Clear communication between you and your child, your health care provider and school staff is the key to managing asthma at school. This is not mandated, but data collection is important to demonstrate the response of the school nurse in a medical emergency, to help advocate for staffing needs, to create policies and programs, and to create a healthy and safe environment. All Rights Reserved. I used the cited calendars for idea and inspiration, but the list is my own, not a template. Children entering or attending school in New York State, including summer school and distance learning, must comply with immunization requirements. Dear [Mr./Ms./Mx.] This letter should be reviewed and approved by the School Medical Director prior to use. As we begin this extraordinary start to the new school year, please know that Seattle School nurses have been working behind the scenes to prepare for a safe return to in-class education and strategizing to support students and families during remote learning. How Does a Parent/Guardian File a 310 Appeal?NYS Education Law 310 provides that persons considering themselves aggrieved by an action taken at a school district meeting or by school authorities may appeal to the Commissioner of Education for a review of such action. Students who become sick during the school day must be picked up within one hour of the nurse contacting a parent or guardian. Human papillomavirus (HPV) vaccine protects against a cancer-causing infection. Please review the following and let us know if you have any questions. It is very common in children. If you go dont forget these [attach sports physical, medication forms, treatment plan forms and link to web forms], These are the forms your child will need [attach and link forms], Please update your health and emergency contact information on this website, These are the forms to have filled out and bring with you so we can update our plans together [forms]. We look forward to establishing a relationship with you and your child. Sample End-of-Year Medication Pick-Up (NYSCSH 3/2017)Medication pick-up information for end of year. Math CalculationCheckerWorksheet for Insulin DeviationThis worksheet may be used to verify math calculations performed by the RN. There are two forms, please complete both. Copyright 2002-2023 Blackboard, Inc. All rights reserved. Includes instructions and sample forms for filing an appeal. During this time of remote learning one of the most important things you can do is to make sure your students immunizations are up to date. Your email address will not be published. Sample Medical Exemption Approval Letter with Notification of Exclusion During Communicable Disease Outbreak (NYSCSH 9/19)This sample letter may be customized to inform parents/guardians that their child has been approved for a medical exemption and that in the case of an outbreak, their child would be excluded for the length of contagion. Communicable Disease | Illness | Injury Notifications, General Information on Illness and School Attendance, Sample Health Office Visit for Illness | Injury Notification, Communicable Disease Information & Factsheets, COVID-19 Sample Consents | Non-Patient Specific Orders, Sample Non-Patient Specific Order for BinaxNow COVID-19 Testing, Sample School COVID-19 Testing Consent Form and Instructions, Disease Specific ECP | IHP | 504 |Diabetes Addendum | Flow Sheets, Asthma Care Plans | Asthma Action Plans (AAP) | Sample Letters, Diabetes Medical Management Plans (DMMPs) | DMMP Addendum, Diabetes Hypoglycemia | Hyperglycemia Plans, Generic Sample Care Plans and Other Emergency Documentation for Students and Staff, Seizure Sample Care Plans | 504 Plans | Interview Questionnaire for Seizure History, Health Examination & Dental Forms | Parent Letters | Notifications, School Health Examination Form and Instructions for an EHR Compatible Form, School Health Examination Form Sample Resources, Screening & Health Exam Requirements Charts | Determination for Ungraded Students, Dental Certificate | Letter to Parents/Guardians Regarding Dental Exams, School Medical Director Delegation Statement, Health Office: Daily Visit Logs | Cumulative Health Record | Summary Records, Implementation of Epinephrine Auto-Injector (EAI) Programs Sample Forms, Immunization Sample Letter & Forms for the 2022-2023 School Year, Sample Letter for Administrators/Principals to Inform Parents/Guardians of Exclusion & 310 Appeals Information, Medical Exemption Forms and Sample Letters, Medication Forms | Letters | Notifications, Sample Administration / Use Tracking Forms, Sample Administration Authorization / Permission Forms, Determining Who Can Administer Medication and Student's Capability, Parent/Guardian Medication Communications & Notification, Receipt Forms for Medications / Expiration of Medication Form / Documentation of Medication Errors, Training & Self-Determination Forms and Checklists, Responsibility Checklists | End of School Year Packet, School Nurse Responsibilities | Checklists | Overview of Tasks, School Health Office Data Collection | Reporting Tools, Health Data Documentation & Tracking Forms, Screening Charts | Forms | Letters | Notifications. Please keep our staff and the school nurse informed of any health conditions that could affect your child while at school. Sample Letters - Notification of Illness from School Nurse Students with PANDAS/ PANS may experience symptoms simply from being exposed to an infection. Sample Sunscreen Parent Permission (NYSCSH 8/18)Can be used for students who can independently apply or apply with adult assistance their own or school-provided sunscreen. Tetanus, diphtheria, and pertussis (Tdap) vaccine includes protection against pertussis (whooping cough), which has been on the rise in the US especially among children 10-19 years old and babies under five years old. Welcoming preschoolers to an adventure can help reframe the experience and make it more exciting. Information may include: When to Keep a Child Home - Instructions to Parents/Guardians (NYSCSH 12/19)Sample letter to share district guidelines. <>/ExtGState<>/Font<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 612 792] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> This lists the steps to go through in the determination of supervised students. Sample Dental Certificate (NYSED 3/18)This form aligns with health exam grade levels. NYS law (Chapter 281) permits schools to request an oral health assessment when requesting a health exam. This letter should be reviewed and approved by the School Medical Director prior to use. Opioid Overdose Prevention Naloxone Inventory Log (NYSCSH 2/2019), Monthly AED/EAI/Naloxone Maintenance Check Sheet (NYSCSH 2/2019), Opioid Overdose Prevention Training Log Summary (NYSCSH 2/2019). Thank you for all of your cooperation this year. cic]i"F-?|JAD66Jmx~>-R)$tik:]oVP)FPWy?WGgqsA_Ks?1-RG/biiVrWv.\V:Bit9 .~W:%euk unJ&V.oIRC)L%> F}FIbW`4_hz1! 1 0 obj <>>>>> endobj 2 0 obj <>>>/Filter/FlateDecode/Length 36>>stream What You Say In Here Stays in Here (NYSCSH 10/17)8.5 x 11-inch printable poster. Educational Service District 105, July 2016. School health services contact information. from: https://www.schoolhealthny.com/cms/lib/NY01832015/Centricity/Domain/85/Calendar%20Template%202016.pdf, Your email address will not be published. Checklist Training Unlicensed Personnel to Assist Supervised Students in Taking Their Own Medications (NYSCSH 11/2021)Checklist of training criteria for unlicensed personnel to assist supervised (formerly self-directed) students in taking their own medications. Calendar/Schedule for the Licensed School Nurse Yearly/Monthly from: https://www.health.state.mn.us/docs/people/childrenyouth/schoolhealth/lsncalendar.pdf. And there is that word:infectious. FERPA Disclosure Log (NYSCSH 8/12)Documents student health records viewed by non-health office staff. In addition to documenting the care of ill or injured students according to district procedures, it is important to share your observations and recommendations for following up with the student's parents/ guardians. The School Nurse position at Ingraham has been shared by two nurses over the past couple of years. The time to begin is nigh! School Nurse To Do List. (If YES, please see the school nurse as soon as possible.) 4 0 obj This year at Ingraham, health and safety is of highest priority. Sample School COVID Testing Consent Form Instructions(PDF NYSCSH 12/20)This instruction sheet was created to assist schools in using the Sample COVID Testing Consent Form as a PDF. stream Sample resources below should be reviewed and approved by the School Medical Director and/or BOE prior to use. School Nurse Phone (225)924-1054 Fax (225)923-2201 cindy.vinning@olomschool.org www.olomschool.org . Sample Recommended Form - Medical Certificate of Limitations (NYSED 2022)Used to document private provider recommendations for accommodation for PE. School sports, medication, and treatment forms are good for 1 year, so summer is a great time to complete them. Use your teacher introduction letter to parents to let them know that you want to be a team. . Guidelines for Anaphylaxis 35 March 2009 . Rarely, some children with strep throat later develop rheumatic fever (abnormalities of the heart valves and inflammation of the joints). You can see more information about this screening tool at www.sdqinfo.com. Sample TBI Return Monitoring (NYSCSH 11/17)Sample tracking tool schools may use to track students' symptoms for RTL and RTP. Sample School Letter to All Parents Sample WASSDA Policy Sample WASSDA Procedure . It contains the required elements of an NYS non-patient-specific order. If strep is found, your child should receive treatment and you should report this to your school health office. x+2T0 BQW\ E Diabetes Medical Management Plan Addendum (NYSCSH 5/2017)Role of Parents/Guardians in Adjustment of Insulin Dose Documents provider permission to allow parents/guardians to adjust the insulin dose. This sample notification letter encompasses multiple ages and grade levels of students. Author: kgarza Sample Procedure for Unlicensed School Staff Responding to Severe Allergic Reactions (NYSCSH 4/17). When to Keep a Child Home - Instructions to Parents/Guardians(NYSCSH 12/19)Sample letter to share district guidelines. Sample Immunization Notification Letters and Packet for Non-Compliant Students Schools have immunization notification requirements stipulated in DC law and regulation (DC Official Code 38-504 and DCMR 5-E 5300.5). For more detailed information, see page 41 in Guidelines for Medication Management in Schools. Its not too late to follow up on those. Use the code SCANKIDS as a quick way to bypass the daily limits for testing. It is school policy to report when your child has when has been absent due to an illness. Strep throat is a sore throat caused by Streptococcus bacteria that are passed around through nose and mouth droplets. Forms can be accessed through Power School Forms. If there is a known life-threatening concern such as diabetes, seizures or anaphylaxis, if I have not already done so, I will be contacting you before school begins. Parent Interview Questionnaire for Seizure History (NYSCSH 6/12)Documents seizure history, medications, and current understanding of the condition, Seizure Observation / Recording Form Can be used to record seizures. Parent/Guardian Permission for Field Trip Parent Designee Medication Administration (NYSCSH 1/2018)Documents field trip information and parent/guardian permission for the administration of medications. Nursing Annual Responsibilities(NYSCSH 11/21), Nursing Monthly Responsibilities(NYSCSH 11/21), Nursing Quarterly/Semiannual Responsibilities(NYSCSH 11/21). Required NYS School Health Examination Form (Fillable PDF) (NYSED 2023)This form may be completed electronically by saving it to your computer, entering the information into the fillable fields, and saving a copy for each student. Appointments are required to drop off medication. Schedule a flu shot for your student and family members. This is a gentle reminder if your son or daughter is playing middle school or high school sports they must have an updated physical form on file before they will be allowed to practice. I am already missing the hustle and bustle of high schoolers whose energy and enthusiasm are infectious. The NYSED Dominic Murray Sudden Cardiac Arrest Prevention Act Memo can be found on the Laws | Guidelines | Memos - Athletics. Sample COVID- 19 Exposure Notification Form(NYSCSH 1/22)Sample letter to parents/guardians to inform that their child was exposed to someone who tested positive for COVID-19. Sample Post-Restraint Assessment Form (NYSCSH 8/17)This sample form may be customized for your district's use in documenting student health status post-restraint use. Take your child to work day is April 27th. If not treated or not treated long enough, your child may continue to spread the infection. I begin my calendar in May because planning and preparation for the next school year begins long before August! Any exclusion policies related to lack of documentation are in place and will be enforced per PA Department of Health/Department of Education mandates. During remote learning, I will be reaching out to check in with students who have a health concern and to connect with students and families who may need extra support. Children with strep infections may return to school after taking medicine for at least 24 hours and fever is gone. Diastat/Seizure Preparedness Plan Links to Diastat website. A parent or guardian must sign a consent form for the student to be seen, except in the areas of mental health and sexual health where minors can self-consent per state law. Medical Exemption Review Procedures for Schools Outside NYC, Guidance on Immunization-Related Medical Exemptions for School-Aged Children, Monthly Medication Administration Record (MAR), Catheterization Care Documentation Record, Gastrostomy Tube Feeding Documentation Record, Suctioning Tracheostomy Documentation Record, Template for Skilled Nursing Procedure Documentation Record. Here is the link to the English form letter https://odh.ohio.gov/wps/wcm/connect/gov/ac81b8d7-ddde-4820-8235-da7da62bfd90/Vision+Screening+Requirements+Letters+a.pdf?MOD=AJPERES&CONVERT_TO=url&CACHEID=ROOTWORKSPACE.Z18_M1HGGIK0N0JO00QO9DDDDM3000-ac81b8d7-ddde-4820-8235-da7da62bfd90-mO6iKmF. Data Collection Calendar for Secondary School Nurses (NYSCSH 8/12), Data Collection Calendar for Elementary School Nurses (NYSCSH 8/12), School Nurse Weekly Excel Worksheet (NYSCSH 3/22), School Nurse Monthly Activities Recording Form (NYSCSH 5/20), Sample Letter to Parent/Guardian Regarding Required Screenings (NYSCSH 12/18), Hearing Screening Parent/Guardian Notification Results and ReferralForm(NYSCSH 5/18), Sample Classroom Teacher Observations- Hearing (NYSCSH 5/18), Scoliosis Screening Parent/Guardian Notification Results and Referral Form (NYSCSH 5/18). Please contact your school nurse for further guidance. Epinephrine Placement/Use Log (NYSCSH 4/17)Provides documentation for storing andaccounting of EAI. Our fax number is 770-781-2254. Your childs personal information and identity will not be disclosed to anyone. c;43iAKO"0J10{!F&/qiK CN/EQlHFnHx"T}B^&e5dxZ\6h/}zZ5=ow`MSS(S ! Note: HCP orders only allow the parent to provide proposed adjustments or dosages and require the health care professional to make the ultimate decision after exercising his/her professional judgment. NOTE: Due to the "Dominic Murray Sudden Cardiac Arrest Prevention Act", which takes effect 7/1/22, the Sample Recommended Interval Health History form has been revised. We want to protect every student from communicable diseases especially during COVID-19. We are asking your assistance in providing the student with a safe learning environment. Includes options for the provision of medication to students who require medication on field trips. This is a rare, but extremely serious disease that kills up to 10 percent of those who get it. Blood Glucose / Insulin Log for Individual Students (NYSDOH Guide-Page 94). Hypoglycemia Sample Emergency Care Plan (NYSCSH 10/17), Hyperglycemia Sample Emergency Care Plan (NYSCSH 10/17), Glucagon Training Documentation Form for School PersonnelDocuments understanding and skills attainment for staff voluntarily administering glucagon for students with patient-specific orders. Janet Boyett, BSN RN NCSNIngraham High School NurseMonday-Wednesday 8:30-4:00Phone: 206 252-3887Fax: 206 743-3130jpboyett@seattleschools.org, 1819 N 135th St. We missed you. Effective 7/1/18). This includes: Dental and Tdap and Menactra for 7th grade. Sample Individual Student Health Office Visit Record (NYSCSH 8/12), Sample Student Cumulative Health Record (NYSCSH 8/19). History and Current Status Check the foods that have caused an allergic reaction: The purpose of the activity is to inculcate a sense of responsibility towards underprivileged people. It includes placement date, location, brand/dose, lot #, expiration date, and date of administration. We want to welcome you as your School Nurse. NYSDOH Sample DMMPThis document is from the NYSDOH Diabetes in Children: A resource guide for families and schools pages 82-86. Phone: 206 252-3887. Note: Any or all of the forms above may be shared with parents/guardians and providers to help keep students on track with immunization requirements. Sample Generic Emergency Care Plan for Unlicensed School Personnel (NYSCSH 12/16)Information for unlicensed school staff to assist with emergency health issues. Currently I am employed as a Nurse . The following data collection is done on a voluntary basis. With 5 years of expertise promoting health and safety at elementary schools, I believe my skills make me a perfect fit for your school. Please note that adolescents need a booster vaccine at age 16. Hand, Foot and Mouth Disease 3. Please feel free to call us anytime at 770-887-6161. It is vital for the School Nurse to foster communication between the entire school population about who and when someone has an infectious illness. If your child must have medication of any type, including over -the -counter drugs, given during school hours, you have the following choices: 1) You may come to school and give the medication to your child at the appropriate time(s). Visit Us. Many sports practices begin August 1. If the local health department, in collaboration with the NYS Department of Health (NYSDOH), determines that there is an outbreak of a reportable communicable disease, they will provide response guidance to schools' medical directors and the Broad of Education (BOE). These are: Hepatitis A (2 doses), Meningococcal B (2 doses), Meningococcal A (1 or 2 doses), HPV (2 or 3 doses). The clinic runs on donations only and supplies of new underwear are sometimes low or out. Sample Provider and Parent Guardian Permission for the use of School Provided Spacer/Valved Holding Chamber (NYSCSH 7/20)Provides schools the opportunity to provide a backup spacer in the event that the students is not available. A LETTER FROM THE SCHOOL NURSE CHARLOTTE ISD 2015-2016 . Please have a backup plan in case you are not available to pick up your child within an hour. SampleMedical History Update Form (NYSCSH 2/18)An optional form that may be used to obtain current health information from the parent/guardian in non-mandated health examination years or to provide student history prior to a school-provided physical exam. Sample Classroom Teacher Observation - Vision (NYSCSH 5/18), Sample Faculty/Staff Emergency Contact Information (NYSCSH 5/16)Documents emergency contact information for staff, Sample Emergency Care Flow Sheet for Staff (NYSCSH 10/17)School Nurse documentation form, Physical Examination Report for New Employees (NYSCSH 5/16)Documents physical exam/certificate of fitness for employment for school employees.
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