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Pride and Excellence

300 W. Van Buren St.
Wyoming, IL 61491
Phone: 309-695-6123 | Fax: 309-695-3062

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Stark County CUSD 100 Health Services Forms and Information

Documents

Forms

Dental Exam Form

Eye Exam Waiver

IDPH School Physical Form

Medication Authorization Form

Orland Park Free Dental Clinic Form

Sports Physical

Asthma Action Plan

Seizure Action Plan

Seizure Parent Questionaire

Food Allergy Action Plan

General Allergy Action Plan

Food Substitution Form

Diabetes Medical Management Plan

Medical Authorization Form

Dental Exam Waiver Form

Religious Exemption Form-Immunizations

IHSA Concussion Sheet & Substance Policy

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