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  4. ASTHMA FORMS AND RESOURCES

ASTHMA FORMS AND RESOURCES

ASTHMA MANAGEMENT IN A SCHOOL SETTING

The Illinois School Code 105 ILCS 5/22-30 requires D29 to request an Asthma Action Plan from parents/guardians of students with asthma each school year.

The Asthma Action Plan must contain:

  1. Instructions from your child's health care provider for the school to follow in the event your child experiences complications related to asthma while at school. You may elect to use the Asthma Action Plan provided on this page, or one from your own health care provider.
  2. Information about any prescribed asthma medication to be used at school, such as an asthma inhaler. In addition to the action plan, please complete the Medication Authorization Form and return it to school. The health care provider should indicate on these documents if your child may carry and self-administer the medication. 


These documents require a signature from both the health care provider and the parent/guardian. Bring the completed and signed document(s), along with any prescribed medication to be kept at school, to the health office.

To discuss your child's asthma with the school nurse, call (847) 881-9455.

ASTHMA ACTION PLAN

The Illinois School Code 105 ILCS 5/22-30 requires D29 to request an asthma action plan from parents/guardians of students with asthma each school year. You may elect to use the plan provided here, or one from your own health care provider. The action plan requires a signature from both the health care provider and the parent/guardian.

 

   .pdf

MEDICATION AUTHORIZATION FORM

To gain authorization for a new medication or change in medication, submit the medication authorization form along with the prescription medication in its original container from the pharmacy to the school nurse. This can also be done prior to the start of the school year for routine medications. The form must be completed, signed and dated by the health care provider who prescribed the medication.

 

   .pdf

Asthma Videos and Links

USING A METERED DOSE INHALER WITH SPACER

 

 

 

Check out the CDC Asthma Page for more information on asthma and educational resources: CDC Asthma Page

USING A METERED DOSE INHALER (INHALER IN MOUTH)