Emergency Notice

Emergency Notification

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Alex M. Martino
Junior High School
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Mrs. McAndrew
School Nurse - Martino

It is essential that parents inform the school nurse of all environmental, medication and food allergies that a student has. Please include the symptoms and severity of symptoms the student experiences with the reaction as well as the treatment required if any. If it is a food allergy we need to know what kind of exposure will result in a reaction; ingestion only or ingestion and contact with the allergen. This information should be updated yearly on the Health Survey.

Any student that has a life-threatening allergy needs to have an Illinois Food Allergy Emergency Action Plan and Treatment Authorization Form on file. This is a form that needs to be completed by the parent and physician and signed by both. The Allergy Action Plan needs to be renewed yearly. The information in the plan will be shared with school personnel that are involved in the education of your child.

Medications ordered may include epinephrine, Benadryl (anti-histamine), and/or a relief inhaler. Medications need to be provided to the school in the original container with the pharmacy label attached. If the medication is over-the-counter it needs to be provided in the original container. Students are allowed to carry epinephrine and inhalers with them during the school day and during school activities, however it is recommended that an additional dose of medication be kept in the school health office. It is essential that the parent and nurse communicate regarding the placement and how emergency medication will be accessed by the student and nurse in the event of an emergency.

 New Lenox School District 122 Food Allergy Procedures can be viewed in the Parent/Student handbook on page 40.

Allergy Emergency Action Plan


If your child has been diagnosed with asthma, even if symptoms have not occurred for a long period of time, the school nurse needs to be notified.

Information given to the nurse needs to be updated yearly and should include:

         1.The symptoms and severity of symptoms your child experiences.

         2.What triggers your child’s symptoms.

         3.What relieves his/her symptoms.

         4.What other medication your child is on.

         5.How often your child experiences symptoms/uses a relief inhaler.

 If your child will need to have medication at school:

         1.  A Medication Authorization Form will need to be completed and signed by you and the doctor. (even if the student will be carrying and self administering the inhaler)

         2.  For inhalers a recent pharmacy label with the prescribing information on it may be accepted as the doctor’s signature. 

  • The child needs to contact the nurse or have the nearest adult contact the nurse immediately in the event the inhaler does not relieve asthma symptoms.
  • It is recommended that a back up inhaler is provided to be stored in the nurse’s office in the event the student forgets or looses the inhaler.
  • A nebulizer is available for use in the event the doctor orders nebulizer treatments. The school will need to be provided with the medication, mouth piece/mask and tubing.
  • A new Medication Authorization Form needs to be provided each school year.
  • Illinois Public Act 099-0843, effective January 1, 2017, requires schools to request an Asthma Action Plan for all students with asthma. This plan must be completed and signed by the child's physician. There is a link to the form below, however we will accept  forms used by the child's medical provider. 
  •  Medication Authorization Form
  •  Asthma Action Plan

Effective July 1, 2005 all Illinois children in kindergarten, second, and sixth grades are required to have a dental examination. The exam must be performed by a licensed dentist and the dentist must sign the school dental examination form. Proof of the exam must be provided to the school by May 15 of the school year and the exam must have been completed with 18 months prior to that date.

 To be in compliance with the mandate the child needs to present, by May 15, one of the following; Proof of School Dental Examination form as described above, a completed Dental Examination Waiver form if any of the conditions listed on the form are met, a letter of religious exemption, or proof that an exam will take place within 60 days of May 15.

 Dental Examination Form

Dental Exam Waiver Form


The CDC recommends routine seasonal flu vaccination for all persons 6 months of age and older. For children between 6 months and 8 years it is recommended that they receive 2 doses 4 weeks apart initially and one dose every year after. It is even more important that persons that are at risk for developing flu-related complications receive a flu vaccine annually. If you are unsure whether or not you should be vaccinated, talk to your doctor. The vaccine provides protection starting about 2 weeks after receiving the dose and lasts about a year.

 The seasonal flu vaccine is usually available starting in September and throughout the flu season. The flu season can start as early as October and end as late as May. The vaccine protects against the viruses thought to be the most common ones to cause illness during the flu season.

 There are viral and bacterial infections in addition to the flu that can cause illness. Adhering to the following guidelines will help to prevent the spread of illness:

  • Turn away from people and cover your cough and sneeze with a tissue and if a tissue is not available into the elbow or shirt NOT into the hands.
  • Make sure tissues are thrown into the trash.
  • Keep hands away from mouth, nose and eyes, especially if you are in public places. Remember that most things you touch have been touched by others that may not have the same hygiene practices you have.
  • Keep objects (pens, pencils, toys, etc…) out of the mouth.
  • Do not share food or beverages with anyone including family members if it involves using the same utensils or taking a bite of the same piece of food.
  • Wash hands (The number one way to stop the spread of germs!) frequently using soap and water. Have hand sanitizer available for times when soap and water are not available.
  • Stay home/keep your child home if he/she:
  •      1) is experiencing vomiting or diarrhea and do not allow him/her to return until 24 hours after 
  •          vomiting and diarrhea have stopped.
  •     2)  has a fever of 100 or more and do not allow him/her to return until he/she has been fever 
  •          free without ibuprofen (Motrin) or acetaminophen (Tylenol) for 24 hours.
  •     3)  is having frequent coughing spells.
  • Any time your child complains of not feeling well or has even mild cold symptoms, please monitor his/her temperature in the morning and at night and keep him/her home if it is elevated.
  • Maintain good general health practices; get plenty of sleep, exercise regularly, manage stress, drink plenty of fluids and eat a balanced diet. 

 Visit www.cdc.gov/flu for more information.

Please remember to call the school 815-485-7593 when your child is going to be absent and let us know if he/she is experiencing influenza like symptoms, especially fever, chills, body aches and fatigue/weakness.


Head bumps occur throughout the year and in any situation. They can range from minor bumps that leave no marks and cause no problems to severe head injuries that result in structural brain damage, bleeding and swelling of the brain, leading to possible coma and death. Even what seems to be a minor bump to the head can be serious.

 When a child bumps his/her head at school, no matter how minor it may seem, the school nurse will assess the child’s neurological status, apply ice as indicated, attempt to make phone contact with a parent, and send a Head Injury Notification home with the student. Symptoms of concussion to watch for are listed on the note and medical attention should be sought if any of the symptoms occur. If the injury is severe, 911 will be called.

 A concussion is a mild traumatic brain injury that changes how the brain works. Many times a brain scan will be normal. There does not necessarily have to be a blow to the head; a concussion can also be caused any jolt to the body that causes the head and brain to move back and forth rapidly. Many times a person suffering a concussion does not lose consciousness.

 A person who has had a concussion has an increased risk of having another one. Having another concussion before a current one heals leads to increased damage to the brain and increased risk for swelling and serious consequences like permanent brain damage. Repeated concussions over a time can lead to cumulative neurological and cognitive deficits.

 Preventing a concussion is the best defense and includes safety measures to prevent falls, use of properly fitting safety equipment when playing sports, bike riding, or skating, and use of seat belts.

 Once a head bump occurs early detection and intervention is essential. Recognize that any blow to the head or jolt to the body that causes the head and brain to move rapidly back and forth can cause a concussion. A person should be watched for 24-48 hours for changes in neurological status. Seek medical attention when signs of concussion are present. Signs of concussion include headache, nausea and vomiting, double or blurred vision, pupils of different size, pupils that do not get smaller when exposed to light, loss of muscle coordination, staggering, seizures, behavior changes, confusion, difficulty remembering events, dizziness, bleeding or discharge from nose or ears.

 911 should be called for severe head injury with open wounds and bleeding, prolonged unconsciousness, bleeding or discharge from nose or ears, unequal pupil size or response, seizures, or if any of the listed signs of concussion are severe.

 Treatment depends on symptoms and severity of injury. Physical and cognitive rest are important until the brain has had time to heal and is determined by the symptoms and what makes them better or worse. The person may need to avoid activities such as reading, texting, computer use, socializing, video games and or hot tubs.  The person should return to activities slowly when symptoms are no longer present. If symptoms reoccur, the person should decrease activity and try again when symptoms are better.

 If you would like more information go to www.cdc.gov/concussion.



HEALTH EXAM REQUIREMENTS (as required by the Illinois School Code)

All children entering school for the first time, entering kindergarten, and upon entering 6th grade are required to undergo a physical exam prior to the start of school. They are also to present proof of immunity to the following communicable diseases as outlined on Minimum Immunization Requirement table (see the link below) These examinations and proof of immunity are due at the start of the school year and must be dated no more than 1 year prior to the first day of school. Students who have not fulfilled these requirements will not be able to attend school after October 15 of the given school year. Any student whose religious beliefs exempt him/her from required immunizations must submit an Illinois Certificate of Religious Exemption to Required Immunizations and/or Examinations Form signed by the parent and physician (see the link below).

All new students entering the district must have an appointment to receive or show proof of having a physical exam and immunizations meeting the Illinois requirements within the year prior to the date of entry within 30 days of entering school.

 Illinois Physical and Immunization Form

 Illinois Certificate of Religious Exemption to Required Immunizations and/or Examinations Form






Lice are very contagious and are passed via head to head contact that can occur during sleepovers, close play, and sharing of hair care items, hats and scarves. To prevent an infestation, avoid sharing all hair care items, hats, and scarves.

 The main symptom of a lice infestation is itching and scratching of the head, especially around the ears and nape of the neck. You may find a dark flecks in the hair and on the scalp or small red bumps on the neck and around the ears. When these symptoms occur, or if someone your child has close contact with has lice, a thorough head check is warranted.

 When checking for lice a well-lit area is required and magnifying reading glasses may be helpful in seeing the nits or lice. Part the hair and inspect small sections at a time, looking at the scalp for lice and hair shafts near the scalp for nits. Lice are very small, grayish-tan, move fast, and move away from light. Nits are pearly white and adhere to the hair shaft near the scalp. If something is easily brushed away, it is not a nit.

A child who is identified to have the presence of live lice in their hair will be sent home for treatment. The child may return the next day but must brought to school by a parent and checked by the nurse for the presence of live lice. If none are found the child may return to class. The presence of nits (eggs) does not indicate an active infestation and therefore a child may remain in school with the presence of nits in their hair.

If nits or live lice are found, treatment is required. There are pesticide shampoos available over the counter or you can consult with your doctor or pharmacist. After shampooing according to manufacturer’s instructions use of a fine-tooth comb can help with louse removal; nits have to be pulled off each strand of hair. Wash all linens and clothing worn within the last 48 hours in hot water and dry. Items that cannot be washed can be placed in the dryer for 10-15 minutes or placed in a sealed plastic bag for 2 weeks. The heat from the dryer kills the lice. Carpets, furniture, and car seats need to be thoroughly vacuumed. All family members should be checked every few days for 3 weeks and treated if evidence of infestation is found. Do not treat more than twice without consulting a physician.  

 For more information go to http://www.cdc.gov/parasites/lice/head/index.html



From the Student/Parent Handbook:

Our District’s Board of Education has adopted a strict medication policy and requires a Student Medication Authorization Form to be completed by the physician and parent for any medication to be taken in school, including prescription as well as over-the-counter medications. Students may use cough drops with written permission from parents. A note for cough drops is good for five days.

In order to ensure the safety of all students, children may not bring his/her medications to school on the bus with the exception of inhalers and epinephrine. If a child brings/carries medication without proper authorization, it may result in disciplinary action. Parents/guardians should bring the medication to school, in the original container, with the student’s name on it, and give it directly to the building secretary or nurse.

Administration of Medications in School

Taking medication during school hours or during school-related activities is prohibited unless it is necessary for a student’s health and well-being. When a student’s licensed health care provider and parent/guardian believe that it is necessary for the student to take a medication during school hours or school-related activities, the parent/guardian must request that the school dispense the medication to the child by completing a “Student Medical Authorization Form.” The use of homeopathic treatments including essential oils do not require a physician prescription and are therefore not allowed to be administered during the school day.

No school or district employee is allowed to administer to any student, or supervise a student’s self-administration of, any prescription or non-prescription medication until a completed and signed Student Medication Authorization Form is submitted by the student’s parent/guardian. No student is allowed to possess or consume any prescription or non-prescription medication on school grounds or at a school-related function other than as provided for in this procedure.

 Although most students will be self-administering medication, please be aware that a certified employee or school secretary will be supervising your child’s self-administration and that we will do everything we can to ensure your child’s safety. If you feel that your child is not capable of self-administration under supervision, you must contact that school nurse to make alternate arrangements. Please be sure that all medication is brought to school in the original package or an appropriately labeled container. If you prefer that your child not be aware of how to open childproof caps, you may request a regular cap from your pharmacist for at-school use.

 1.Prescription medications shall display:

       (1)Student’s name

       (2) Prescription number

       (3) Medication name/number

       (4) Administration route and/or other directions

       (5) Date and refill

       (6) Licensed prescriber’s name

       (7) Pharmacy name, address and phone number

       (8)Name or initials of pharmacist


2. Over-the-counter or non-prescription medication shall be brought to school with the manufacturer’s original label, the ingredients listed, with the student’s name affixed to the container and given to the office. Vitamins are not allowed at school.

Parents must bring all medication to the school office. Students should not bring any medication, prescription/non-prescription, to school themselves. No medications are allowed on the bus. Should any student be required to carry an inhaler, Epi-pen, or glucose on the bus to assist in a medical condition, he/she will be required to receive an additional note from the attending physician that must be on file. Medications will be stored in a safe place in the nurse’s office. If a child brings/carries medication without proper authorization, it may result in disciplinary action.

 The school nurse will review each medication request and approve the administration of all medications. Any questions regarding the administration of medications should be directed to the school nurse.


Medication Authorization Form


From the Student/Parent Handbook:

Pink Eye (Conjunctivitis) - Can be allergic, viral, or bacterial in nature. Any child with symptoms of conjunctivitis (swollen eyes, red eyes, itching, drainage from eye) will need a doctor’s note with a diagnosis to return to school. If antibiotic drops are started, the child needs to be on them for 24 hours before returning to school.



From the Student/Parent Handbook:

Rashes - Rashes will be evaluated on an individual basis. Rashes can be caused by many things including allergies, viruses, various skin conditions, bacterial illnesses, and sometimes unknown causes. If the cause of the rash is not easily determined, the school may require a doctor's note stating the diagnosis before the child can return. This is required by the health department as some serious illnesses (scarlet fever, measles, chicken pox) are accompanied by a rash and need to be reported.



Sports physicals are required yearly for participation in athletics.

According to Illinois Elementary School Association (IESA) bylaw 3.061 for 2013-2014:

No student shall be permitted to compete in a try-out, practice, or game unless such student has filed with the school principal a certificate of physical fitness issued by a licensed physician, physician’s assistant, or nurse practitioner as set forth in the Illinois State Statutes not more than 395 days preceding such tryout, practice, or contest in any athletic activity.


Sports Physical Form


Vision and Hearing Screening

Vision and Hearing Screening are performed as mandated by Illinois law.

Vision screening is performed for preschool, kindergarten, second grade, and eighth grade students, special education students, students new to the district, and for any student upon request of parents or teachers. If your child fails the first screening a second screening will be done in 10-14 days. If your child fails the second screening you will receive a letter informing you that your child was unable to pass and follow up with an optometrist or ophthalmologist is recommended. A Vision Exam Report will be enclosed for the examining doctor to complete and sign, parent to sign and return to school.

Hearing screening is performed for preschool, kindergarten, first grade, second grade, and third grade students, special education students, students new to the district, and for any student upon request of parents or teachers. If your child fails the first screening the screening a second screening will be done in 10-14 days. If the second screening is failed an audiogram will be done. If your child is unable to pass the audiogram you will receive a letter recommending follow up with your child’s doctor. A Treating Physician’s Report will be enclosed for the examining doctor to complete and sign, parent to sign and return to school. 

 Please note:

 "Vision screening is not a substitute for a complete eye and vision evaluation by an eye doctor.  Your child is not required to undergo this vision screening if an optometrist or ophthalmologist has completed and signed a report form indicating that an examination has been administered within the previous 12months." (Section 27-8.1 of the School Code)

 Vision Exam Report

Treating Physician’s Report


  • All students entering Kindergarten or the school for the first time must present proof before October 15 of the current school year of an eye examination performed within one year prior to entry of Kindergarten or the school. Failure to present proof by October 15, allows the school to hold the student’s report card until the student presents: (1) of a completed eye examination, or (2) that an eye examination will take place within 60 days after October 15.

    Vision Exam Report Form
  • Vision Exam Waiver Form