• Digital Medical Forms for 2022-23 School Year

    Welcome to Amos Alonzo Stagg High School. All incoming freshman must complete a health questionaire as well as complete and submit all the required medical and dental forms before your student can begin school in the fall. Below are the deadline dates for this information. This online form submission process has been made available to ease the process of turning in all medical forms for incoming Freshman and returning students. 
    The district is excited about the modernization of this process and appreciates families’ participation utilizing this new system.  Once submitted, all documents will be reviewed by staff to assure authenticity.

    STEP 1: Go to the online form below to complete the Health Questionaire by Feb. 15th, 2022. 
                   If you have medical forms to upload at this time you may do so.
                   Click here to begin completing the Emergency and Health Related Information

                                 qualification questions

    STEP 2: Below are the forms that will need to be completed. Upload, or submit to the nurses office, by May 1, 2022 

                  Emergency and Health Related Information

    Forms for Incoming Freshman or Transfer Student 

    **Required** Certificate of Child Health Exam Form: State of Illinois form must be completed and signed by a licensed physician, APN, or PA. Form MUST show the following immunizations: 

    •  Tetanus Diphtheria, Pertussis series with Tdap booster 
    •  Two (2) doses of measles, mumps, rubella vaccine (MMR) – 1st dose having been given on or after the 1st birthday 
    •  Polio vaccine series with booster given on or after the 4th birthday 
    •  Two (2) doses of varicella vaccine (the 1st dose having been given on or after the 1st birthday)
    •  Three (3) doses of Hepatitis B according to the required schedule 
    •  One dose of Meningococcal vaccine on or after 11th birthday for freshman 
    •  One dose of Meningococcal vaccine on or after the 16th birthday for incoming seniors.

    All incoming Freshmen students must have a complete physical with immunization dates and a dental examination on file with the School Nurse before they can receive their schedules in August.  

    Click on the links below to obtain the correct form(s).

    Dental Examination Form

    Dental Examination Waiver Form

    Medication Authorization Form: if applicable for daily and as needed medications at school.  

    Asthma Action Plan: an Asthma Action Plan from the doctor for students with Asthma.  

    Allergy and Anaphylaxis Emergency Plan: The Anaphylaxis Action Plan for students for Allergies 

    State of Illinois Eye Examination Report: required for students entering the Illinois School System for the first time.  

    State of Illinois Eye Exam Waiver Form

     

    Parents interested in submitting documents digitally should following the steps below:

    If using a Smartphone:

    1. Click on D230 Student Medical Forms & Information
    2. Fill out the form and upload the document(s).
    3. Provide electronic signature at the bottom of the form and click submit.

    If using a computer (Desktop, laptop, etc.):

    1. Click on D230 Student Medical Forms & Information
    2. Fill out the form and upload the document(s).
    3. Provide electronic signature at the bottom of the form and click submit.