We are asking your assistance in providing the student with a safe learning environment. This includes: Dental and Tdap and Menactra for 7th grade. 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. 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. Note: Samples and Forms are provided based on current best practices. We request that everyone does this consistently. endobj Take your child to work day is April 27th. Required Forms are indicated in the title. Immunization Requirements for School Attendance Medical Exemption Statement for Children 0-18 years of Age FormThis form must be completed annually. Guidelines for Anaphylaxis 35 March 2009 . Letter Samples - (not from template or form, my own work) May 2019. 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. If you have trouble accessing this page and need to request an alternate format, contact u@osu.edu. 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. Students must register at the ITHC before receiving services. Join our mailing list to receive the latest news and updates from our team. Please review the following and let us know if you have any questions. The following is my calendar section. Includes area for medication and Vagal Nerve Stimulator orders. Required fields are marked *. No Problem. Training must be completed annually. Provider & Parent Permission to Administer Medication at School/School Sponsored Events (NYSCSH 3/2019) Documents provider order & parent permission for medication use at school. The following data collection is done on a voluntary basis. stream [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. This letter should be reviewed and approved by the School Medical Director prior to use. NYSDOH Sample DMMPThis document is from the NYSDOH Diabetes in Children: A resource guide for families and schools pages 82-86. SampleMedical History Update Form (NYSCSH 2/18)An optional form that may be used to obtain current health information from the parent/guardian in non-mandated health examination years or to provide student history prior to a school-provided physical exam. You can see more information about this screening tool at www.sdqinfo.com. Educational Service District 105, July 2016. JDRF School Advisory ToolkitContains information on Section 504, Legal Rights of the Child, common 504 Plan questions, and references. The COVID-19 pandemic has made clear the importance of health and health safety. PDF. 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. Sample Parent Notification/Request for Mandated Health Appraisal (NYSCSH 1/20). Home : 000-000-0000 Cell: 000-000-0000. email@email.com. 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. Build relationships with parents. Epinephrine Placement/Use Log (NYSCSH 4/17)Provides documentation for storing andaccounting of EAI. 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. AAP Allergy and Anaphylaxis Emergency Plan, FARE Food Allergy ECP in both English and Spanish. Sample Non-Patient Specific Order for BinaxNow COVID-19 Testing(NYSCSH 12/20)This sample order can be used for schools implementing BinaxNow COVID-19 testing of students. A description of the illness, including the complaint's date, time, and details. Sample Flow Chart for Sports Clearance(NYSCSH 4/18)May be used to determine clearance for sports participation. 3 0 obj We promise to give your students the quality care they deserve. 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. We are always available by phone or you may come to see me in the clinic. We have listed some information below that should help answer questions you may have regarding the operations of the clinic at Sawnee Elementary. I can be reached: Monday-Wednesday 8:30-4:00Phone: 206 252-3887Fax: 206 743-3130jpboyett@seattleschools.org. Math CalculationCheckerWorksheet for Insulin DeviationThis worksheet may be used to verify math calculations performed by the RN. For more information on which vaccines adolescents need, visit HYPERLINK "http://www.adolescentvaccination.org/"adolescentvaccination.org. We are seeing an increase in the reported cases of Strep throat. 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 . Note: Samples and Forms are provided as guidance based on current best practices. Thank you for your cooperation. We missed you. Children entering or attending school in New York State, including summer school and distance learning, must comply with immunization requirements. Again, welcome! Our nurse cards are electronic this year! Dear Ms. Snodgrass, I would like to apply for the School Nurse position with the Clark County Elementary School. HGw8npB} r\"4p4]i),^/pbDqtW4X`~Gr"2SA?P/": & All action plans food/insect allergies, asthma, diabetes, seizures, etc must be signed by a Georgia physician. Copyright 2023. Please use the hopefully less hectic summer months to have your child seen if they have not been already. Ideally, this information should be communicated when the exemption is granted. Many sports practices begin August 1. 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. Farrow Carson RN BSN Amy Langevin RN BSN Pershing School Nurse: 523-2430 Nurse Fax Number: 523-2539 Nursing Assessment for Determination of Supervised Student (NYSCSH 11/2021)This is a customizable version. Copyright 2002-2018 Blackboard, Inc. All rights reserved. The calendar for the school at which I hope to work can be found here: There is no specific nursing calendar available here. Your involvement makes a difference. If you have any questions, please feel free to contact me. Athletes Health Issues Sample Fillable Form (NYSCSH 7/21)May be used by school nurses to share student medical needs with athletic directors/coaches. %PDF-1.7 Communicable disease prevention, surveillance, notification, and reporting are important roles provided by the school health team. (111) 789-3456. School Nurse Professional Organizations and Resources, Sample Calendar reminders for a School Nurse. [Hiring Manager's Last Name], It's with great excitement that I learned of your school nurse vacancy at [School Name]. Seizure Emergency Care Plan Provides information for emergency management in both English and Spanish. School Nurses should send out letters that Request for Notice of Infectious Illness to the school community or to a specific classroom and set of staff that is in direct contact with the student. 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). Sample Acute Concussion Care Plan and Parent Information Sheet (NYSCSH 12/19)This template can be customized for your needs. Letter to Parents Regarding Health and Dental Examination Requirements (NYSCSH 5/21)Informs parents/guardians of the mandated requirements for health appraisal within 30 days of school entry. 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. School Nurse Beginning of School Checklist(NYSCSH 11/21)- List of tasks for the beginning of the schoolyear. Pediatricians offices get very busy in the fall. They do not constitute a mandate nor imply liability should the school choose other options. Head Lice/Nits 4 . All of these are available through the School-based health centers or through vaccination clinics. Sample Letter to Parents About Cold Weather Precautions (NYSCSH 2/18). RequiredNYS School Health Examination Form FAQ's Provides answers to questions the Center has received regarding the use and completion of the form. The 2019-2020 school year, Pennsylvania school immunization requirements include the . NYS law (Chapter 281) permits schools to request an oral health assessment when requesting a health exam. I strongly recommend a comprehensive healthcare visit for all adolescents at age 11-12 years, or as early as possible thereafter. 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. Younger adolescents have higher antibody levels to vaccination compared to older adolescents and young adults. 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. 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). Adolescents are at increased risk of getting this infection. kBn[ )9@:BLIHosu42HmM_>@eb~Z. It can be found at https://www.ccsoh.us/Page/1215. 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. Get email updates from We are here to assist in any way that we can as a nurse in the school clinic. Its not too late to follow up on those. @&>D8q!""u]WMvsE&H|+ 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. It is very important that you notify the school if your child is diagnosed with Strep throat or any other illness. Starting school for the first time can be intimidating. These are: Hepatitis A (2 doses), Meningococcal B (2 doses), Meningococcal A (1 or 2 doses), HPV (2 or 3 doses). 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]. 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. Our fax number is 770-781-2254. 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 Letters to Parents Rob Wickham 2015-01-14T18:01:38+00:00. How Does a Parent/Guardian File a 310 Appeal? The NYSED Dominic Murray Sudden Cardiac Arrest Prevention Act Memo can be found on the Laws | Guidelines | Memos - Athletics. Please let me know if I can be of assistance to you. 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. It is vital for the School Nurse to foster communication between the entire school population about who and when someone has an infectious illness. Hypo and Hyperglycemia Chart for School Staff Excerpted from NYSDOH Diabetes in Children with the permission of the NYSDOH. (BDP>c%:] &n`,N^QEY> 4"%f9+Tsce;3WoPx6e|@[[[7boat #]0MCvc4,Qe[&NzY]U afb /-L%5:le,R]dgTSdcZUZLXQcff61}lQMPEPQ4030eZo#kR[A&i%\;GQr=NMGe a:aJGWFH_M*q< +'QtGXSs\}V$`WLBjsaE+:$m#~w{A$,aAsAEVQbpv7aj]QysQjw t-Hz4pbfdfVF%XA`U<wU)u(a]t*0hcYU#yQQ8XF@_go8M3-A[F9@$OThlw"lE`LA% XZED e1a.NIcOaR$Im;Jnu2TX]Y|d A~f{4c[PfRm`,Gq4v,!4KEhkm^a -8>(I0Iuah5+m]_av9dl(gY_DdraJ$g%7Y)XF.v27p,x{`TT*)5rk**Q3&KPWiLH0O N@0/frY#Kz}{N^T?Da|Yq^'Ymh E%\JV%s#]2PSGv[w}]Q"eM;,Z>U'r"](./,v*rQKlJF{pu Please make sure all health and emergency contact information are up to date on this site that the school uses for information management. Includes options for the provision of medication to students who require medication on field trips. 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. I am wanting to make parents aware and to remind their students to wash hands frequently, . Learn more about PANS PANDAS in the school setting. ? d9y0Eqdme]l*{ qzN_z]-bW5D !kYg}h#1u|H=YI6f{[IIFI7aj&Pfyzi Hand, Foot and Mouth Disease 3. Seizure ECP (NYSCSH 6/12)Customizable template for the HCP to document the type of seizure and treatment plan. c;43iAKO"0J10{!F&/qiK CN/EQlHFnHx"T}B^&e5dxZ\6h/}zZ5=ow`MSS(S ! Seattle, WA 98133 from: https://www.schoolhealthny.com/cms/lib/NY01832015/Centricity/Domain/85/Calendar%20Template%202016.pdf, Your email address will not be published. Spanish Sample Recommended NYSED Interval Health History for Athletics (NYSED 6/22). You and your child are invited to join us in this activity. 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. These sample resources may be modified for your use consistent with NYSED, local district policy, and school medical director guidance. Letter to Parents: School Nurse 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. Alliance to Solve PANS & Immune-Related Encephalopathies. in Nursing. 8BB)p18yN:9B There are students at our school who have a serious autoimmune condition related to strep throat and other common infections. The sample communications below should be reviewed and approved by your school medical director and school administrator. Nurse Letter to Parents 2020-2021 Welcome Back! Diastat/Seizure Preparedness Plan Links to Diastat website. SCHOOL NURSE WELCOME LETTER . When to Keep a Child Home - Instructions to Parents/Guardians(NYSCSH 12/19)Sample letter to share district guidelines. This letter should be reviewed and approved by the School Medical Director prior to use. 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. This lists the steps to go through in the determination of supervised students. Additional permission from the provider and parent for Independent Medication Carry and Use must also be completed for that to occur. Ideally, adolescents should get their vaccines during a routine pre-adolescent check-up at age 11-12 years. Our role is to work with you and your child to ensure a smooth, healthy transition from the home/preschool setting to Sawnee Elementary. 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. I begin my calendar in May because planning and preparation for the next school year begins long before August! With 5 years of expertise promoting health and safety at elementary schools, I believe my skills make me a perfect fit for your school. This is the disclaimer text. 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. Its a great way to stay up to date about PANS/PANDAS and to see what events are available in your area. Older adolescents (age 13-18 years) who have not been vaccinated should receive their vaccines as soon as possible. Teens or young adults who have not gotten any or all of the recommended doses should make an appointment to be vaccinated. Author: Charlene Schexnayder Taking medications at school regularly or as needed? PANS PANDAS is a medical condition in which symptoms affect a students ability to attend school and learn. This is a rare, but extremely serious disease that kills up to 10 percent of those who get it. Author: kgarza They do not constitute a mandate nor imply liability should the school choose other options. I may use the SDQ screening tool in grade 9 to help identify students who may need additional supports to thrive academically and socially. 2 0 obj You and your family excelled through another school year. . However, if they fail, you should provide the findings, so the follow-up provider has a frame of reference. It includes placement date, location, brand/dose, lot #, expiration date, and date of administration. Strict avoidance of peanut/nut products is the only way to prevent a life threatening allergic reaction. 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. Samples do not constitute a mandate nor imply liability should the school choose other options. Daily Medication Sheet - Summer School (NYSCSH 11/2021)July and August calendar view of medication charting. Please work with your childs provider for alternative options. 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. Sample School Letter to All Parents Sample WASSDA Policy Sample WASSDA Procedure . You are receiving this letter because your child had an IHP and / or EAP with us last year. Sample Recommended Form - Medical Certificate of Limitations (NYSED 2022)Used to document private provider recommendations for accommodation for PE. 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. Monthly Medication Administration Record (Medicaid Compliant)(NYSCSH 2/2017)Records date, times, doses, exception codes, reactions, Medicaid-compliant signature boxes, and NPI number. 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. Sample End-of-Year Medication Pick-Up (NYSCSH 3/2017)Medication pick-up information for end of year. Classroom Treats (NYSCSH 3/17)General letter that should be altered to align with your districts policies on classroom treats (some districts only allow pre-packaged snacks, some allow home-baked goods). A parent or guardian must sign a consent form for the student to be seen, except in the areas of mental health and sexual health where minors can self-consent per state law. The sample resources may be modified for your district's use consistent with NYSED, local district policy, and school medical director guidance. The school district medical Director is responsible for oversight of the school health program and should be informed of any EAI programs implemented. If your child is lacking school-district required vaccines, I will contact you. 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. endobj 3 0 obj <>/Font<>/XObject<>>>/Filter/FlateDecode/Length 3732>>stream We missed you. History and Current Status Check the foods that have caused an allergic reaction: <>/Metadata 141 0 R/ViewerPreferences 142 0 R>> Treatment reduces the spread of illness. You can access free COVID-19 screening through the Public Health SCAN program for your children. If your child becomes sick, please let the School Nurse office know. Save my name, email, and website in this browser for the next time I comment. We thank you in advance for your cooperation in helping us maintain a safe, healthy environment for all of our students. This is a template only and does not reflect any state guidance or recommendations. Join us by subscribing to our newsletter. Wash Hands thoroughly wash your hands after wiping noses and before eating or preparing food. Sample Illness Notification (NYSCSH 9/22)This letter may be customized to alert parents/guardians about the reason their child was seen in the health office, the care provided, recommendations, and notification of an attempt to contact them. What should you do to prevent the spread of strep throat? For more detailed information, see page 41 in Guidelines for Medication Management in Schools. 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. Tia Petersen. Thank you in advance for your cooperation in helping us maintain a safe, healthy environment for all of our students. Please keep our staff and the school nurse informed of any health conditions that could affect your child while at school. It is essential to maintain the confidentiality of affected students when sending notifications. Instructions for School Nurses and School Medical Directors Related to Completion of the Required Health Examination Form (NYSCSH 1/21)Effective 1/31/2021. Appointments are required to drop off medication. 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. Epinephrine District Staff Training Summary (NYSCSH 4/17)Provides a form to document staff trained in the administration of EAI. Data Collection Calendar for Secondary School Nurses (NYSCSH 8/12), Data Collection Calendar for Elementary School Nurses (NYSCSH 8/12), School Nurse Weekly Excel Worksheet (NYSCSH 3/22), School Nurse Monthly Activities Recording Form (NYSCSH 5/20), Sample Letter to Parent/Guardian Regarding Required Screenings (NYSCSH 12/18), Hearing Screening Parent/Guardian Notification Results and ReferralForm(NYSCSH 5/18), Sample Classroom Teacher Observations- Hearing (NYSCSH 5/18), Scoliosis Screening Parent/Guardian Notification Results and Referral Form (NYSCSH 5/18).

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