Instructions for Completion of the New York State School Health Examination EHR Compatible Form (NYSED 2020)Provides directions for health care providers on the required components and presentation order of those components for an electronic health record form to be an equivalent form. 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. No nebulizer treatments will be provided at school. Athletes Health Issues Sample Fillable Form (NYSCSH 7/21)May be used by school nurses to share student medical needs with athletic directors/coaches. School health services contact information. Blood Glucose / Insulin Log for Individual Students (NYSDOH Guide-Page 94). Seattle, WA 98133 Please let me know if you would like to hear from me. It does not indicate permission for the student to carry and use the medication independently. 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. 3 0 obj Use your teacher introduction letter to parents to let them know that you want to be a team. (If YES, please see the school nurse as soon as possible.) The School Nurse position at Ingraham has been shared by two nurses over the past couple of years. All action plans food/insect allergies, asthma, diabetes, seizures, etc must be signed by a Georgia physician. All of these are available through the School-based health centers or through vaccination clinics. Our fax number is 770-781-2254. Sample Generic Emergency Care Plan for Unlicensed School Personnel (NYSCSH 12/16)Information for unlicensed school staff to assist with emergency health issues. The sample resources may be modified for your district's use consistent with NYSED, local district policy, and school medical director guidance. Wash Hands thoroughly wash your hands after wiping noses and before eating or preparing food. Join our mailing list to receive the latest news and updates from our team. Note: Samples and Forms are provided based on current best practices. 2 0 obj Please work with your childs provider for alternative options. Our nurse cards are electronic this year! School Nurse To Do List. 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 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. However, if they fail, you should provide the findings, so the follow-up provider has a frame of reference. 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. They are available in many languages. Please note that adolescents need a booster vaccine at age 16. Medication Expiration Tracking Tool (Word - NYSCSH 8/2022)Documents student initials, DOB, medication name, expiration date, and date of parent communication. Please contact your school nurse for further guidance. My name is Janet Boyett, I am your school nurse. PANS PANDAS is a medical condition in which symptoms affect a students ability to attend school and learn. This is the disclaimer text. 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). Ideally, adolescents should get their vaccines during a routine pre-adolescent check-up at age 11-12 years. Sample Recommended Medical Certificate of Limitations Form (NYSED 2022)May be used to document private provider recommendations for PE accommodation. 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. Your involvement makes a difference. These sample resources may be modified for your use consistent with NYSED, local district policy, and school medical director guidance. endobj 3 0 obj <>/Font<>/XObject<>>>/Filter/FlateDecode/Length 3732>>stream 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. Seizure ECP (NYSCSH 6/12)Customizable template for the HCP to document the type of seizure and treatment plan. School Nurse Beginning of School Checklist(NYSCSH 11/21)- List of tasks for the beginning of the schoolyear. You can participate even if you work from home. 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. Additional permission from the provider and parent for Independent Medication Carry and Use must also be completed for that to occur. I am requesting the care plan and medication authorizations to be signed by the Sept 8th, with some flexibility if needed. If you dont use it, the Bb footer will slide up. 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). These sample resources may be modified for your use consistent with NYSED, local district policy, and school medical director guidance. Starting school for the first time can be intimidating. I can be reached: Monday-Wednesday 8:30-4:00Phone: 206 252-3887Fax: 206 743-3130jpboyett@seattleschools.org. Clinic Information (2022-2023) Health and Safety News; Health News Links; Effingham County BOE Letter To Parents; Health Forms; . The letter is designed to be sent by the school nurse. There are a wide variety of resources on the King County website. May be modified by local school districts. Again, welcome! 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. Build relationships with parents. A description of the illness, including the complaint's date, time, and details. Currently I am employed as a Nurse . Sample resources below should be reviewed and approved by the School Medical Director and/or BOE prior to use. Treatment with antibiotics can usually prevent rheumatic fever. <>/ExtGState<>/Font<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 612 792] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> To make an appointment at Ingrahams Teen Health Center call: 206 477-9715. 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. District homepage from: Educational Service District 105, July 2016. This may result in longer lasting immunity for those vaccinated earlier in adolescence. AED-Epi Maintenance Checklist (NYSCSH 4/17)The checklist may be used to document the security of both the AED and the EAI, District Epi Notification to Parents/Guardians (NYSCSH 4/17)Provides information regarding the implementation of the program within the school district and contact resources for more information and date of administration. They are available in many languages. Those two things will help keep you and our community healthy. Minnesota Department of Health, May 2016. BJx^@d3%gGL5R/]cC[i;:$d"WYMv)1gjzepY For more detailed information, see page 41 in Guidelines for Medication Management in Schools. If not treated or not treated long enough, your child may continue to spread the infection. 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. Our nurse cards are electronic this year! Welcoming preschoolers to an adventure can help reframe the experience and make it more exciting. It can be found at. Similar School Nurse qualifications are visible in the example cover letter provided below. There are teen vaccines that are not required for school but are recommended by the Center for Disease Control. ACE (Acute Concussion Evaluation) Care PlanThis form is part of the "Heads Up: Brain Injury in Your Practice" toolkit developed by the CDC. Face coverings are currently required during the school day per the Pennsylvania Department of Health and Department of Education. Human papillomavirus (HPV) vaccine protects against a cancer-causing infection. The Ohio Department of Health has a brochure that can be shared with families: https://odh.ohio.gov/wps/portal/gov/odh/know-our-programs/school-nursing-program/media/what_should_i_do_if_my_child_gets_head_lice_brochure, When it comes to vision and hearing screenings, the Ohio Department of Health provides templates for letters to families to inform them of the upcoming screenings. school day. 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. Please use the sign up genius to make an appointment before school starts. in Nursing. These letters are provided as guidance based on current best practices. 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 Field Trip Notification with Information for Parents on Insect Repellents (NYSCSH 6/2018). DMMP Addendum: Role of Parents/Guardians in Adjustment of Insulin DoseAllows the HCP to provide criteria by which the parent may be consulted in adjusting insulin doses administered by a nurse during school hours and at school-sponsored events to the extent reasonably practicable. 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. National Take Your Child to Work Day 2023 is Thursday, April 27th. Last Modified on November 9, 2022. It is important that these families know if their child has been exposed to strep or other illnesses. The following data collection is done on a voluntary basis. Dear Ms. Snodgrass, I would like to apply for the School Nurse position with the Clark County Elementary School. Aspire. Food allergies are not recognizedunless we have a food/insect allergy action plan signed by a Georgia physician listing the specific allergen. %PDF-1.7 There are students at our school who have a serious autoimmune condition related to strep throat and other common infections. Sample Letter: Notice to Parents and Guardians Sample Letter: Notice to Parents and Guardians [School Letterhead] [Date] Dear Parent or Guardian: The [name of school district or region] wants to provide a healthy school environment for all students. 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 year at Ingraham, health and safety is of highest priority. 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. All grade level mandates and immunizations are required for the 2020-21 school year regardless of the education platform (virtual or in person). Head Lice/Nits 4 . Receipt of Medication Delivered to School (NYSCSH 8/2012)Documents receipt of initial and subsequent medication delivery from parents. 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. All students should have a face covering with them. Samples do not constitute a mandate nor imply liability should the school choose other options. Required Forms are indicated in the title. Epinephrine District Staff Training Summary (NYSCSH 4/17)Provides a form to document staff trained in the administration of EAI. Recommended vaccines protect adolescents from very serious illnesses: Meningococcal vaccines protect against infection with a type of bacteria that causes meningitis and blood infection (sepsis). Sample School Health Office Data Collection Tool (NYSCSH 5/21)Customizable, easy-to-use documentation tool to collect data on school health care staffing, student health data, vision & hearing deficits, and student outcomes. There are two forms, please complete both. Epinephrine Placement/Use Log (NYSCSH 4/17)Provides documentation for storing andaccounting of EAI. 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. 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. 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. Our fax number is 770-781-2254. For more information on which vaccines adolescents need, visit HYPERLINK "http://www.adolescentvaccination.org/"adolescentvaccination.org. We have listed some information below that should help answer questions you may have regarding the operations of the clinic at Sawnee Elementary. Please feel free to call us anytime at 770-887-6161. You can see more information about this screening tool at www.sdqinfo.com. Sample Letters to Parents; School Medications; WV Health Programs; Newsletters; Health & Wellness; Search for: Sample Letters to Parents. 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. 8BB)p18yN:9B These services are rendered for accidents and illnesses that occur during the school day. We are always available by phone or you may come to see me in the clinic. It contains the required elements of an NYS non-patient-specific order. Forms can be accessed through Power School Forms. Includes calendars, diaries, and logs from Epilepsy.com. NYS law (Chapter 281) permits schools to request an oral health assessment when requesting a health exam. Dear Mr. Vestal: As a skilled nurse with more than nine years of experience providing comprehensive healthcare services to a wide variety of students, I am pleased to present the enclosed resume in response to your opening for a new School Nurse. We are asking your assistance in providing the student with a safe learning environment. We want to protect every student from communicable diseases especially during COVID-19. Strict avoidance of peanut/nut products is the only way to prevent a life threatening allergic reaction. RequiredNYS School Health Examination Form FAQ's Provides answers to questions the Center has received regarding the use and completion of the form. Communicable disease prevention, surveillance, notification, and reporting are important roles provided by the school health team. It is very important that you notify the school if your child is diagnosed with Strep throat or any other illness. Alliance to Solve PANS & Immune-Related Encephalopathies. Please complete the permission/refusal form by _____. The following is my calendar section. Thank you for your cooperation. Letter Samples - (not from template or form, my own work) May 2019. Please keep our staff and the school nurse informed of any health conditions that could affect your child while at school. 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. 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. I may use the SDQ screening tool in grade 9 to help identify students who may need additional supports to thrive academically and socially. 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. Adolescents are at increased risk of getting this infection. kK>L[gcW ifijV ?+ KM&7^}iAhfn#{Hn|V7N"&S,2p4ed-B^Z.[(SPxYXz\JPVm0INA4Xf2$m~BC!)O]D{us+"t)U36{T2d2GjT~Gq9(im6'bQbep0Q 3zK=~CKeGhcGz!(tWz:.WPU Er/HMW. $3.00. The clinic runs on donations only and supplies of new underwear are sometimes low or out. Strep throat is a sore throat caused by Streptococcus bacteria that are passed around through nose and mouth droplets. Encourage personal growth and self-advocacy as your child gets older by giving him the responsibility to explain his diagnosis, how it may affect him day to day, as well as state his commitment to succeed in school. 1100 Ebenezer . How Does a Parent/Guardian File a 310 Appeal? 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). This form allows you to provide that information. Calendar/Schedule for the Licensed School Nurse Yearly/Monthly from: https://www.health.state.mn.us/docs/people/childrenyouth/schoolhealth/lsncalendar.pdf. When the child that has been treated for head lice returns to school, his or her head should be checked by the school nurse or health representative to insure that it is free of lice and nits. Nurse Letter to Parents 2020-2021 Welcome Back! Take If you have any questions, please feel free to contact me. Fax: 206 743-3130. jpboyett@seattleschools.org. Farrow Carson RN BSN Amy Langevin RN BSN Pershing School Nurse: 523-2430 Nurse Fax Number: 523-2539 Main Office: 206-252-3880, Northwest Coast Art by Andrea Wilbur-Sigo, Squaxin/Skokomish, See Registration and Course Catalog Information, Continuous School Improvement Plan and School Profile. Clear communication between you and your child, your health care provider and school staff is the key to managing asthma at school. Hypo and Hyperglycemia Chart for School Staff Excerpted from NYSDOH Diabetes in Children with the permission of the NYSDOH. Dose Counting Medication Record(PDF - NYSCSH 7/2018) Calendar view record of medication administration which provides a continuous count of medication given and medication remaining. All controlled substances must be brought to school by a parent or guardian. 1. Observed on the fourth . The HPV vaccine is given as a three-dose series over a six-month period to protect both females and males. No Problem. endstream Daily Medication Record School Year(Excel - NYSCSH 12/2021) Calendar view of medication charting for an individual student modifiable for your school district. Sample Parent Notification/Request for Mandated Health Appraisal (NYSCSH 1/20). 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. [INSERT SCHOOL NURSE SIGNATURE, NAME, AND TITLE] July 2015 & ' = U _ c m H I k l r pYK7 &*h&. 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. Put preschoolers at ease. Sample TBI Return Monitoring (NYSCSH 11/17)Sample tracking tool schools may use to track students' symptoms for RTL and RTP. !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 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.
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