SPEED SEJA #802
SPEED SEJA #802
Health Manual
Table of Contents
Section 1: Illinois State Board of Education and Illinois Department of Public
Health: Management of Chronic Infectious Diseases in School Children
spec-ed or idph.state.il.us
Section 2: Illinois Department of Public Health: Communicable Disease Guide
idph.state.il.us
Section 3: Health Service Forms and Written Communication
Authorization for Exchange of Confidential Education & Health Information
Authorization for Release of Information
Child, Il State law Requires letter for Parent
Child Health Exam ILL 444-4737
Child Health Exam IL 444-4735 – Spanish
Contact with Parent letter – Absence 3 days
Dental Exam Waiver
Dental Examination Requirement
Dental Ill Proof of Examination
Dental Ill Proof of Examination – Spanish
Dental, Smile, IL Mobile Save the Date
Determination for 1-1 Paraprofessional
Health Plan
Health Plan Criteria Guidelines
Hearing letter – did not pass annual school screening
Hearing letter – unable to be conditioned
Hearing Screening Follow-up
Intake IEP Information
Parent Letter - Upcoming case study
Parent Letter Ill Law – Immunizations/physical examination
Parent Letter – School Nurse Visit
Parent Letter – Physical Exam history requirement
Post surgical hospital report
Request for Physicians orders for 1-1 nursing services
Second Request for medical follow-up
Seizure Action Plan
Seizure Questionnaire for parent
Student Report of Accident Form
Section 3: Health Service Forms and Written Communication (continued)
Student Accident Claim Form
Student Incident Report
Student Participation Emergency Form
Treating Physician’s Report
Vision Exam Report State of Ill –Eye Exam Report
Vision Exam Report State of Ill
Vision Exam Waiver
Vision Hearing Screening results
Section 4: Parent/Guardian Letters Re. Communicable Diseases
Chicken Pox
Chicken Pox - Spanish
Conjunctivitis (Pink eye)
Conjunctivitis (Pink eye) - Spanish
Fifth Disease
Fifth Disease - Spanish
Hand-Foot-Mouth Disease
Herpanginga (Viral Sores in Throat)
Lice
Lice – Spanish
Ringworm
Ringworm - Spanish
Scabies
Scabies - Spanish
Scarlet Fever
Scarlet Fever - Spanish
Strep Throat
Strep Throat - Spanish
Student with Lice
Student with Lice – Spanish
Section 5: Procedure Guidelines
Medical Procedure Authorization Form
Medical Procedure Authorization Form G-Tubes
Medical Procedure Log
Medication Authorization Form
Medication Log
Medication Medical Procedure Request
Medication Procedure Guidelines
Parent Letter for G Tube Supplies
Parent Letter Procedure Plan
Procedure Log
Voluntary Agreement Plan
Section 6: Staff Inservice and Handout Materials
Allergy Action Plan
DCFS Forms for Reporting Abuse/Neglect
Diabetes Health Plan
Employee Worker’s Compensation Guidelines
Epi Pen
In Service Training Record
Menstrual record
Seizure Action Plan
Seizure Observation record
Skin-Level Gastrosomy Indwelling Feeding Device
Section 7: Staff Injury/Bloodborne Pathogen Exposure
Bloodborne Pathogen Inservice Attendance Log
Employee Authorization for Medical Records Report
Employee Exposure Testing
Employee First Report of Injury
Employee Injury Report
Employee Injury Report by Witness
Employee Supervisor’s Report
SPEED Employee Injury Report
Student Bloodborne with Student Accident Claim Form
Student Bloodborne without Student Accident Claim Form
Universal Precautions and Work Practice Controls
Section 8: Additional Materials
General Guidelines for Agency/1:1 Nurses Working in a SPEED Program
SPEED Job Description: Nurse
Health Requirements from State of Il
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