enjoyed being a School Nurse and feel very blessed to be at CLA." 

Kramer Nancy

Click here to see full Nurse's Profile

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