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. PDF LETTER TO PARENT/GUARDIAN - Pennsylvania Department of Health You can use this area for legal statements, copyright information, a mission statement, etc. It should be reviewed and approved by the school medical director prior to use. This letter is an example he can follow. Sample Recommended Medical Certificate of Limitations Form (NYSED 2022)May be used to document private provider recommendations for PE accommodation. 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. Strep throat is a sore throat caused by Streptococcus bacteria that are passed around through nose and mouth droplets. I can be reached: Monday-Wednesday 8:30-4:00Phone: 206 252-3887Fax: 206 743-3130jpboyett@seattleschools.org. 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. PDF SECTION 5 SAMPLE FORMS - k12.wa.us Our new community has launched. from: https://www.schoolhealthny.com/cms/lib/NY01832015/Centricity/Domain/85/Calendar%20Template%202016.pdf. Author: Charlene Schexnayder Note: Samples and Forms are provided based on current best practices. 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. If you're ready to apply for your next role, upload your resume to Indeed Resume to get started. I strongly recommend a comprehensive healthcare visit for all adolescents at age 11-12 years, or as early as possible thereafter. All controlled substances must be brought to school by a parent or guardian. I know, I know you dont want to hear about it yet, but August will be here before you know it. 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). 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. Dear Parents and Guardians, Congratulations! It is very common in children. 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. $3.00. SCHOOL NURSE WELCOME LETTER . 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. How to Get Someone Out: Evicting a Family Member With No Lease 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. Copyright 2002-2023 Blackboard, Inc. All rights reserved. Students with PANDAS/ PANS may experience symptoms simply from being exposed to an infection. endstream Please complete the Annual Student Health Update form either online or in PowerSchool (Sept 1-30), or by letting me know by email or phone. Thank you in advance for your cooperation in helping us maintain a safe, healthy environment for all of our students. Sample Letters - Notification of Illness from School Nurse AGeorgia physicians signature is required on all Medical Care Plans and Administration of Medication forms for prescription medications and medications given for longer than a 2 week period of time on a routine basis. 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). 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 communications below should be reviewed and approved by your school medical director and school administrator. My . 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. We must have an Authorization for Medication form on file with the school nurse. school nurse. The Texas School Nurse. 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. 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. If you have any questions, please feel free to contact me. DOC Maryland.gov - Official Website of the State of Maryland Required NYS School Health Examination Form (PDF) (NYSED 2023)This form may be printed and completed by hand. The form is available on-line, in person or by request. PDF Head Lice Information Letter for Parent/Guardian of Classmates 1. Adolescents are at increased risk of getting this infection. To make an appointment at Ingrahams Teen Health Center call: 206 477-9715. Put preschoolers at ease. If modified, it should be reviewed and approved by the School Medical Director and Administration prior to use. Elastic waist pants or shorts for girls/boys, Disposable plastic Dixie cups Rubbing Alcohol. Sample Letters to Parents | School Based Health 4v(w"Eyh?y,/X[#Y _c[ 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. 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. 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. We thank you in advance for your cooperation in helping us maintain a safe, healthy environment for all of our students. Why is it important that your child receive treatment? ~~G@Q2Gq)ZNR wQ:]oZql96s(a V5Xt}6E/ V.n`:}/I5#1]X"(cdKnZ?5-y#/l'#Ax$d\mOBPC8168c!f| Save my name, email, and website in this browser for the next time I comment. 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 an effort to have a smooth and successful transition into the next school year, we would like to meet with you and your child to go over information for this school year. Supporting Student Success Through Health and Education. The school district medical Director is responsible for oversight of the school health program and should be informed of any EAI programs implemented. Our nurse cards are electronic this year! 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. If you dont use it, the Bb footer will slide up. Providers can fax any paperwork to my confidential fax: 206 743-3130 . 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. . Medication Expiration Tracking Tool (Fillable PDF - NYSCSH 8/2022)Documents student initials, DOB, medication name, expiration date, and date of parent communication. Taking medications at school regularly or as needed? PDF Appendix 8 Sample Notification Letters to Parents gBk"wA76\1?B2J0J$k@-P+IoP5[1c9Cl*uJlL-^AC34f y ;fmpY^yt2"F`X7NeWkY+$He\ #vt4m7b/bk>kV^>/Q(d The content of this site is published by the site owner(s) and is not a statement of advice, opinion, or information pertaining to The Ohio State University. Blood Glucose / Insulin Log for Individual Students (NYSDOH Guide-Page 94). Operated by Public Health and Kaiser Permanente, the ITHC is located next to the attendance and counseling office. 1 0 obj Pediatricians offices get very busy in the fall. 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. Before we. Nurse Letter to Parents 2020-2021 Welcome Back! Treatment with antibiotics can usually prevent rheumatic fever. Heather: Welcome back! Schedule a flu shot for your student and family members. 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. Sample End-of-Year Medication Pick-Up (NYSCSH 3/2017)Medication pick-up information for end of year. 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. @&>D8q!""u]WMvsE&H|+ 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. School Nurse To Do List. It contains the required elements of an NYS non-patient-specific order. Take Minnesota Department of Health, May 2016. School Nurse Phone (225)924-1054 Fax (225)923-2201 cindy.vinning@olomschool.org www.olomschool.org . 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. Seizure ECP (NYSCSH 6/12)Customizable template for the HCP to document the type of seizure and treatment plan. Calendar/Schedule for the Licensed School Nurse Yearly/Monthly from: https://www.health.state.mn.us/docs/people/childrenyouth/schoolhealth/lsncalendar.pdf, New York State Center for School Health, n.d.,2016. 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. We missed you. Sample Field Trip Notification with Information for Parents on Insect Repellents (NYSCSH 6/2018). Home : 000-000-0000 Cell: 000-000-0000. email@email.com. What You Say In Here Stays in Here (NYSCSH 10/17)8.5 x 11-inch printable poster. National Institute of Diabetes & Digestive & Kidney Diseases (NIH) ToolsSample DMMP, IHP, and ECPs under Health Care and Education Plans. 1100 Ebenezer . NYS law (Chapter 281) permits schools to request an oral health assessment when requesting a health exam. Administrative Assistant for Grades 4-8 and Main Office State Road. 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. NYSCSH Non-Patient Specific Order Checklist based on NYS Office of Professions Information Page(NYSCSH 5/19). These letters are provided as guidance based on current best practices. Department of Public Health, you may find useful to be able to send to parents. The following data collection is done on a voluntary basis. You are receiving this letter because your child had an IHP and / or EAP with us last year. 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. These are: Hepatitis A (2 doses), Meningococcal B (2 doses), Meningococcal A (1 or 2 doses), HPV (2 or 3 doses). 2022-2023 School Year NYSDOH Immunization Requirements for School Entrance/Attendance Chart, Chronological Age/Grade Chart (NYSCSH 6/22), Meningococcal Vaccine School Requirement Flyer. To be completed by the parent/guardian no earlier than 30 days before the start of the sport. PDF School Nurse Welcome Letter 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. p5mWsl *M:2z{ads7?Tc w_/%^T7@Uj^6BZ%^pURd4?8453ROC,d{ODuEwh.&pR(HSXS _L ?!p;BqktvR|$QN(`@@%qK'L/F]C DY'Yo*I4H!)TXR_^T% byIh-qE8m~AT$n4B)";n"O\rPRT# olHYV ,jBveo The School Nurse position at Ingraham has been shared by two nurses over the past couple of years. 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 vital for the School Nurse to foster communication between the entire school population about who and when someone has an infectious illness. Medication Incident Report Form (NYSCSH 3/2023)Sample document for medication errors, notifications made, and outcomes. Provides resources and information for creating a seizure emergency plan. in Nursing. Please discuss and reinforce with your child(ren) proper hand hygiene and cough and sneeze etiquette. Here is the link to the English form letter https://odh.ohio.gov/wps/wcm/connect/gov/ac81b8d7-ddde-4820-8235-da7da62bfd90/Vision+Screening+Requirements+Letters+a.pdf?MOD=AJPERES&CONVERT_TO=url&CACHEID=ROOTWORKSPACE.Z18_M1HGGIK0N0JO00QO9DDDDM3000-ac81b8d7-ddde-4820-8235-da7da62bfd90-mO6iKmF. Sample Medication Delivery Information for Parents (NYSCSH 7/2020)Provides information for Parents/Guardians on what is needed to administer medications at school, including recommendations for a spacer for MDI use vs. a nebulizer. This letter should be reviewed and approved by the School Medical Director prior to use. ACE (Acute Concussion Evaluation) Care PlanThis form is part of the "Heads Up: Brain Injury in Your Practice" toolkit developed by the CDC. Please have a backup plan in case you are not available to pick up your child within an hour. Did your child have a vision or hearing referral this year? School Nurse Cover Letter Examples | Nursing | LiveCareer Observed on the fourth . Dear [Mr./Ms./Mx.] Calendar/Schedule for the Licensed School Nurse Yearly/Monthly from: https://www.health.state.mn.us/docs/people/childrenyouth/schoolhealth/lsncalendar.pdf.