Table of Contents .k12.nc.us

Table of Contents

School Health Nursing Services

Goal of School Health Services

1

Quality Assurance in the School Health Program

2

Management of Students with Chronic Medical Conditions

3,4

Request to Parent regarding Students with Chronic Conditions or Meds (English)

5

Chronic Condition Form (English)

6

Request to Parent regarding Students with Chronic Conditions or Meds (Spanish)

7

Chronic Condition Form (Spanish)

8

UCPS Authorization for Exchange of Health and Education Information (English)

9

UCPS Authorization for Exchange of Health and Education Information (Spanish) 10

Individual Health Plan Policy and Procedure

11,12

Request for Medical Documentation to write IHP (English)

13

Request for Medical Documentation to write IHP (Spanish)

14

Parent Cover Letter for Initial IHP (English)

15

Parent Cover Letter for Initial IHP (Spanish)

16

Students with Special Health Care Procedures and Needs

17-19

Parent Authorization for Specialized Health Care (English)

20

Parent Authorization for Specialized Health Care (Spanish)

21

UCPS Plan of Treatment

22

Vagal Nerve Stimulator Order from MD

23

Protocols

Protocols for School Nurses

24

Protocol for Fever

25

Protocol for Vomiting

26

Protocol for Diarrhea

27

Protocol for PPD Skin Testing in the Schools

28,29

Protocol for Stock Albuterol Use in the Schools

30

Protocol for Treatment of Anaphylaxis with Epinephrine

31,32

Protocol for Treatment of Status Asthmaticus with Epinephrine

33,34

Protocol for Human Bites

35,36

Protocol for Blood Glucose Testing of Students

37

Protocol for Pulse Oximetry

38

Protocol for Treatment of Allergic Reactions/Prevent Sting Reactions/Benadryl 39,40

Health-Related Classes offered by School Health

41

Medications

Administration of Medication- UCPS policy

42-45

Guidelines for Administration of Medications at School

46-49

UCPS Medication Consent Form (English)

50

UCPS Medication Consent Form (Spanish- for information only)

51

Authorization for Self-Medication for Emergency Meds (English)

52

Authorization for Self-Medication for Emergency Meds (Spanish for information)

53

Responsibility of Trained Medication Administrator

54

Attendance Roster for Administration of Medications in the School Setting

55

Medication Administration Test and Key

56,57

Reference Guidelines for Administration of Medicine by Staff

58

Medication Incident Report- Explanation

59

Medication Incident Report Form

60

Field Trip Medication Log

61

End of the Year Medication Information (English)

62

End of the Year Medication Information (Spanish)

63

Immunizations

Immunizations ? School and Nurse Responsibilities

64

UCPS North Carolina Immunization Law Information to be signed by parent (English) 65

UCPS North Carolina Immunization Law Information to be signed by parent (Spanish) 66

Notification of Needed Immunizations (English)

67

Notification of Needed Immunization (Spanish)

68

Necessary Proof of Immunization Compliance (English)

69

Necessary Proof of Immunization Compliance (Spanish)

70

Rising 6th Graders Tdap Notification (English)

71

Rising 6th Graders Tdap Notification (Spanish)

72

Kindergarten Health Assessment

Kindergarten Health Assessment ? School and Nurse Responsibilities

73

Notification of Needed Immunizations & Physical Exam ? Pre-K (English)

74

Notification of Needed Immunizations & Physical Exam ? Pre-K (Spanish)

75

Notification of Needed Immunizations & Physical Exam ? Kindergarten (English)

76

Notification of Needed Immunizations & Physical Exam ? Kindergarten (Spanish) 77

Suspension Notice of Delinquent Kindergarten Health Assessment (English)

78

Suspension Notice of Delinquent Kindergarten Health Assessment (Spanish)

79

Emergency Medical Response in the Schools

Emergency Medical Response in the Schools ? School and Nurse Responsibilities 80

Treatment of Anaphylaxis with Epinephrine

81

Heart Attacks

82

Head Injury Notification (English)

83

Head Injury Notification (Spanish)

84

Emergency Assessment Form

85

Emergency Evaluation Request Form

86

Emergency Response Bag List

87

Health Room

First Aid in the Classroom

88-98

Health Room Basic First Aid Needs

99

School Health Documentation Audit Tool

100

Health Room Visit Form

101

Health Room Volunteer Guidelines

102,103

ESL Referral Form

104

Vision Screenings

Vision Screenings- School and Nurse Responsibilities

105

Vision Screening Log

106

Vision Referral Letter (English)

107

Vision Referral Letter (Spanish)

108

Follow Up Letter for Vision Referral (English)

109

Follow Up Letter for Vision Referral (Spanish)

110

Color Vision Referral (English)

111

Color Vision Referral (Spanish)

112

Functional Vision Test Form

113

Functional Vision Test Instructions

114-119

Communicable Disease Control

Communicable Disease Control

120

Reportable Diseases ? School, Nurse, & Health Department Responsibilities

121

Reportable Diseases in North Carolina

122

Measles

123,124

Mumps

125

Rubella

126

Tuberculosis

127

Pertussis

128,129

Meningitis Non-Reportable Communicable Diseases and Conditions

MRSA MRSA Protocol Confirmed MRSA Report Form MRSA letter to inform parent of confirmed case (English) MRSA letter to inform parent of confirmed case (Spanish) MRSA in Schools (English) MRSA in Schools (Spanish) MRSA FAQS MRSA FAQS (Spanish)

Chickenpox Individual Letter for Chickenpox (English) Individual Letter for Chickenpox (Spanish) Classroom Letter for Chickenpox (English) Classroom Letter for Chickenpox (Spanish)

Shingles Classroom Letter for Shingles (English) Classroom Letter for Shingles (Spanish)

Fifth Disease Individual Letter for Fifth Disease (English) Individual Letter for Fifth Disease (Spanish) Classroom Letter for Fifth Disease (English) Classroom Letter for Fifth Disease (Spanish)

Conjunctivitis Individual Letter for Conjunctivitis (English) Individual Letter for Conjunctivitis (Spanish) Classroom Letter for Conjunctivitis (English) Classroom Letter for Conjunctivitis (Spanish) Differential Nursing Diagnosis Letter for Conjunctivitis (English) Differential Nursing Diagnosis Letter for Conjunctivitis (Spanish)

Head Lice UCPS policy regarding Lice and Nits Tips on Getting Rid of Head Lice (English) Tips on Getting Rid of Head Lice (Spanish) Individual Letter for Head Lice (English) Individual Letter for Head Lice (Spanish) Classroom Letter for Head Lice (English) Classroom Letter for Head Lice (Spanish)

Ringworm Individual Letter for Ringworm (English) Individual Letter for Ringworm (Spanish) Classroom Letter for Ringworm (English) Classroom Letter for Ringworm (Spanish)

Impetigo Individual Letter for Impetigo (English) Individual Letter for Impetigo (Spanish) Classroom Letter for Impetigo (English) Classroom Letter for Impetigo (Spanish)

Scabies Individual Letter for Scabies (English) Individual Letter for Scabies (Spanish) Classroom Letter for Scabies (English)

130,131 132

133-135 136 137 138 139 140

141,142 143,144 146,147

148 149 150 151 152,153 154 155 156,157 158 159 160 161 162,163 164 165 166 167 168 169 170 171,172 173-175 176-179 180,181 182,183 184 185 186,187 188 189 190 191 192,193 194 195 196 197

198 199 200 201

Classroom Letter for Scabies (Spanish) Strept Throat and Scarlet Fever

Individual Letter for Strept Throat (English) Individual Letter for Strept Throat (Spanish) Classroom Letter for Strept Throat (English) Classroom Letter for Strept Throat (Spanish) School Wide Letter for Strept Throat (English) School Wide Letter for Strept Throat (Spanish) Influenza Classroom Letter for Influenza (English) Classroom Letter for Influenza (Spanish) Mononucleosis Classroom Letter for Mono (English) Classroom Letter for Mono (Spanish) Poison Ivy/Oak Hepatitis A Molluscum Contagiosum E. Coli Diarrhea Common Skin Warts Ear Infections Tick Borne Illnesses Tick Removal Letter (English) Tick Removal Letter (Spanish) Bloodborne Diseases Hepatitis B Hepatitis C HIV/AIDS Exposure Control Plan BBP Exposure Plan Administrative Guidelines ? Exposure to Bloodborne Pathogens Appendix A1 ? Employee Exposure Determination Questionnaire Appendix A2 ? Job classification Categories Appendix B ? Risk Assessment ? PPE by Job Classification Appendix C1 ? Immunization Administration/Declination Form Appendix C2 ? Hepatitis B Vaccine Standing Orders for At-Risk Staff Appendix D1 ? Injury with Exposure Report Section 1 Appendix D2 ? Injury with Exposure Report Section 2 Appendix D3 ? Injury with Exposure Report Section 3 Appendix E1 ? Bloodborne Pathogens Training Attendance Record Appendix E2 ? BBP At-Risk Employee Post-Test

BBP At-Risk Employee Test- Answer Key & Teaching Points Appendix E3 ? BBP Class Information UCPS Specific Information Appendix F ? Annual Update Log Appendix G ? OSHA Log for At-Risk Staff Members Appendix H ? OSHA Bloodborne Pathogen Standards BBP Letter 1 ? Referral to Physician BBP Letter 2 ? Follow Up for Possible BBP Exposure BBP Letter 3 ? Bloodborne Pathogens Exposure Contact Information BBP Letter 4 ? Authorization for Exchange of Confidential Health Information

202 203,204

205 206 207 208 209 210 211 212 213 214 215 216 217 218,219 220 221 222 223,224 225,226 227 228

229,230 231,232 233,234

235-247 248-251 252,253

254 255 256 257 258 259 260 261 262 263-265 266,267 268 269 270-306 307 308 309 310

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