School Nurse To Do List. For more information on which vaccines adolescents need, visit HYPERLINK "http://www.adolescentvaccination.org/"adolescentvaccination.org. 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. Author: Charlene Schexnayder Sanitize toothbrushes by replacing or boiling them. Please let me know if I can be of assistance to you. The purpose of the activity is to inculcate a sense of responsibility towards underprivileged people. Providers can fax any paperwork to my confidential fax: 206 743-3130 . Before we wrap up the school year I wanted to send you off with a few tasks and dates in mind for the summer, especially for those of you with children who will play school . Sample Dental Certificate (NYSED 3/18)This form aligns with health exam grade levels. If not treated or not treated long enough, your child may continue to spread the infection. This may result in longer lasting immunity for those vaccinated earlier in adolescence. Sample Medical Exemption Approval Letter with Notification of Exclusion During Communicable Disease Outbreak, Immunization Requirements for School Attendance Medical Exemption Statement for Children 0-18 years of Age Form, Monthly Medication Administration Record (Medicaid Compliant), Provider & Parent Permission to Administer Medication at School/School Sponsored Events, Attestation: Sample Letter to Parents/Guardians, Provider & Parent/Guardian Permission for the Use of School-Provided Spacer/Valved Holding Chamber, Levels of Assistance in Administering Medications Guide, Blood Glucose / Insulin Log for Individual Students, Diabetes Medical Management Plan Addendum, Parent/Guardian Permission for Field Trip Parent Designee Medication Administration, School Checklist for Medications on Field Trips, Sample Field Trip Notification with Information for Parents on Insect Repellents, Sample Medication Delivery Information for Parents, Parent/Guardian Designation to Authorize Another Adult to Administer Medication, Receipt of Medication Delivered to School, Receipt of Medication Returned to Parent/Guardian, Guidelines for Medication Management in Schools, Checklist Training Unlicensed Personnel to Assist Supervised Students in Taking Their Own Medications, Nursing Assessment for Determination of Supervised Student, Opioid Overdose Prevention Naloxone Inventory Log, Monthly AED/EAI/Naloxone Maintenance Check Sheet, Opioid Overdose Prevention Training Log Summary, Nursing Quarterly/Semiannual Responsibilities, School Nurse Beginning of School Checklist, Diastat Administration Sample Reporting Tool, Epinephrine Administration Sample Reporting Tool, Glucagon Administration Sample Reporting Tool, Opioid Overdose Prevention Sample Reporting Tool, Sample School Health Office Data Collection Tool, Data Collection Calendar for Secondary School Nurses, Data Collection Calendar for Elementary School Nurses, School Nurse Monthly Activities Recording Form, Sample Letter to Parent/Guardian Regarding Required Screenings, Hearing Screening Parent/Guardian Notification Results and ReferralForm, Sample Classroom Teacher Observations- Hearing, Scoliosis Screening Parent/Guardian Notification Results and Referral Form, Vision Screening Parent/Guardian Notification Results and Referral Form, Sample Classroom Teacher Observation - Vision, Sample School Medical Director Delegation Statement, Physical Examination Report for New Employees, Blackboard Web Community Manager Privacy Policy (Updated). school day. This letter is an example he can follow. Welcome back! in Charlotte. We request that everyone does this consistently. School Checklist for Medications on Field Trips (NYSCSH 12/2016)Checklist of responsibilities regarding medication administration on field trips for the School Board/Administration, School Nurse/District Personnel, and Parent/Student. The following data collection is done on a voluntary basis. As a final reminder, before your child can begin school with us we need these items. Phone: 206 252-3887. May be modified by local school districts. 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. Those two things will help keep you and our community healthy. Take your child to work day is April 27th. Effective 7/1/18). Its not too late to follow up on those. Sample Medication Delivery Information for Parents (NYSCSH 7/2020)Provides information for Parents/Guardians on what is needed to administer medications at school, including recommendations for a spacer for MDI use vs. a nebulizer. It is possible that I am missing records of vaccines your child has already had. Note: Samples and Forms are provided based on current best practices. This sample notification letter encompasses multiple ages and grade levels of students. x+2T0 BQW\ E All SPS students can access mental and physical health services through our many school-based health centers. This letter should be reviewed and approved by the School Medical Director prior to use. Sample Letters - Notification of Illness from School Nurse Students with PANDAS/ PANS may experience symptoms simply from being exposed to an infection. 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. endobj 3 0 obj <>/Font<>/XObject<>>>/Filter/FlateDecode/Length 3732>>stream Please work with your childs provider for alternative options. ACE (Acute Concussion Evaluation) Care PlanThis form is part of the "Heads Up: Brain Injury in Your Practice" toolkit developed by the CDC. Nurse Letter to Parents 2020-2021 Welcome Back! Students with PANDAS/ PANS may experience symptoms simply from being exposed to an infection. It provides a referral plan by the private provider containing information on current symptoms and recommendations for RTL and RTP. Monthly Medication Administration Record (Medicaid Compliant)(NYSCSH 2/2017)Records date, times, doses, exception codes, reactions, Medicaid-compliant signature boxes, and NPI number. In an effort to have a smooth and successful transition into the next school year, we would like to meet with you and your child to go over information for this school year. Contains instructions for school nurses and school medical directors and customizable sample notifications for parents/guardians and community health care providers reminding them of the need to use the required form. Children entering or attending school in New York State, including summer school and distance learning, must comply with immunization requirements. (111) 789-3456. 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. Did your child have a vision or hearing referral this year? endobj Please let me know if you would like to hear from me. Students who become sick during the school day must be picked up within one hour of the nurse contacting a parent or guardian. Sample School Letter to All Parents Sample WASSDA Policy Sample WASSDA Procedure . We are always available by phone or you may come to see me in the clinic. Sample Permission to Share Protected Health Information(HIPAA) (NYSCSH 8/12)Allows the parent to designate health care providers who may share information with designated school staff. It should be reviewed and approved by the school medical director prior to use. I strongly recommend a comprehensive healthcare visit for all adolescents at age 11-12 years, or as early as possible thereafter. Please feel free to call us anytime at 770-887-6161. wrap up the school year I wanted to send you off with a few tasks and dates in mind for the summer, especially for those of you with children who will play school sports. Sample Individual Student Health Office Visit Record (NYSCSH 8/12), Sample Student Cumulative Health Record (NYSCSH 8/19). This form also informs the parent/guardian of their childs test results and other information which may be disclosed as permitted by law. There are also vaccines that adolescents may need if they werent fully vaccinated when they were younger and vaccines for adolescents who have certain risk factors. Athletes Health Issues Sample Fillable Form, Spanish Sample Recommended NYSED Interval Health History for Athletics, Sample Parent/Guardian Letter for Sudden Cardiac Arrest (SCA) Prevention, Sample Recommended Medical Certificate of Limitations Form, SampleAthlete with Special Needs Supplemental History Form, When to Keep a Child Home - Instructions to Parents/Guardians, Conjunctivitis - Letter to Parents/Guardians, Head Lice Alert Letter For Parents/Guardians, NYSED Guidelines for Concussion Management In Schools, Sample School Recommendations Following Concussion, Sample Acute Concussion Care Plan and Parent Information Sheet, ACE (Acute Concussion Evaluation) Care Plan, Sample COVID- 19 Exposure Notification Form, Your Child Was Seen In The Health Office With Symptoms of COVID-19, NYSCSH Non-Patient Specific Order Checklist based on NYS Office of Professions Information Page, Sample Spanish School COVID Testing Consent Form, Sample School COVID Testing Consent Form Instructions, Sample Emergency Care Plan for Unlicensed School Personnel: ASTHMA, Sample Letter to Families about Metered Dose Inhalers, Spacers, and Nebulizers, Sample Provider and Parent Guardian Permission for the use of School Provided Spacer/Valved Holding Chamber, NYSDOH Diabetes in Children: A resource guide for families and schools, Helping the Student with Diabetes Succeed, National Institute of Diabetes & Digestive & Kidney Diseases (NIH) Tools, DMMP Addendum: Role of Parents/Guardians in Adjustment of Insulin Dose, Math CalculationCheckerWorksheet for Insulin Deviation, Hypo and Hyperglycemia Chart for School Staff, Glucagon Training Documentation Form for School Personnel, NYSCSH e-Learning & Learning Management System (LMS), Sample Generic Emergency Care Plan for Unlicensed School Personnel, Sample Students With Special Health Care Needs Record, Sample Emergency Care Flow Sheet for Staff, Sample Faculty/Staff Emergency Contact Information, Parent Interview Questionnaire for Seizure History, Sample Permission to Share Protected Health Information(HIPAA), Required NYS School Health Examination Form (PDF), Required NYS School Health Examination Form (Fillable PDF), Instructions for Completion of the New York State School Health Examination EHR Compatible Form, Instructions for School Nurses and School Medical Directors Related to Completion of the Required Health Examination Form, Sample Parent Notification/Request for Mandated Health Appraisal, RequiredNYS School Health Examination Form FAQ's, Sample Recommended Form - Medical Certificate of Limitations, NYS & NYC Screening & Health Examination Requirements Chart, Letter to Parents Regarding Health and Dental Examination Requirements, Sample Individual Student Health Office Visit Record, Sample Parent Letter - Animals in the Classroom, Sample Permission Form - Animals in the Classroom, District Epi Notification to Parents/Guardians, Epinephrine District Staff Training Summary, Sample Procedure for Unlicensed School Staff Responding to Severe Allergic Reactions, Sample Letter to Parents About Cold Weather Precautions, Immunization Request Letter to Parents/Guardians of Students in PreK-12, Sample Exclusion Letter for Principals to Send to Parent/Guardian. Note: Samples and Forms are provided as guidance based on current best practices. SCHOOL NURSE WELCOME LETTER . The Texas School Nurse. You are receiving this letter because your child had an IHP and / or EAP with us last year. Observed on the fourth . If I have not reached out to you please contact me. 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. Our fax number is 770-781-2254. Parents should use caution when dealing with any insecticide, particularly on children. Parents should also ask about a second type of meningococcal vaccine (meningococcal B) that may be appropriate for their child between ages 16-18 years. 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. Sample Recommended Medical Certificate of Limitations Form (NYSED 2022)May be used to document private provider recommendations for PE accommodation. As for infestation information, The Columbus City School offers information on lice and bedbug infestation. However, if they fail, you should provide the findings, so the follow-up provider has a frame of reference. 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). Before we. 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. Sample School COVID Testing Consent Form(Fillable PDF NYSCSH 10/21)This sample consent form was created to assist schools with the requirement to have parent/guardian permission on file prior to testing a child. CDC Diseases & ConditionsA-Z directory of information, NYSDOH Diseases & Conditions FactsheetA-Z directory of factsheets, NYSED Guidelines for Concussion Management In Schools(NYSED 7/2022). NYS law (Chapter 281) permits schools to request an oral health assessment when requesting a health exam. Charlotte ISD School Nurse Phone: 830-277-1637 Fax: 830-277-1675 kgarza@charlotteisd.org . Dear Parents and Guardians, Congratulations! Welcoming preschoolers to an adventure can help reframe the experience and make it more exciting. Health examinations are required for new entrants and in grades Pre-K or K, 1, 3, 5, 7, 9, and 11 (Section 136.3 Health Examinations and Screenings. There are two forms, please complete both. Information may include: When to Keep a Child Home - Instructions to Parents/Guardians (NYSCSH 12/19)Sample letter to share district guidelines. Seizure Emergency Care Plan Provides information for emergency management in both English and Spanish. Your email address will not be published. Sample Acute Concussion Care Plan and Parent Information Sheet (NYSCSH 12/19)This template can be customized for your needs. Diastat/Seizure Preparedness Plan Links to Diastat website. Your involvement makes a difference. Its a great way to stay up to date about PANS/PANDAS and to see what events are available in your area. Seizure ECP with Medication Information (NYSCSH 9/12)Customizable template for HCP to document response plan for seizures. Again, welcome! History and Current Status Check the foods that have caused an allergic reaction: Thank you for all of your cooperation this year. The school nurse will help by giving first aid, administering prescribed medication, notifying parents of illness or injury, and providing education on health related matters. Any exclusion policies related to lack of documentation are in place and will be enforced per PA Department of Health/Department of Education mandates. Helping the Student with Diabetes Succeed Sample Diabetes Medical Management Plan, a sample template for an Individualized Health Care Plan, and sample Emergency Care Plans for Hypoglycemia and Hyperglycemia. I am wanting to make parents aware and to remind their students to wash hands frequently, . 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. Treatment reduces the spread of illness. If modified, it should be reviewed and approved by the School Medical Director and Administration prior to use. 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. Immunization Request Letter to Parents/Guardians of Students in PreK-12 (NYSCSH 6/22)Sample letter that may be used with the Immunization Requirements for School Entrance/Attendance Chart to notify parents/guardians of students in grades PreK - 12 about immunization requirements for school entrance/attendance. Please complete the following forms if the emergency medication or treatment listed is used: *Note: All naloxone use should be reported in accordance with district policy utilizing the NYSDOH Reporting Form located on the NYSDOH website. stream Sample Letter to Families about Metered Dose Inhalers, Spacers, and Nebulizers (NYSCSH 9/20)Provides information on why an MDI and Spacer is preferable over a nebulizer during the COVID-19 Pandemic. It includes placement date, location, brand/dose, lot #, expiration date, and date of administration. Sample resources below should be reviewed and approved by the School Medical Director and/or BOE prior to use. Chicken Pox 2. 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. 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.