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Welcome to the school nurse's page. This page is where you will find access to medical forms, action plans, and upcoming information. If your child has a serious medical condition, such as seizures, diabetes, asthma, heart issues, or food allergies, please complete an action plan and turn it in to me or their school at registration with their other paperwork. Also, medication authorizations must be filled out by your physician if your child will be taking any prescription or over the counter medication while at school. Children entering Pre-K, Kindergarten, 6th, or 9th grades require physical exams (Please note that sports physicals do not count as health exams). Please refer to the immunization guide for grades requiring immunizations. If you are new to the district, please contact me for further specific needs.

Donna Pierson, BSN, RN
Health Care Supervisor
2803 South Banker Street
Effingham, IL 62401
Phone # 217-540-1507
Fax# 217-540-1512
piersond@u40gw.effingham.k12.il.us

Action Plans
PDF DocumentAsthma Action Plan 
PDF DocumentBee Sting Action Plan 
PDF DocumentCardiac Action Plan 
PDF DocumentDiabetes Action Plan 
PDF DocumentFood Allergy Action Plan 
PDF DocumentGeneral Action Plan 
PDF DocumentSeizure Action Plan 

Immunization Forms
PDF DocumentImmunization Requirement Guide 
PDF DocumentReligious Exemption Form 

Forms
PDF DocumentDental Exam Form (Spanish) 
PDF DocumentDental Exam Form  
PDF DocumentDental Exam Waiver Form (Spanish) 
PDF DocumentDental Exam Waiver Form  
PDF DocumentEpi Pen Authorization Form 
PDF DocumentEye Exam Form 
PDF DocumentMedication Authorization Form 
PDF DocumentPhysical Form  

Information 
PDF DocumentLead Questionaire (Spanish)  
PDF DocumentLead Questionaire
PDF DocumentLice Brochure