PATOKA CUSD 100

PATOKA PRIDE

Mrs. Casey Murray
Patoka CUSD #100  School Nurse
618-432-5440
cmurray@patokaschool.com



To access each form, click on the listing below and print.  If at any time there are questions on one of the medical forms, please contact our School Nurse.

Patoka School's Cardiac Emergency Response Plan (CERP)

School Immunization Summary for Patoka School District 2024-2025

School Vision Summary for Patoka School District 2024-2025

2025-2026 School Year Medical Requirements 

Understanding Type 1 Diabetes for Parents and Guardians

School Physical Form (Certificate of Child Heath Examination)

Sports Physical Form

Dental Providers that Accept Medicaid

Eye Exam Form

Dental Exam Form

Physician Statement for Food Substitution Form

Lead Risk Assessment Form

School Medication Authorization Form

P.E. Excuse Form

Authorization for Exchange of Confidential Information Form

Patoka School's Concussion Protocol

Concussion Symptom Checklist Form

When to Keep your Child at Home!  Fact Sheet

Checklist for Eliminating Headlice