Guidelines for Anaphylaxis 35 March 2009 . Sample School Recommendations Following Concussion (NYSCSH 12/19)A customizable checklist which can be provided to the health care provider to allow them to indicate what Return To Learn (RTL) and Return To Play (RTP) accommodations they recommend for the student. Please note that adolescents need a booster vaccine at age 16. (111) 789-3456. Sample Student Daily Visit Form (NYSCSH 1/18)Aids school health personnel in tracking follow-up on student visits to the health office. You can see more information about this screening tool at www.sdqinfo.com. Please feel free to call us anytime at 770-887-6161. As for infestation information, The Columbus City School offers information on lice and bedbug infestation. Includes options for the provision of medication to students who require medication on field trips. Please review the following and let us know if you have any questions. I can help you sort out possible COVID-19 symptoms and to access help for testing. Clinic Information (2022-2023) Health and Safety News; Health News Links; Effingham County BOE Letter To Parents; Health Forms; . Our fax number is 770-781-2254. 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. <>/Metadata 141 0 R/ViewerPreferences 142 0 R>> Spanish Sample Recommended NYSED Interval Health History for Athletics (NYSED 6/22). Welcome to Ingraham High School. You can participate even if you work from home. New York State Center for School Health, n.d.,2016. These are: Hepatitis A (2 doses), Meningococcal B (2 doses), Meningococcal A (1 or 2 doses), HPV (2 or 3 doses). Epi-pens, Albuterol, Benadryl, Childrens Tylenol, Childrens Motrin or any other medications are. 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). 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. Adolescents are at increased risk of getting this infection. Watch your child for signs of a sore throat and other signs of strep (headache, fever, stomachache, swollen and tender neck glands). For more detailed information, see page 41 in Guidelines for Medication Management in Schools. School Health Examination Guidelines (NYSED 2022)Requirements and guidance for administrators and school health personnel on mandated student health examinations and establishing a health program. <> We look forward to getting to know you and your child during the 2018-19 school year! It includes placement date, location, brand/dose, lot #, expiration date, and date of administration. Immunization Requirements for School Attendance Medical Exemption Statement for Children 0-18 years of Age FormThis form must be completed annually. 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. Sample Generic Emergency Care Plan for Unlicensed School Personnel (NYSCSH 12/16)Information for unlicensed school staff to assist with emergency health issues. In the same way that you might reference resume samples, the following School Nurse cover letter example will help you to write a cover letter that best highlights your experience and qualifications. 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. To be completed by the parent/guardian no earlier than 30 days before the start of the sport. Your email address will not be published. % Full training found here: NYSCSH e-Learning & Learning Management System (LMS), Model 504 Plan from the American Diabetes Association. Includes area for medication and Vagal Nerve Stimulator orders. 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. What You Say In Here Stays in Here (NYSCSH 10/17)8.5 x 11-inch printable poster. This is the disclaimer text. Seattle, WA 98133 Nursing Annual Responsibilities(NYSCSH 11/21), Nursing Monthly Responsibilities(NYSCSH 11/21), Nursing Quarterly/Semiannual Responsibilities(NYSCSH 11/21). The COVID-19 pandemic has made clear the importance of health and health safety. Observed on the fourth . They do not constitute a mandate nor imply liability should the school choose other options. Parent/Guardian Designation to Authorize Another Adult to Administer Medication (NYSCSH 1/2018)Document parent/guardian permission to authorize another adult to administer medication to their child for a specific event. Information may include: When to Keep a Child Home - Instructions to Parents/Guardians (NYSCSH 12/19)Sample letter to share district guidelines. endstream You are receiving this letter because your child had an IHP and / or EAP with us last year. To aid in keeping students well we do abide by a sickness policy. endobj 3 0 obj <>/Font<>/XObject<>>>/Filter/FlateDecode/Length 3732>>stream Copyright 2002-2018 Blackboard, Inc. All rights reserved. Medication Incident Report Form (NYSCSH 3/2023)Sample document for medication errors, notifications made, and outcomes. Pediatricians offices get very busy in the fall. For busy months like in the fall I will separate by early month and mid-month tasks. 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. 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. My . Blackboard Web Community Manager Privacy Policy (Updated). BJx^@d3%gGL5R/]cC[i;:$d"WYMv)1gjzepY Over-the-counter treatment: Head lice may be treated with shampoos specifically labeled for head lice. Please complete the permission/refusal form by _____. The School Nurse position at Ingraham has been shared by two nurses over the past couple of years. Charlotte ISD School Nurse Phone: 830-277-1637 Fax: 830-277-1675 kgarza@charlotteisd.org . Farrow Carson RN BSN Amy Langevin RN BSN Pershing School Nurse: 523-2430 Nurse Fax Number: 523-2539 This letter is an example he can follow. The excused absence notes from your doctors almost never indicate the specific reason. 1 0 obj <>>>>> endobj 2 0 obj <>>>/Filter/FlateDecode/Length 36>>stream Vaccines are recommended to protect adolescents now and into adulthood. Medication Expiration Tracking Tool (Fillable PDF - NYSCSH 8/2022)Documents student initials, DOB, medication name, expiration date, and date of parent communication. Visit Us. 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. Nursing Assessment for Determination of Supervised Student (NYSCSH 11/2021)This is a customizable version. It can be found at. 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. This poster can be printed and displayed to make students aware of school staff members' responsibility to share information that could result in self-harm or harm to others, according to school policies. Your childs personal information and identity will not be disclosed to anyone. 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. OLOM School Medication Form completed by parent and signed by your pediatrician. We are here to assist in any way that we can as a nurse in the school clinic. Provider attestation must be included for independent medication use. It is vital for the School Nurse to foster communication between the entire school population about who and when someone has an infectious illness. 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. Provides resources and information for creating a seizure emergency plan. Medication Expiration Tracking Tool (Word - NYSCSH 8/2022)Documents student initials, DOB, medication name, expiration date, and date of parent communication. Take your child to work day is April 27th. NYSCSH Non-Patient Specific Order Checklist based on NYS Office of Professions Information Page(NYSCSH 5/19). RequiredNYS School Health Examination Form FAQ's Provides answers to questions the Center has received regarding the use and completion of the form. Forms can be accessed through Power School Forms. Blood Glucose / Insulin Log for Individual Students (NYSDOH Guide-Page 94). The following is my calendar section. Vaccination is important even if your child was vaccinated as an infant, because the protection from those vaccines may not last into the teen years. 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. This is a template only and does not reflect any state guidance or recommendations. Our role is to work with you and your child to ensure a smooth, healthy transition from the home/preschool setting to Sawnee Elementary. Neither text, nor links to other websites, is reviewed or endorsed by The Ohio State University. Please have a backup plan in case you are not available to pick up your child within an hour. We want to protect every student from communicable diseases especially during COVID-19. 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. Sample Students With Special Health Care Needs Record (NYSCH 2/21)May be used by the school nurse to record students' health care concerns, medication, and emergency care plan status. Those two things will help keep you and our community healthy. All of these are available through the School-based health centers or through vaccination clinics. 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. 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. You and your family excelled through another school year. Take Try to work it out: In the end, even paying a renter or nonpaying guest to go away might be faster and cheaper than trying to evict him. 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). AAP Allergy and Anaphylaxis Emergency Plan, FARE Food Allergy ECP in both English and Spanish. We request that everyone does this consistently. 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. Use your teacher introduction letter to parents to let them know that you want to be a team. The sample resources may be modified for your district's use consistent with NYSED, local district policy, and school medical director guidance. Please contact your school nurse for further guidance. School Nursing Activities Annual Calendar from:https://www.esd105.org/site/handlers/filedownload.ashx?moduleinstanceid=2140&dataid=2364&FileName=2017%20School%20Nursing%20Activities_Annual_Calendar.pdf, Minnesota Department of Health, May 2016. 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. Copyright 2023. This letter should be reviewed and approved by the School Medical Director prior to use. Our fax number is 770-781-2254. Human papillomavirus (HPV) vaccine protects against a cancer-causing infection. 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. Sample Letters to Parents; School Medications; WV Health Programs; Newsletters; Health & Wellness; Search for: Sample Letters to Parents. Starting school for the first time can be intimidating. gBk"wA76\1?B2J0J$k@-P+IoP5[1c9Cl*uJlL-^AC34f y ;fmpY^yt2"F`X7NeWkY+$He\ #vt4m7b/bk>kV^>/Q(d Dear Parents and Guardians, Congratulations! 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. Thank you for your cooperation. If you dont use it, the Bb footer will slide up. Face coverings are currently required during the school day per the Pennsylvania Department of Health and Department of Education. You and your child are invited to join us in this activity. When to Keep a Child Home - Instructions to Parents/Guardians(NYSCSH 12/19)Sample letter to share district guidelines. ACE (Acute Concussion Evaluation) Care PlanThis form is part of the "Heads Up: Brain Injury in Your Practice" toolkit developed by the CDC. endobj School health services contact information. 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. The school district medical Director is responsible for oversight of the school health program and should be informed of any EAI programs implemented. It should be reviewed and approved by the school medical director prior to use. R R R R R $ v v v P 4 v X% P , , , , ` ` ` $ $ $ $ $ $ $ $ ' Z* $ R ` ` $ R R , , 4 % G G G ^ R , R , $ G $ G G V " G$ , P!~+ # $ (% 0 X% # x * * G$ G$ * R [$ h ` 0 " G ` ` ` $ $ ` ` ` X% * ` ` ` ` ` ` ` ` ` : Letter/Email to Parents: School Nurse The following template can be personalized and sent via mail or email to families to educate them about the vaccinations that adolescents should receive and to encourage them to make an appointment with their healthcare professional. Schedule a flu shot for your student and family members. c# Please discuss and reinforce with your child(ren) proper hand hygiene and cough and sneeze etiquette. Laws & Commissioner's Regulations by Content Area, Searchable Bills, Codes, Laws, Rules, and Regulations, NYSCSH e-Learning and Learning Management System (LMS), Athletics Forms | Letters | Notifications, Student-Athletes with Medical Conditions - Confidential List, Sample Recommended NYSED Interval Health History for Athletics. Customizable, available in landscape and portrait. 1 0 obj I am a list maker and work well off lists. Sample resources below should be reviewed and approved by the School Medical Director and/or BOE prior to use. Copyright 2002-2023 Blackboard, Inc. All rights reserved. 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). All students should have a face covering with them. The clinic runs on donations only and supplies of new underwear are sometimes low or out. Sample letters 1- Notification letter to parent for a school activity Dear parents, This is to inform you that the annual bake sale for charity will be held on Saturday, October 06, 20xx. Its a great way to stay up to date about PANS/PANDAS and to see what events are available in your area. It provides a referral plan by the private provider containing information on current symptoms and recommendations for RTL and RTP. 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. Levels of Assistance in Administering Medications Guide (NYSCSH 9/2019) Provides guidance in determining how may and may not administer medications in school and how to determine who may do so. These letters are provided as guidance based on current best practices. 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. kBn[ )9@:BLIHosu42HmM_>@eb~Z. 8BB)p18yN:9B If strep is found, your child should receive treatment and you should report this to your school health office. 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. Provider & Parent Permission to Administer Medication at School/School Sponsored Events (NYSCSH 3/2019) Documents provider order & parent permission for medication use at school. I may use the SDQ screening tool in grade 9 to help identify students who may need additional supports to thrive academically and socially. These sample resources may be modified for your use consistent with NYSED, local district policy, and school medical director guidance. 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. I used the cited calendars for idea and inspiration, but the list is my own, not a template. Sample Flow Chart for Sports Clearance(NYSCSH 4/18)May be used to determine clearance for sports participation. This letter to parents is created for the school nurse to remind and educate 6th grade parents at the end of the year of the required vaccines for the 7th grade and recommended vaccines as well!Note: The vaccination requirements listed in this document are specific to Texas. Dear Parents, This letter is to inform you that a student in your child's classroom has a severe peanut/nut allergy. Again, welcome! What should you do to prevent the spread of strep throat? How Does a Parent/Guardian File a 310 Appeal? NYSDOH Sample DMMPThis document is from the NYSDOH Diabetes in Children: A resource guide for families and schools pages 82-86. 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. Vision Screening Parent/Guardian Notification Results and Referral Form (NYSCSH 10/18) Note: Parents must be notified of both passing and failing vision results. {og"3"" sh"LvE8&/lsg9f%^G5~]?4 5,"5`5j9+R/J-C I know, I know you dont want to hear about it yet, but August will be here before you know it. Put preschoolers at ease. Phone: 206 252-3887. Clear communication between you and your child, your health care provider and school staff is the key to managing asthma at school. Eviction can cost $1,000 to $10,000 in legal fees, and . NYS law (Chapter 281) permits schools to request an oral health assessment when requesting a health exam. Subjects: The form is available on-line, in person or by request. It is vital for the School Nurse to foster communication between the entire school population about who and when someone has an infectious illness. FERPA Disclosure Log (NYSCSH 8/12)Documents student health records viewed by non-health office staff. The calendar for the school at which I hope to work can be found here: https://www.columbusacademy.org/events There is no specific nursing calendar available here. Samples do not constitute a mandate nor imply liability should the school choose other options. No nebulizer treatments will be provided at school. If your child was seen in the clinic during their school day, a copy of a Clinic Referral Slip will be sent home providing details of their visit. Most sore throats, however, are caused by viruses and are not treated with antibiotics. Diastat/Seizure Preparedness Plan Links to Diastat website. Heather: Welcome back! Medical Exemption Review Procedures for Schools Outside NYC, Guidance on Immunization-Related Medical Exemptions for School-Aged Children, Monthly Medication Administration Record (MAR), Catheterization Care Documentation Record, Gastrostomy Tube Feeding Documentation Record, Suctioning Tracheostomy Documentation Record, Template for Skilled Nursing Procedure Documentation Record. If your child must have medication of any type, including over -the -counter drugs, given during school hours, you have the following choices: 1) You may come to school and give the medication to your child at the appropriate time(s). HGw8npB} r\"4p4]i),^/pbDqtW4X`~Gr"2SA?P/": & If your child develops a sore throat and any of these other signs, please see your healthcare provider; tell her or him that other children in the school have been diagnosed with strep and ask to have your child tested for strep throat. x[mo8 Cz"&^%Ecf$De_w__w=g=-8[pgY,'Xg#9?cy!,fV^~uUGy)O =,qy`9~0=qdLM~=? Administrative Assistant for Grades 4-8 and Main Office State Road. 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. Sample Letter to Parents About Cold Weather Precautions (NYSCSH 2/18). If you have any questions, please feel free to contact me. Aspire. 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. You and your family excelled through another school year. 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. [INSERT SCHOOL LOGO OR LETTERHEAD] Dear [INSERT PARENT/GUARDIAN NAME]: As children reach their teen years, their risk of becoming ill due to certain serious infectious diseases increases. These sample resources may be modified for your use consistent with NYSED, local district policy, and school medical director guidance. Monthly Medication Administration Record (Medicaid Compliant)(NYSCSH 2/2017)Records date, times, doses, exception codes, reactions, Medicaid-compliant signature boxes, and NPI number. Per AGCS handbook and CDC guidelines, parents will be required to assess their child(ren)s health daily prior to reporting to school. It is very important to read and follow the label directions carefully and specifically. Please let me know if I can be of any assistance. Sample Acute Concussion Care Plan and Parent Information Sheet (NYSCSH 12/19)This template can be customized for your needs. I am already missing the hustle and bustle of high schoolers whose energy and enthusiasm are infectious. Sample School Letter to All Parents Sample WASSDA Policy Sample WASSDA Procedure . in Nursing. We are asking your assistance in providing the student with a safe learning environment. Sample Letters to Parents Rob Wickham 2015-01-14T18:01:38+00:00. If you do NOT want the SDQ given to your child, please call or email me with your students name and I will send you an exemption form to complete and return. Sample Recommended Form - Medical Certificate of Limitations (NYSED 2022)Used to document private provider recommendations for accommodation for PE. Younger adolescents have higher antibody levels to vaccination compared to older adolescents and young adults. JDRF School Advisory ToolkitContains information on Section 504, Legal Rights of the Child, common 504 Plan questions, and references. Any exclusion policies related to lack of documentation are in place and will be enforced per PA Department of Health/Department of Education mandates. Communicable disease prevention, surveillance, notification, and reporting are important roles provided by the school health team. This includes: Dental and Tdap and Menactra for 7th grade. <>/ExtGState<>/Font<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 612 792] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> If I have not reached out to you please contact me. We thank you in advance for your cooperation in helping us maintain a safe, healthy environment for all of our students.
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