York Community High School Home

Office Hours:

Monday thru Friday    


Room#: C154

Health Services Fax#:



Other Services Provided in the Health Services Office

Medication Care: Nurses

Vision and Hearing: Nurses

Physical Education Waivers: Secretary

Elevator Key Distribution: Secretary

Requests for copies of medical records/Secretary




February 2016


Dear Parents/Guardians,


Re:  Immunization Requirements for the School Year 2016-2017:


Per the Illinois Department of Public Health, beginning with the school year 2015-16, any child entering the 12th grade shall show proof of having received 2 doses of meningococcal conjugate vaccine prior to entering the 12th grade.  The first dose shall have been received on or after the 11th birthday and the 2nd dose shall have been received on or after their 16th birthday, at least eight weeks after the first dose.  If the first dose is administered when the child is 16 years of age or older, only one dose is required.


The requirements of this section also apply to children who transfer into Illinois child care or school programs, and to schools from other states, regardless of the age or grade level at which the child transfers.  


What does this mean to you and your student?  Your student may have already received the two doses of the meningococcal conjugate vaccination, but it has not been specified on their immunization form.  Please ask your doctor if your student has received the two meningococcal conjugate vaccinations and have them provide the dates they were given, along with a doctor’s signature.  If they have NOT received both doses, you are required to get this vaccination for your child.  Without the required proof of immunization, your child will be subject to exclusion in the fall of 2016, as described in the school code of Illinois and per Elmhurst District 205 procedure.  



Pat Hatz,R.N., MSN, NCSN                                         

York High School Health Services                             

Elmhurst School District  #205                                           


Jennifer Conwell R.N., BSN,PEL-CSN

School Health Supervisor

Elmhurst School District #205

Please submit this form, or a valid immunization documentation record, verified by an M.D., by the first day of school August 15, 2016.


Student Name: __________________________________        

 ID # ___________________

Meningococcal Conjugate Vaccine #1 Date _____________

                                                             #2 Date _____________


Physician Clinic Stamp and Signature: _________________________________________


As the York Health Services Office prepares to welcome your freshman next fall, we want to take this opportunity to explain the requirements for the 9th grade physical.


Illinois State Law requires that all freshmen submit a completed State-approved physical examination form to the school no later than October 15, 2016.  The state-approved form can be provided by your physician’s office or can be found on the District website at www.elmhurst205.org.  Please be aware that the IHSA sports 

physical form is NOT acceptable for entry into the 9th grade, but the 9th grade physical can be used as a sport physical.


In order to meet the State requirement, ALL sections of the form must be completed.  Please pay specific attention to the following:


   The immunization chart must be filled in with correct dates.  This must be signed and dated by a physician, RN, or Medical Assistant.  It is important to note that the chart must show that your child received the Tdap vaccine.

   The section titled Health History (upper half of reverse side) must be completed, signed and dated by the parent/guardian.

   The section titled Physical Examination must be completed, signed and dated by the physician.  Please make sure the physician has checked the boxes at the bottom of this page indicating whether or not your child can participate in physical education and interscholastic sports.


You may mail, fax or bring the completed form to the York High School Health Services Office.  

Our direct fax number is:  630-782-6594 and our mailing address is 

355 W. St Charles Road.  Over the summer, the form can be turned into the York High School Main Office.  Do not turn in the form to summer school staff, counselors, campus supervisors, coaches or the Athletic Office.


Please note:  If any portion of the physical examination form is incomplete, it will be returned to you.  Your child will be considered out of compliance with Illinois State Laws until all sections of the form have been completed and received in our office.


In accordance with State Law, students who do not have a physical examination form on file by October 15, 2016 will be excluded from school on that day.  Until the completed form is received in the Health Services Office, the student will not be allowed to attend school, participate in school activities, or attend school functions.


To ensure that your child’s physical is completed in a timely manner, we suggest that you make an appointment with your physician prior to the start of school.  Students who do not have access to a health care provider may contact the DuPage County All Kids Program at 630-682-7400 for information on available health clinics.


Freshman Sports:  The freshman physical, if completed after June 1, 2016, will cover all interscholastic sports participation for the

2016-17 school year.  Freshmen trying out for a fall interscholastic activity must have a current physical examination prior to August

pre-season practices.


If you have any questions, please call the Health Services Office at 630-617-2435 or 630-617-2438.  The Health Services Office is closed over the summer.  During this time, please direct all questions to the York main office at 630-617-2400.  We look forward to working with you and your child.


Health Services Office


Pat Hatz, RN, MSN, IL/NCSN

Pam Lerud RN, BSN

Mary Ann Patti, Secretary

Home Page

Health Services Staff

Hatz, Pat (630) 617-2435 School Nurse phatz@elmhurst205.org
Lerud, Pam (630) 617-2435 School Nurse
Patti, MaryAnn (630) 617-2438 Health Services Secretary


PPT, Word, Excel Viewers [Go]
Acrobat Reader [Go]

Medication Care

**No medications will be administered without the   appropriate forms on file in our office**

Students in need of daily or "as needed" medication require Doctor's orders and permission forms on file.     This includes Tylenol, allergy, Midol, or any over the counter medication. Per school policy, students in possesion of any "drug" will be referred to the Deans office for disciplinary action.  

The medication forms are available above. Please note that there are forms for self-administration(EpiPens, or inhalers only), and for staff administration (everything else). Once the forms are completed and signed by both the Doctor and parent/guardian, the forms and medication(in its original bottle) must be brought into our office. The forms and medication are only kept for the current school year, and must be renewed yearly. All medications need to be picked up at the end of the school year or they will be destroyed. If you have questions please call one of  the school nurses.

Medical Records

If you are in need of copies of your student's records please contact our office secretary. If she is unavailable, leave a message/email with the following information:

  1. Student's name-please spell
  2. Student's id#
  3. The year that your student will graduate/has graduated-per the HIPPA act, any student over the age of 18 must request their files themselves-parents no longer have access
  4. Contact person's name and phone #
  5. How you would like to receive this information:
  • fax #:
  • email address
  • home address

This information is not available during the Summer break.

Health Services Mission

Health Services are available to all York students and staff for health counseling and immediate care for illnesses and accidents occurring during school hours.    All incoming freshman and new student physical forms are verified in our office for compliance with Illinois State laws.

Student Visit Policy

All students who come to the office for an illness or accident must have a pass from the class they are missing with the exception of an emergency. Students are not allowed to come in during the passing period. The only exception is during their lunch period. Each student is asked to sign in and then will see one of our nurses. The nurse will assess the student to determine the appropriate action to be taken. If the student is being released to go home, we must speak with a parent/guardian or an emergency contact; that has been designated by their parent.

Vision and Hearing

Illinois State law mandates that the following high school students be screened for vision and hearing on an annual basis: ALL SPECIAL EDUCATION STUDENTS, NEW and TRANSFER STUDENTS.

The screening process is ongoing throughout the school year and is administered by a certified vision and hearing technician. Vision screening is not a substitute for regular professional examinations by an eye doctor. Your student is not required to undergo this vision screening if an optometrist or ophthalmologist has completed and signed a form indicating that an examination has been administered within the previous 12 months. We do require a copy of the evaluation to be on file at the school. This notice is not permission to test and is not required to be returned.  

Physical Education Waivers

Physician's orders for a student to be exempt from gym due to an accident or illness should be brought to our office secretary. Please do not turn them into their p.e. teacher, coach or counselor as this information should be maintained in the student's medical file. Parent notes are not accepted in our office, but should be shown directly to the p.e. teacher.

The Doctor's note needs to have a time frame (beginning and ending date), as we have different types of waivers. Once submitted, we will determine which waiver is best suited for your student. Please keep us updated to any changes.  We will send a reminder to your student when he/she needs to return to pe several days prior to the ending date. Please call our secretary with any questions or concerns.

Elevator Key Distribution

When a student has sustained an injury or illness that requires the use of the elevators, they can be obtained in our Secretary's office. Have your student bring in a Doctor or parent note with reason for this, then the key will be issued. There is a $10 deposit required at this time which will be reimbursed at the time the key is returned. If the key is lost or not returned your deposit will be used to purchase a replacement.