Nurse Forms
 

Nurse - Trisha Modeen MSN RN PEL-CSN
Office Phone - (815) 431-2461
Office Fax      - (815) 431-3350

Nurse Summer Hours:  I will be out of the office from June 1, 2019 - August 1, 2019.  My first day back for the 2019-2020 school year will be August 2, 2019.

If you have any questions while I am out of the office, please contact an Administrator in 201.

Parents: Click on the links on the left hand side of page to print a copy of Health forms for your Physician.

9th Grade Requirements:
1. 9th Grade Physical/Immunization Form
2. Health History Form
3. Meningococcal Vaccine - MCV Dose required.

10th Grade Requirements:
1. Health History Form
2. Sports Physical if participating in any Sports Team.  
Immunizations must be up to date.
        **Immunization Records can be viewed in Family Web Access Account**

11th Grade Requirements:
1. Health History Form
2. Sports Physical if participating on any Sports Team.  Immunizations must be up to date.
   **Immunization Records can be viewed in your Family Web Access Account**

12th Grade Requirements:
1. Health History Form
2. Meningococcal Vaccine - 2nd MCV Dose required at the Start of Senior Year or after turning 16 years of age.  One dose required if received after age 16.
3. Sports Physical if participating on a Sports Team.  Immunizations must be up to date.
  **Immunization Records can be viewed in your Family Web Access Account**


Parents - Click on the links on the left hand side of page to print a copy of Health forms for your Physician.

Class of 2023 & Transfer Students
Mandatory Health Requirement Checklist

Check when complete

Event
      
     Timeline
Emergency Information Sheet
This form should be completed and turned in at registration
Aug 7, 2019
Certificate of Child Health Exam
State of Illinois form must be completed and signed by a licensed physician, APN, or PA.  This requirement applies to transfer students also.  Note: Obtaining a copy of your child’s 6th grade physical may help your physician complete the immunization section of this form.  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 (IPV) series with booster given on or after the 4th birthday
  • Two (2) doses of varicella vaccine (the 1sst dose having been given on or after the 1st birthday.  History of varicella (chickenpox) disease is acceptable if verified by health care provider, school heal professional or health official.
Three (3) doses of Hepatitis B according to the required schedule
  • Two (2) doses of Meningococcal vaccine administered at least 8 weeks apart or one (1) dose after the 16th birthday is required for all SENIORS.
  • Aug 14, 2019
  • Parents/Guardians will complete and will complete and sign the Health History section on the back of the physical form.  Incomplete or unsigned forms will be returned.
  • August 14, 2019
  • An Asthma Action Plan is required from the doctor for all asthmatic students.
  • August 14, 2019
  • Make a copy of this completed form for your records
  • When complete
  • Deliver or mail the completed form to Ottawa Township High School, 211 E. Main St. Ottawa, IL 61350, Attention Nurse’s Office or FAX to Trisha Modeen, RN, at 815/431-3350 or email to tmodeen@ottawahigh.com.
  • As soon as complete
  • SPORTS PHYSICALS (Freshmen do not need a separate sports physical).  In order for a Freshman student’s health exam to be eligible for the full school year, it should be dated AFTER May 1, 2018.  Copy the Health Exam Form for the Athletic Department.  Keep a copy for yourself.  Send the original to the Nurse as noted above.
  • After May 1st, 2019
  • Dental Examinations
Strongly recommended but not required for entrance into school
Recommended
State of Illinois Eye Examination Report
Required for students entering the Illinois School System for the first time.
On Registration Day
LaSalle County Health Department (815/433-3366) provides immunization clinics by appointment only.
Contact Trisha Modeen, RN PEL-CSN, at tmodeen@ottawahigh.com with any questions. 815/431-2461 (office phone), or 815/431-3350 (office fax).


End of Year Medication Pick Up

It is the parent/guardian’s responsibility to pick the medication/Epi-Pens/Diabetic Supplies/Nebulizer Equipment up by the last day of school.  Students will not be allowed to pick this m
edication up, it will only be released to the parent/guardian.  The last day of student attendance for the 2018-2019 school year will be May 24th, 2019.  All medication left in the Nursing Office after May 24th will be destroyed.  If you are unable to pick up the medication by May 24th please contact Trisha Modeen, RN PEL-CSN (School Nurse), at (815) 431-2461 by May 24th, 2019 to make different arrangements.  
If your student will continue the use of medication/Epi-Pens/Diabetic Supplies/Inhaler/Nebulizer Equipment for the 2018-2019 school year, you will be required to complete new forms and have the student’s physician sign approval forms.  These forms will be required before any medication is left in the Nurse’s office. Parent permission and MD Permission forms are located on the OTHS Website under Parent Resources in the “Nurse Office” link.  You may also stop by the Nursing Office, room 205, to discuss your student’s health needs with Trisha Modeen, RN, and pick the forms up.
If you have any questions please contact Mrs. Modeen at (815) 431-2461.

Nurse - Trisha Modeen MSN RN PEL-CSN
Office Phone - (815) 431-2461
Office Fax      - (815) 431-3350