District Health Check Off Forms
District Health Action Plans
Illinois Health Forms
Western CUSD 12 is formally requesting parent/guardians of a student with an asthma diagnosis to submit an Asthma Action Plan completed by student’s health care provider to the Health Office. This plan is written and developed by a student’s medical provider to help control the student’s asthma and gives detailed instructions on how to treat Asthma symptoms. This request is stemming from Illinois Public Act 099-0843, which requires schools to request this information on all students with a diagnosis of Asthma. Illinois Public Act 099-0843 also required School Districts in Illinois to develop an “Asthma Episode Emergency Response Protocol,” which are the procedures to provide assistance to a student experiencing symptoms of wheezing, coughing, shortness of breath, chest tightness, or breathing difficulty. More information on Illinois Public Act 099-0843 can be located on the Illinois General Assembly website. If questions arise regarding this, please contact the School Nurse at 217-335-2323 or contact your student’s building administrator.