Sample Emergency Care Plan for Unlicensed School Personnel: ASTHMA (NYSCSH 11/21)Provides easy-to-understand information for unlicensed school staff to assist and respond to an asthma emergency. It is vital for the School Nurse to foster communication between the entire school population about who and when someone has an infectious illness. Younger adolescents have higher antibody levels to vaccination compared to older adolescents and young adults. Sample Recommended Form - Medical Certificate of Limitations (NYSED 2022)Used to document private provider recommendations for accommodation for PE. We are always available by phone or you may come to see me in the clinic. My job is to support you and your childs health and learning this year, and I hope that I can help you stay healthy during these challenging times. All action plans food/insect allergies, asthma, diabetes, seizures, etc must be signed by a Georgia physician. Children with a fever (100.4 or higher), vomiting, diarrhea, or other symptoms should be kept home from school until symptom free per the AGCS Sick Child Policy. We want to welcome you as your School Nurse. [INSERT SCHOOL NURSE SIGNATURE, NAME, AND TITLE] July 2015 & ' = U _ c m H I k l r pYK7 &*h&. Guidelines for Anaphylaxis 35 March 2009 . City, State, Zip Code. 8BB)p18yN:9B Your childs personal information and identity will not be disclosed to anyone. Copyright 2002-2023 Blackboard, Inc. All rights reserved. With 5 years of expertise promoting health and safety at elementary schools, I believe my skills make me a perfect fit for your school. 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. Aspire. Please review the following and let us know if you have any questions. ASPIRE Facebook Group & ChitChat Meetings, Clinical Urgency of Diagnosing & Treating, Sample Letter Section 504 Determination Request, Sample Letter Request to an Evaluation for an IEP & 504 Plan, Sample Letter Request for Prior Written Notice PWN, Sample Letters Notification of Illness from School Nurse. 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). in Charlotte. Vaccines are recommended to protect adolescents now and into adulthood. If you're ready to apply for your next role, upload your resume to Indeed Resume to get started. You can access free COVID-19 screening through the Public Health SCAN program for your children. Sample Recommended NYSED Interval Health History for Athletics (Fillable PDF NYSED)This form now includes questions related to the Dominic Murray Sudden Cardiac Arrest Act effective 7/1/22 and COVID-19. 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. Any exclusion policies related to lack of documentation are in place and will be enforced per PA Department of Health/Department of Education mandates. Sanitize toothbrushes by replacing or boiling them. It provides a referral plan by the private provider containing information on current symptoms and recommendations for RTL and RTP. Medication Expiration Tracking Tool (Fillable PDF - NYSCSH 8/2022)Documents student initials, DOB, medication name, expiration date, and date of parent communication. Before we. 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. Phone: 206 252-3887. Separate medication orders would be needed. Daily Medication Sheet - Summer School (NYSCSH 11/2021)July and August calendar view of medication charting. End of School Year Parent Letter (NYSCSH 3/23) To be sent home with the NYS Required Health Examination Form and the NYS Immunization Requirements for School Entrance/Attendance to complete the End of School Year Packet. If you dont use it, the Bb footer will slide up. Please make an appointment with your childs healthcare professional and be sure to check that your childs immunizations are up to date. National Take Your Child to Work Day 2023 is Thursday, April 27th. Dear Parents, This letter is to inform you that a student in your child's classroom has a severe peanut/nut allergy. My . I can be reached: Monday-Wednesday 8:30-4:00Phone: 206 252-3887Fax: 206 743-3130jpboyett@seattleschools.org. For more information on the Role of the School Nurse. I can help you sort out possible COVID-19 symptoms and to access help for testing. We are here to assist in any way that we can as a nurse in the school clinic. Sample resources below should be reviewed and approved by the School Medical Director and/or BOE prior to use. I begin my calendar in May because planning and preparation for the next school year begins long before August! Again, welcome! Alliance to Solve PANS & Immune-Related Encephalopathies. !Y?qLNFK`p;tTBGLVxQ$ mPfUJKM60iP+_^R%{Z+AmUTi(OaWch*hle|m8=eUp/hFp%;u4h!p$##nEm\ :ao%-L|!m ~";*`1Tqd7+of=c*T~#DM9fiTh?$A !bC"4gO}o The sample resources may be modified for your district's use consistent with NYSED, local district policy, and school medical director guidance. Asthma Action Plan: Parent Letter Date: Dear Parent/Guardian of: School: Room Grade: Good management of your child's asthma is important to his or her success at school. Observed on the fourth . Please use the sign up genius to make an appointment before school starts. Food allergies are not recognizedunless we have a food/insect allergy action plan signed by a Georgia physician listing the specific allergen. It can be found at https://www.ccsoh.us/Page/1215. To aid in keeping students well we do abide by a sickness policy. Neither text, nor links to other websites, is reviewed or endorsed by The Ohio State University. Please contact your school nurse for further guidance. Communicable disease prevention, surveillance, notification, and reporting are important roles provided by the school health team. 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. Seattle, WA 98133 Sample Emergency Care Flow Sheet (NYSCSH 12/16), Sample Emergency Care Flow Sheet for Staff (NYSCSH 9/17), Sample Faculty/Staff Emergency Contact Information (NYSCSH 5/16), Sample Individual Health Care Plan (NYSCSH 8/18). It is very important to read and follow the label directions carefully and specifically. The purpose of the activity is to inculcate a sense of responsibility towards underprivileged people. The sample communications below should be reviewed and approved by your school medical director and school administrator. 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. However, if they fail, you should provide the findings, so the follow-up provider has a frame of reference. As a final reminder, before your child can begin school with us we need these items. I may use the SDQ screening tool in grade 9 to help identify students who may need additional supports to thrive academically and socially. Wash Hands thoroughly wash your hands after wiping noses and before eating or preparing food. Teens or young adults who have not gotten any or all of the recommended doses should make an appointment to be vaccinated. <> Medication Incident Report Form (NYSCSH 3/2023)Sample document for medication errors, notifications made, and outcomes. I strongly recommend a comprehensive healthcare visit for all adolescents at age 11-12 years, or as early as possible thereafter. School Nurse To Do List. 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. Author: kgarza Sample Parent Notification/Request for Mandated Health Appraisal (NYSCSH 1/20). Why is it important that your child receive treatment? It can be found at. Subjects: Math CalculationCheckerWorksheet for Insulin DeviationThis worksheet may be used to verify math calculations performed by the RN. The time to begin is nigh! Home : 000-000-0000 Cell: 000-000-0000. email@email.com. Though we do not know when we will resume in-person learning, for emergency medications, please have these forms back to me at the start of the year. in Nursing. What You Say In Here Stays in Here (NYSCSH 10/17)8.5 x 11-inch printable poster. For younger students --Children do have accidents at school; please be sure to send a change of clothing in their backpack to keep at school. Students must register at the ITHC before receiving services. 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. A description of the illness, including the complaint's date, time, and details. All students entering kindergarten must have had TWO varicella vaccinations All students entering 7th grade must have had one Tdap vaccination and one meningococcal vaccination These new requirements are in addition to the existing school immunization requirements. Dear Ms. Snodgrass, I would like to apply for the School Nurse position with the Clark County Elementary School. SampleAthlete with Special Needs Supplemental History Form (AAP-Bright Futures, 3/2018)May be used to obtain additional health information from athletes with special needs. Copyright 2002-2018 Blackboard, Inc. All rights reserved. Dear Parents and Guardians, Congratulations! You can participate even if you work from home. We are always available by phone or you may come to see me in the clinic. c;43iAKO"0J10{!F&/qiK CN/EQlHFnHx"T}B^&e5dxZ\6h/}zZ5=ow`MSS(S ! This letter should be reviewed and approved by the School Medical Director prior to use. It should be reviewed and approved by the school medical director prior to use. School health services contact information. To make an appointment at Ingrahams Teen Health Center call: 206 477-9715. Treatment with antibiotics can usually prevent rheumatic fever. NYSDOH Sample DMMPThis document is from the NYSDOH Diabetes in Children: A resource guide for families and schools pages 82-86. Nurse Letter to Parents 2020-2021 Welcome Back! Join our mailing list to receive the latest news and updates from our team. stream And there is that word:infectious. You and your child are invited to join us in this activity. Treatment will also prevent other rare, but possibly dangerous, complications such as PANS/PANDAS, a form of autoimmune encephalitis resulting in OCD, tics, anxiety and other symptoms. Students with PANDAS/ PANS may experience symptoms simply from being exposed to an infection. Epinephrine Placement/Use Log (NYSCSH 4/17)Provides documentation for storing andaccounting of EAI. Please email the nurse to schedule a time (. 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]. This is a rare, but extremely serious disease that kills up to 10 percent of those who get it. endstream 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. Did your child have a vision or hearing referral this year? SAMPLE Rev 11/2019 LETTER TO PARENT/GUARDIAN Dear Parent/Guardian of _____ Our school is excited to offer an education and prevention program for school aged students in collaboration with . I am a list maker and work well off lists. We will know soon, who will be overlapping on Wednesdays and working on Fridays, in the meantime, I will handle paperwork and questions you may have. 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. Our fax number is 770-781-2254. Effingham County BOE Letter To Parents; Nurse. This also provides us with the information on how to reach you if your child becomes ill or injured. Sample Exclusion Letter for Principals to Send to Parent/Guardian (NYSCSH 9/22)This sample may be customized to send to parents/ guardians whose children have not received the required immunizations for school attendance. school nurse. All Rights Reserved. To prepare for a healthy and safe 2020-21 school year, please provide updated health and medication information on your child before the first day of school in September. 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. endobj 3 0 obj <>/Font<>/XObject<>>>/Filter/FlateDecode/Length 3732>>stream AAP Allergy and Anaphylaxis Emergency Plan, FARE Food Allergy ECP in both English and Spanish. Includes calendars, diaries, and logs from Epilepsy.com. Thank you in advance for your cooperation in helping us maintain a safe, healthy environment for all of our students. NYS & NYC Screening & Health Examination Requirements Chart (NYSCSH 7/18), Chronological Age/Grade Chart (NYSCSH 6/21). 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. If you have any questions, please feel free to contact me. ? d9y0Eqdme]l*{ qzN_z]-bW5D !kYg}h#1u|H=YI6f{[IIFI7aj&Pfyzi Athletes Health Issues Sample Fillable Form (NYSCSH 7/21)May be used by school nurses to share student medical needs with athletic directors/coaches. Sample TBI Return Monitoring (NYSCSH 11/17)Sample tracking tool schools may use to track students' symptoms for RTL and RTP. School Nurse End of School Checklist(NYSCSH 11/21)- List of tasks for the end of the school year. Daily Medication Record School Year(Excel - NYSCSH 12/2021) Calendar view of medication charting for an individual student modifiable for your school district. Many sports practices begin August 1. The calendar for the school at which I hope to work can be found here: https://www.columbusacademy.org/events There is no specific nursing calendar available here. Expand All No Problem. I am a professional in the nursing field with over 12 years of experience and I hold a B.A. Finally, If working to find health topics to educate or celebrate each month, one resource is the National Health Observances page at HealthFinder.gov: Columbus City Schools Board of Education, n.d. 2019. We must have an Authorization for Medication form on file with the school nurse. We look forward to establishing a relationship with you and your child. Please make sure all health and emergency contact information are up to date on this site that the school uses for information management. May be modified by local school districts. 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. Parents and school staff may use this tool to give feedback about how well the student in any grade is doing in four areas: emotions, focus, behavior and getting along with others. These sample resources may be modified for your use consistent with NYSED, local district policy, and school medical director guidance. Visit Us. {og"3"" sh"LvE8&/lsg9f%^G5~]?4 5,"5`5j9+R/J-C Minnesota Department of Health, May 2016. This form also informs the parent/guardian of their childs test results and other information which may be disclosed as permitted by law. 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. If modified, it should be reviewed and approved by the School Medical Director and Administration prior to use. x+2T0 BQW\ E Our fax number is 770-781-2254. Ideally, this information should be communicated when the exemption is granted. Our role is to work with you and your child to ensure a smooth, healthy transition from the home/preschool setting to Sawnee Elementary. This sample notification letter encompasses multiple ages and grade levels of students. BJx^@d3%gGL5R/]cC[i;:$d"WYMv)1gjzepY Nursing Assessment for Determination of Supervised Student (NYSCSH 11/2021)This is a customizable version. Please contact your school nurse for further guidance. Author: Charlene Schexnayder We promise to give your students the quality care they deserve. 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). Your involvement makes a difference. Effective 7/1/18). Seizure ECP with Medication Information (NYSCSH 9/12)Customizable template for HCP to document response plan for seizures. 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. Samples do not constitute a mandate nor imply liability should the school choose other options. It is important that these families know if their child has been exposed to strep or other illnesses. Please feel free to call us anytime at 770-887-6161. When to Keep a Child Home - Instructions to Parents/Guardians(NYSCSH 12/19)Sample letter to share district guidelines. This year at Ingraham, health and safety is of highest priority. Sample Recommended NYSED Interval Health History for Athletics (Fillable Word NYSED)This form now includes questions related to the Dominic Murray Sudden Cardiac Arrest Act effective 7/1/22 and COVID-19. New York State Center for School Health, n.d.,2016. With the new state of health we, as the Nursing Department, have some new procedures that we would like to make you aware of for the 2020/2021 school year. Please have a backup plan in case you are not available to pick up your child within an hour. You can email me and or fax this information to me. Your Child Was Seen In The Health Office With Symptoms of COVID-19(NYSCSH 1/22)Sample letter to send home with students who present with COVID-19 symptoms. Please note that adolescents need a booster vaccine at age 16. Children with strep infections may return to school after taking medicine for at least 24 hours and fever is gone. We are asking your assistance in providing the student with a safe learning environment. Sample Recommended Medical Certificate of Limitations Form (NYSED 2022)May be used to document private provider recommendations for PE accommodation. Welcome to Ingraham High School. 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 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. 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.
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