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. Sample Students With Special Health Care Needs Record (NYSCSH 2/21)May be used to record students' health care concerns, medication, and emergency care plan status. x[mo8 Cz"&^%Ecf$De_w__w=g=-8[pgY,'Xg#9?cy!,fV^~uUGy)O =,qy`9~0=qdLM~=? The sample communications below should be reviewed and approved by your school medical director and school administrator. You can use this area for legal statements, copyright information, a mission statement, etc. As for infestation information, The Columbus City School offers information on lice and bedbug infestation. Currently I am employed as a Nurse . 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. Food allergies are not recognizedunless we have a food/insect allergy action plan signed by a Georgia physician listing the specific allergen. It should be reviewed and approved by the school medical director prior to use. This lists the steps to go through in the determination of supervised students. New York State Center for School Health, n.d.,2016. What You Say In Here Stays in Here (NYSCSH 10/17)8.5 x 11-inch printable poster. It contains the required elements of an NYS non-patient-specific order. Phone: 206 252-3887. Strep throat is a sore throat caused by Streptococcus bacteria that are passed around through nose and mouth droplets. Letter Samples (not from template or form, my own work), Congratulations! Sample Recommended NYSED Interval Health History for Athletics (Fillable Word NYSED)This form now includes questions related to the Dominic Murray Sudden Cardiac Arrest Act effective 7/1/22 and COVID-19. I am a professional in the nursing field with over 12 years of experience and I hold a B.A. The form is available on-line, in person or by request. PDF Letter to Parent Regarding Administration of Medication in School - Corvian Vaccines are recommended to protect adolescents now and into adulthood. During remote learning, I will be reaching out to check in with students who have a health concern and to connect with students and families who may need extra support. 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. Your childs personal information and identity will not be disclosed to anyone. 8BB)p18yN:9B 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. Includes calendars, diaries, and logs from Epilepsy.com. When to Keep a Child Home - Instructions to Parents/Guardians(NYSCSH 12/19)Sample letter to share district guidelines. 1. Why is it important that your child receive treatment? Welcome back! I am requesting the care plan and medication authorizations to be signed by the Sept 8th, with some flexibility if needed. 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 . gBk"wA76\1?B2J0J$k@-P+IoP5[1c9Cl*uJlL-^AC34f y ;fmpY^yt2"F`X7NeWkY+$He\ #vt4m7b/bk>kV^>/Q(d All action plans food/insect allergies, asthma, diabetes, seizures, etc must be signed by a Georgia physician. Older adolescents (age 13-18 years) who have not been vaccinated should receive their vaccines as soon as possible. Children entering or attending school in New York State, including summer school and distance learning, must comply with immunization requirements. Take Sample Exclusion Letter for Principals to Send to Parent/Guardian (NYSCSH 9/22)This sample may be customized to send to parents/ guardians whose children have not received the required immunizations for school attendance. %PDF-1.5 % Administrative Assistant for Grades 4-8 and Main Office State Road. If your child becomes sick, please let the School Nurse office know. 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. All students should have a face covering with them. from: https://www.schoolhealthny.com/cms/lib/NY01832015/Centricity/Domain/85/Calendar%20Template%202016.pdf, Your email address will not be published. Sample Acute Concussion Care Plan and Parent Information Sheet (NYSCSH 12/19)This template can be customized for your needs. Younger adolescents have higher antibody levels to vaccination compared to older adolescents and young adults. In addition to school nursing, I have a background in the ICU taking care of patients with traumatic injuries, burns, bone marrow transplants and on the lighter side, many summers of camp nursing. I strongly recommend a comprehensive healthcare visit for all adolescents at age 11-12 years, or as early as possible thereafter. Sample Recommended Form - Medical Certificate of Limitations (NYSED 2022)Used to document private provider recommendations for accommodation for PE. I look forward to meeting you in person when we are able, but I can speak to you on the phone, or through online platforms. This is a template only and does not reflect any state guidance or recommendations. If you dont use it, the Bb footer will slide up. The following data collection is done on a voluntary basis. I begin my calendar in May because planning and preparation for the next school year begins long before August! School Nurse Phone (225)924-1054 Fax (225)923-2201 cindy.vinning@olomschool.org www.olomschool.org . I can be reached: Monday-Wednesday 8:30-4:00Phone: 206 252-3887Fax: 206 743-3130jpboyett@seattleschools.org. Please do not hesitate to contact your school nurse to make this a Happy and Healthy school year together! 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). You can see more information about this screening tool at www.sdqinfo.com. Your involvement makes a difference. All controlled substances must be brought to school by a parent or guardian. Please use the hopefully less hectic summer months to have your child seen if they have not been already. Sample Dental Certificate (NYSED 3/18)This form aligns with health exam grade levels. Subjects: This information is important to the nurses as soon as the school year starts, even if your child is not on campus right now. NYS & NYC Screening & Health Examination Requirements Chart (NYSCSH 7/18), Chronological Age/Grade Chart (NYSCSH 6/21). Health examinations are required for new entrants and in grades Pre-K or K, 1, 3, 5, 7, 9, and 11 (Section 136.3 Health Examinations and Screenings. The 2019-2020 school year, Pennsylvania school immunization requirements include the . 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. 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. Again, welcome! 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. Wash Hands thoroughly wash your hands after wiping noses and before eating or preparing food. (111) 789-3456. We missed you. Clear communication between you and your child, your health care provider and school staff is the key to managing asthma at school. School Nurse Cover Letter Examples and Templates | Indeed.com For more information on the Role of the School Nurse. The clinic runs on donations only and supplies of new underwear are sometimes low or out. 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. Health Services Samples & Forms / Overview In addition to these vaccines, the Centers for Disease Control and Prevention (CDC) also recommends that everyone age six months and older get an influenza vaccine every year. 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. This includes all physician prescribed medications and any over- . This is not mandated, but data collection is important to demonstrate the response of the school nurse in a medical emergency, to help advocate for staffing needs, to create policies and programs, and to create a healthy and safe environment. Ideally, this information should be communicated when the exemption is granted. Children with strep infections may return to school after taking medicine for at least 24 hours and fever is gone. Please let me know if I can be of assistance to you. Your email address will not be published. cic]i"F-?|JAD66Jmx~>-R)$tik:]oVP)FPWy?WGgqsA_Ks?1-RG/biiVrWv.\V:Bit9 .~W:%euk unJ&V.oIRC)L%> F}FIbW`4_hz1! You can email me and or fax this information to me. District homepage from: Educational Service District 105, July 2016. Please make sure all health and emergency contact information are up to date on this site that the school uses for information management. PDF Head Lice Information Letter for Parent/Guardian of Classmates Math CalculationCheckerWorksheet for Insulin DeviationThis worksheet may be used to verify math calculations performed by the RN. Our new community has launched. school day. We look forward to establishing a relationship with you and your child. Please feel free to call us anytime at 770-887-6161. This letter should be reviewed and approved by the School Medical Director prior to use. Medication Incident Report Form (NYSCSH 3/2023)Sample document for medication errors, notifications made, and outcomes. Take your child to work day is April 27th. Sample Letters to Parents Rob Wickham 2015-01-14T18:01:38+00:00. Author: Charlene Schexnayder x+2T0 BQW\ E The sample resources may be modified for your district's use consistent with NYSED, local district policy, and school medical director guidance. PDF A Letter From the School Nurse Charlotte Isd Operated by Public Health and Kaiser Permanente, the ITHC is located next to the attendance and counseling office. Provider & Parent/Guardian Permission for the Use of School-Provided Spacer/Valved Holding Chamber (NYSCSH 7/2020) Provides schools the opportunity to provide a backup spacer if the student's spacer is not available. 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. The HPV vaccine is given as a three-dose series over a six-month period to protect both females and males. Hypo and Hyperglycemia Chart for School Staff Excerpted from NYSDOH Diabetes in Children with the permission of the NYSDOH. This also provides us with the information on how to reach you if your child becomes ill or injured. If a student passes, it is sufficient to just indicated passed. 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. School Nurse To Do List. Taking medications at school regularly or as needed? Ideally, adolescents should get their vaccines during a routine pre-adolescent check-up at age 11-12 years. If you have any questions, please feel free to contact me. 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. The Texas School Nurse. It can be found at https://www.ccsoh.us/Page/1215. Farrow Carson RN BSN Amy Langevin RN BSN Pershing School Nurse: 523-2430 Nurse Fax Number: 523-2539 PDF WELCOME FROM YOUR SCHOOL NURSE - Springfield Public Schools 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. 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. Separate medication orders would be needed. 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. Communicable disease prevention, surveillance, notification, and reporting are important roles provided by the school health team. Calendar/Schedule for the Licensed School Nurse Yearly/Monthly from: https://www.health.state.mn.us/docs/people/childrenyouth/schoolhealth/lsncalendar.pdf. 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. It is essential to maintain the confidentiality of affected students when sending notifications. 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. I can help you sort out possible COVID-19 symptoms and to access help for testing. 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. Seizure ECP (NYSCSH 6/12)Customizable template for the HCP to document the type of seizure and treatment plan. HGw8npB} r\"4p4]i),^/pbDqtW4X`~Gr"2SA?P/": & 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. Did your child have a vision or hearing referral this year? If strep is found, your child should receive treatment and you should report this to your school health office. 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). 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. Includes instructions and sample forms for filing an appeal. 1 0 obj Fax: 206 743-3130. jpboyett@seattleschools.org. Please use the sign up genius to make an appointment before school starts. 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. {og"3"" sh"LvE8&/lsg9f%^G5~]?4 5,"5`5j9+R/J-C 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 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. [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. All Rights Reserved. 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. Observed on the fourth . Note: HCP orders only allow the parent to provide proposed adjustments or dosages and require the health care professional to make the ultimate decision after exercising his/her professional judgment.
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