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The School District of Osceola County, Florida

School Health Services Manual

The School District of Osceola County, FL School Health Manual

Revised July 2020

EMS: 911

Police: 911

Sheriff: 911

Fire: 911

Poison Control: 1-800-222-1222

Animal Control: 407-742-8000

Environmental Health: 407-742-8606 (Florida Department Health in Osceola County)

Abuse Hotline: 1-800-962-2873

1-800-96-ABUSE

Kissimmee Police Dept – 407-846-3333

St. Cloud Police Dept – 407-891-6700

Osceola Sheriff Dept – 407-348-2222

Emergency Phone Numbers

Non Emergency Numbers


School Health Manual

Introduction Health services are a public service provided to students in Pre-K through 12th grade. These services address any number of minor and/or major health issues encountered on any given day in Osceola County schools. During the school year, a majority of a child’s waking hours are spent on school grounds. Registered Nurses (RNs), Licensed Practical Nurses (LPNs), teachers, paraprofessionals, and office staff address a constant flow of students with an assortment of health issues. This manual is designed and written, in compliance with Florida Statues and Florida Administrative Codes for the School Health Program, to provide guidelines for all district RNs, LPNs, and other school staff members for the delivery of school health services to the students of The School District of Osceola County, FL. It is written in conjunction with the Osceola County School Health Services Plan. School health services are intended to supplement, rather than replace parental responsibility and appropriate pediatric health care.

School Health Services District Office

The School District of Osceola County through the Student Services and Exceptional Student Education Departments are responsible for the coordination, direction and standards of student health services. The recruitment, hiring, training and evaluation of District RNs and District LPNs and the interpretation of rules, statutes, policies and standards are the responsibility of the district office. Additional responsibilities include immunization compliance, reporting and training at the school level and supervision of school based health room personnel.

The School Principal

The principal of each individual school is responsible for enforcement of the District School Health Service Manual.

Intro – P1

School District and Osceola County Health Department School Health Registered Nurses

The RN’s responsibilities include evaluation of student health care needs. The RN will develop an individual health care plan, train staff in physician ordered medical procedures, implement state mandated health screenings, supervise school health services staff including LPNs and other school personnel, and consult with parents, school staff, physicians and other health care professionals. The RN will update and enforce compliance of immunizations, arrange and staff immunization clinics, develop and implement school health policies and programs and facilitate in-services for district staff related to school health.

School Health Care Assistant/Nurse

School health room personnel provide a variety of services based upon the needs of the students in the individual school. The nurse’s responsibilities include the following activities; administration of medication, acute health room care, first aid, meeting emergency health needs, assistance with complex and chronic health conditions, medical procedures as delegated and trained (F.S. 1006.062), health screenings, notification of a student’s parent or guardian as the need arises, and attend monthly in- service trainings designed to further educate school health issues.

RNs, LPNs and other trained personnel staff school health rooms. Only RNs and LPNs are referred to as a “nurse”. In addition, all schools will have at least two additional staff members that are currently certified by a nationally recognized agency to provide first aid and CPR.

Each nurse is responsible for maintaining his/her health room, monitoring the adequacy and expiration dates of first aid supplies, emergency equipment and other health room supplies under the supervision of the School District or Osceola County Health Department (OSCHD) school health RNs. All injuries or episodes of sudden illness referred for emergency treatment shall be reported immediately to the parent/guardian, supervising RN, and principal/designee and documented on a Student Accident/Incident Report (FC-600-0419).

It is not the nurse’s responsibility to diagnose any suspected ailment. Instead, they share and discuss observations with the parent/guardian and supervising RN.

Intro – P2

Meeting Emergency Health Needs Students shall have a Student Health Information form (FC-600-1963E/S) which is updated annually by parent/guardian and maintained at their school of enrollment. According to the Florida Administrative Code 64-F-6.004, the Student Health Information form shall be collected from each individual student and contain at minimum the following information.

• Contact person • Family physician • Allergies • Significant health history

All employees who staff school health rooms shall be currently certified in first aid and cardiopulmonary resuscitation by a nationally recognized certifying agency. A copy of this certification shall be kept on file in the health room or the school office, and a list of those persons currently certified in first aid and cardiopulmonary resuscitation shall be displayed in the health room, school office, cafeteria, gymnasium, home economics classrooms, industrial arts classrooms, and other areas that pose an increased potential for injuries. [F.A.C. 64F-6.004(2)]

Intro – P3


Section 1

Florida’s Legislative Authority Governing School Health

Florida Statutes and Administrative Code requirements for School Health Services and related activities in schools for Florida schools are updated annually.

http://www.floridahealth.gov/programs-and-services/childrens-health/school-health/laws-rules.html Click on Statutory Requirements Related School Health for current updates.


Revised July 2020

http://www.floridahealth.gov/programs-and-services/childrens-health/school-health/laws-rules.html


Section 2

Medication Administration Guidelines


Revised July 2020


Medication Administration Index

Purpose ...................................................................................................................... 1

Personnel Who Administer Medication ....................................................................... 1

Confidentiality ............................................................................................................. 1

Medication Authorization Forms .............................................................................. 1-2

Record Keeping and Reporting .................................................................................. 2

Emergency Medications ............................................................................................. 2

Medical Marijuana/Low THC Cannabis ...................................................................... 3

Herbal Products ......................................................................................................... 3

Receipt of Medication ................................................................................................. 4

Storage of Medication ................................................................................................ 4

Medication Cabinet Key Protocol ............................................................................... 5

Steps for Administering Medications .......................................................................... 5

Disposal of Medication ............................................................................................ 5-6

Medication Related Emergencies ............................................................................... 7

Medication Errors ....................................................................................................... 7

Contacting Parent/Guardian Regarding Medication Issues ........................................ 8

Specific Medications .............................................................................................. 8-10

Parent Responsibilities ............................................................................................. 10

Guidelines for Administration of Medication on Field Trips ....................................... 11

Guidelines for the Administration of Medication in Schools Purpose

The School District of Osceola County, FL recognizes it may be necessary to administer medication for the physical/mental health of the student during school hours. These guidelines have been prepared for the use of Osceola County school personnel who administer medications to students in accordance with Florida Statute 1006.062. This guide is a supplement to, not a substitute for, formal training in medication administration.

Personnel Who Administer Medication

• School health staff and/or trained school personnel, as designated by the

principal/designee administer medications. • Staff administering medications must attend the school district medication

training and complete a competency test with the school nurse. • All personnel should be re-trained every 2 years. • Volunteers or individuals not employed by The School District of Osceola

County or School Health Nurses of the Osceola County Health Department cannot administer medications.

Confidentiality

Maintaining the confidentiality of personal student health information is an ethical standard that must be upheld. Communication of student health information is limited to staff within the school with a need to know for the student’s health, safety, and educational needs. Established school district guidelines for student records must be followed, including signed “release of information” when indicated.

Medication Authorization Forms

An Authorization for School Personnel to Administer Medication form is required for each medication administered. The form must be completed with all required information and signature(s).

• Prescription medications require a completed Authorization for School

Personnel to Administer Medication form (FC-600-1769E/S) signed by the parent/guardian. This form is available in all school health rooms.

• Non-prescription medications require a completed Authorization for School Personnel to Administer Medication form (FC-600-1769E/S) signed by the parent/guardian. This form is available in all school health rooms.

• All authorization forms are valid for one school year (including summer school) unless limited by earlier stop date.

• See separate requirements for accepting Medical Marijuana/Low THC Cannabis (S2-P3) and Herbal Products (S2-P4).

S2 - P1

• Any change in prescription medication requires a new Authorization for School Personnel to Administer Medication form and doctor’s order.

• Consult with the school nurse if clarification of medication instructions is needed, before administering any medication.

• When the medication is discontinued or the authorization is no longer valid, draw a line through the authorization form with the date of discontinuation and file with the student’s Professional Treatment Record.

Record Keeping and Reporting

• Daily count on all prescribed medications • Weekly count of prescribed PRN medication must be documented. • A Medication Book will be established at each school site. The book must

be organized systematically by student with the authorization form for each medication in place.

• An Authorization for School Personnel to Administer Medication (FC- 600-1769E/S) must be established for each medication and used to document drug counts, administration of medication, and other comments related to the administration of medication. Medication count balance must be recorded in the box provided for each medication brought to school.

• If a mistake is made on a health record, draw a single line through the error, initial and date the error. DO NOT USE WHITE OUT on any health record.

Emergency Medications Section 1002.20, Florida Statutes includes provisions regarding the use of specific medications in schools. Refer to the statute for the full requirements and amended sections.

• Section 1002.20(3)(h), Florida Statutes clearly states that the students must be allowed to carry metered dose inhalers on their person while in school, with written parental and physician authorization.

• Section 1002.20(3)(i), Florida Statutes specifies that students may carry and self- administer an epinephrine auto-injector while in school, during school sponsored activities, or in transit to school or school-sponsored activities, with written parental and physician authorization. This statute also addresses safety provisions and liability indemnification.

• Section 1002.20(3)(j), Florida Statutes specifies that a school district may not restrict assignment of a student who has diabetes to a particular; may carry diabetic supplies and equipment on their person; attend to the management and care of diabetes while in school; encourages every school with students with diabetes to have personnel trained in routine and emergency diabetes care.

• Section 1002.20(3)(k), Florida Statutes specifies that students who are at risk for pancreatic insufficiency or diagnosed with cystic fibrosis may carry and self- administer a prescribed pancreatic enzyme supplement while in school, during school-sponsored activities, or in transit to school or sponsored activities, with written parental and physician authorization.

S2 – P2

Medical Marijuana/Low THC Cannabis

A. School nurses or health care personnel or school administration staff are not allowed to administer, store/hold or transport the medical marijuana/low THC cannabis in any form and it will not be stored on any District property, including school grounds, at any time.

B. A student’s parent/guardian or caregiver may administer the permissible form of

medical marijuana to the qualified student/patient on District property in the designated location if all of the following criteria are met:

1. A copy of the student’s valid registration form for medical marijuana must be

provided to the District.

2. A written statement signed by the qualified student’s parent/guardian must be on file which assumes all responsibility for ensuring the administering individual is qualified to perform the task, assumes all responsibility for the administration, maintenance and use under state and federal law, and releases the District from liability for any injury arising out of the administration of medical marijuana on District property.

3. The parent/guardian/caregiver shall be responsible for providing the permissible

form of medical marijuana to be administered to the qualified student and for removing the medical marijuana from school grounds immediately after the administration is complete. (School Board Rule 5.622)

Herbal Products FDA regulated, non-prescription herbal or natural products should be treated the same as other non-prescription medications. Since the ingredients of non-regulated herbal or “natural” substances are often not clearly delineated, it is recommended that school districts refuse to allow school personnel to administer such substances during the school day. Parents may be permitted to come to school and administer such substances to their children. (School Health Administrative Resource Manual page 21 Revised 2017) The School District of Osceola County, FL does not allow school personnel to administer non-regulated herbal or “natural” substances during the school day.

S2 – P3

Receipt of Medication • Non-prescription medications must be received in the original

manufacturer’s labeled container. The student’s name must be recorded on the container.

• Prescription medications must be received in the original container from the pharmacy. This label must be consistent with the student’s medication authorization form. However, the physician’s name on the label may be different from that recorded on the student’s medication authorization form.

• Compare medication label with authorization form. Directions must match. • All medication must be counted and witnessed upon receipt and

documented on the Authorization for School Personnel to Administer Medication form. Preferably, the adult providing the medicine should observe the counting process and sign as a witness. If the parent/guardian is not available to count, a school district employee or school health employee can observe and sign as a witness.

• A maximum of a 30-day supply of the medication may be kept at the school.

• It is required that a parent/guardian or responsible adult deliver the medication to the school.

• Verify expiration date. Notify parent/guardian if medication is out of date or soon to expire. Document parent/guardian contact.

Storage of Medication

• All medication will be stored under lock and key. Emergency inhalers

and medications with doctor’s authorization and parent permission may be carried by the student for self-administration.

• Refrigerated medications must be stored in a locked box within the refrigerator maintained at 35-46 degrees F.

• If refrigeration of a medication is required and is not available outside the health room, the parent/guardian must provide a cooler for medication storage.

• A Medication Refrigerator Temperature Log (FC-600-2378) must be maintained and recorded daily.

• If a parent/guardian requests any medication to be returned to them, document the count returned with parent/guardian’s initials on the Authorization for School Personnel to Administer Medication form (FC-600-1769).

S2 - P4

Medication Cabinet Key Protocol • All medication cabinet keys shall remain on campus. • All medication cabinet keys including the second set of keys shall be stored

in a locked and secure location designated by the principal/designee when not in use.

• All keys to the medication cabinets shall be signed out and returned daily on a Medication Cabinet Key Log (FC-600-2411). Completed monthly log forms shall be kept at the school in a location designed by the principal/designee.

• IND classrooms with medication cabinets shall have the keys stored in a locked and secure location within the classroom.

Steps for Administering Medications

• Over the counter medication should not be given the first or last hour of the day. Exceptions will be made on an individual basis.

• Wash hands prior to assisting with medication administration. • Identify the student by asking the student to state his/her name

without prompting. • Locate medication and verify medication label with student’s name and

authorization form. Check for right dose, right time and right route. • Give medication according to instructions:

a. No earlier than ½ hour before prescribed time. b. No later than ½ hour after prescribed time. c. If student is absent, document “Absent” on student log.

• Verify for second time; right student, right medication, right dose, right time, and right route.

• Administer the medication and confirm complete dosage taken/swallowed. • Immediately document administration on the Authorization for

School Personnel to Administer Medication Form (FC-600-1769E/S). • While returning medication to storage, verify for third time; right

student, right medication, right dose, right time, and right route. • For increased student safety, the first dose of any new prescription or non-

prescription medication will be dispensed by the parent/guardian at home so that any possible side effects will be noted at home.

Disposal of Medication

• Notify parent/guardian medication will be destroyed if not picked up within one week of termination of medication or at the close of the school year unless the child is attending a summer school program. Two attempts to contact the parent/guardian will be made and documented prior to medication disposal.

• The parent/guardian must pick up all medications. Document the date, name, and amount of medication returned or disposed of on the Authorization for School Personnel to Administer Medication Form (FC- 600-1769E/S).

• Disposal must be witnessed by two persons, (nurse and one other staff member), and documented on the Medication Disposal Log (FC-600- 2123).

S2 – P5

The Florida Department of Environmental Protection (DEP) advises against flushing medications down the toilet through the municipal sewerage system. This practice contaminates the environment and wastewater treatment systems are not designed to remove many of these medications. DEP recommends the following procedure: • Keep the medicines in the original container. • Mark out the name and prescription number for safety. • For pills: add some water or soda to dissolve them • For liquids: add something inedible like cat litter, dirt or cayenne pepper. • Close the lid and secure with duct or packing tape. • Place the bottle(s) inside an opaque (non-see-through) container like a

coffee can or plastic laundry bottle. • Tape that container closed. • Place container inconspicuously in the trash. Do not dispose of any

containers with medications in the recycle bin. • Metered dose inhalers should be emptied outdoors by pumping the

container into the air, as if being administered. • Injectable medication can be emptied into absorbent material and

disposed in the trash according to the procedure described above, with the empty containers being placed in the sharps disposal container.

Additional information can be found on the Florida Department of Environmental Protection (DEP) web page, How to Dispose of Unwanted Medications.

S2 – P6

Medication Regulated Emergencies

• An allergic reaction to medication can occur at anytime, no matter how long the student has been taking the medication.

• The most common allergic symptoms are rash, itching, swelling, breathing problems, diarrhea, abdominal cramps, bluish color of skin and increasing anxiety.

• Never leave a student having a possible allergic reaction alone. • Notify parent/guardian and principal/designee immediately. EMS (911) may need

to be called. Notify District RN. • If a student is sent to a hospital emergency room, send medication container,

a copy of the Authorization for School Personnel to Administer Medication form (FC-600-1769E/S) and a copy of the Student Health Information sheet (FC- 600- 1963E/S) with the student.

• Document adverse reactions on Progress Report.

Medication Errors

• Medication errors include:

o Wrong student; o Wrong medication; o Incorrect dosage; o Missed or late dose, call parent/guardian; o Wrong time (greater than 30 minutes before or after prescribed time)

• Verbally report medication errors immediately to: o Poison Control (1-800-222-1222) o Principal/designee o Parent/guardian o School District RN (for wrong medication or dosage) who will determine

need to contact student’s physician o Observe student o Any error must be documented on a Report of Medication Administration Error

form (FC-600-2125) and submitted within 24 hours of the error. School District employees will submit original form to the Principal and submit a copy to the District RN.

o Any adverse effects from a medication error must be documented on a Progress Report. Notify District RN and parent/guardian.

S2 – P7

Contacting Parent/Guardian Regarding Medication Issues All contact with parent/guardian must be documented on a progress report. Contact parent/guardian if: o Medication instructions are not clear. o Student fails to receive medication due to vomiting or refusal of medication

administration. o Medication supply has not been provided. o Medications have not been picked up within 1 week of discontinuance or close of

school year.

Specific Medications

Epinephrine Auto Injector o Requires a written order from the student’s physician stating the necessity of the

medication and under what conditions the medication should be given. A signed Authorization for School Personnel to Administer Medication form (FC-600- 1769E/S) must be completed.

o EMS (911) must be called if the medication is given. o Only school staff who have documentation of training on the Student Specific

Medical Procedures Training Record (FC-600-2123) may administer the Epinephrine Auto Injector.

o Student Checklist for Self-Administration of Auto-Injector for Allergic Reactions (FC-600-2360E/S) must be completed by the student and school nurse.

o Requests for a student to carry the Epinephrine Auto Injector will be considered on a case-by-case basis. Such requests should accompany a written physician’s statement as to the necessity of carrying the Epinephrine Auto Injector at school. Improper handling of the Epinephrine Auto Injector by the student could result in disciplinary action according to The Code of Student Conduct. The parent/guardian will be notified if a problem arises due to the student’s misuse/mishandling of an Epinephrine Auto Injector.

S2 – P8

Glucagon

o Requires a written order from the student’s physician stating the necessity of the medication and under what conditions the medication should be given. A signed Authorization for School Personnel to Administer Medication (FC-600- 1769E/S) must be completed.

o Only trained school staff members who have documentation of training on the Student Specific Medical Procedure Training Record (FC-600-2123) may administer Glucagon.

o Glucagon will be given ONLY if student has a documented low blood sugar and is unresponsive, having a seizure or unable to control airway.

o EMS (911) must be called if the medication is given. Diastat®

Requirements

The parent/guardian is required to complete an Authorization for School Personnel to Administer Medication Form FC-600-1769E/S. A physician’s (written and signed) order must be obtained. The parent/guardian is required to provide all necessary medication, equipment and supplies.

Personnel Authorized to Perform Procedure Procedures may be performed by a RN, LPN, or by a trained designated school staff member who has current CPR certification. Training will be reviewed on an annual basis.

Note: Diastat® should be used with caution in people with respiratory (breathing) difficulties, such as asthma or pneumonia, in women of child bearing potential, pregnancy and nursing mothers.

When EMS Arrives

1. Turn care of student over to EMS. 2. Provide all Emergency Medical Information to EMS personnel

(Copies not originals). • Student Health Information Sheet • Physician’s Order for Diastat® (FC-600-2370) • Seizure Monitoring Form (FC-600-2371)

3. Give used Diastat® syringe and package with prescription label to EMS personnel.

4. Notify Health Services

S2 – P9

Insulin

• Only Osceola County School District licensed nurses will administer insulin. • Non-Medically licensed Osceola County School District Personnel WILL NOT

administer insulin. • Non-Medically licensed school staff WILL NOT be responsible for adjusting,

calculating or otherwise programming insulin pumps. • The student, if so ordered by their physician, may give his/her own insulin

injections. A written physician’s order must be provided to the school. A school staff member may observe the student self- administer the dose of insulin but will not be responsible for the dosage.

• Students will demonstrate and complete the Blood Glucose Monitoring Skills Checklist (FC-600-2363ERS) with the school nurse.

• Improper handling of the equipment by the student could result in disciplinary action according to The Code of Student Conduct.

Parent Responsibilities

Medication – Prescription and Non-Prescription

1. An Authorization for School Personnel to Administer Medication form (FC-600- 1769E/S) form must be filled out by the parent/guardian.

2. A separate authorization form must be filled out for EACH medication administered.

3. Changes in prescription medication requires a new authorization form signed by the parent.

4. Medication dosage must be age appropriate as stated on the manufacturer’s label or physician’s written authorization stating otherwise.

5. Medication must be in the original pharmacy-labeled bottle. 6. Medication must be split or cut before being sent to school. 7. No more than a 30-day supply of medication may be accepted. 8. A responsible adult listed on the emergency contact list must deliver and pick-up

the medications in the school health room. 9. The first dose of a newly prescribed medication must be administered at home. 10. When medication is discontinued or the school year ends, pick up all unused

medication within one week. Unclaimed medication will be destroyed prior to the start of the next school year.

S2 – P10

Guidelines for Administration of Medication on FieldTrips

Purpose: These guidelines have been prepared to address student’s medication administration on field trips. This supports student’s full participation in out of school learning experiences that contribute to the achievement of educational goals. It is recognized that not all students will require scheduled medications out of the classroom for field trips and therefore, medications should be administered only if medically necessary. The determination of whether a medication is administered during a school sponsored activity should be determined by the designated school health professional in collaboration with the school administrator, teacher, and parent/guardian.

Medication will be administered according to The Osceola County School District guidelines in accordance to Florida Statue 1006.062, with the following modification:

• Personnel designated to administer medication may be school or

health staff. Volunteers do not administer medication. • All medication must be signed out and back in to the health room on

the Medication Log for Field Trips (FC-600-2274). • Medication must be maintained securely at all times by

designated medication administrator (e.g. fanny/back pack). • A copy of the Authorization for School Personnel to Administer Medication

form (FC-600-1769E/S) must be kept with the medication. • Medication must be in the original labeled medication bottle that is

consistent with the Authorization for School Personnel to Administer Medication form (FC-600-1769E/S).

• The prescription bottle is returned to the health room and the designated medication administrator is responsible for documenting his/her name and initials on the student medication record.

• Students who are authorized to carry their own medication may do so on field trips. The designated medication administrator must have a copy of the Authorization for School Personnel to Administer Medication form as well as the physician’s order authorizing student to self-carry medication.

• Designated personnel require student specific training for students on emergency medications.

S2 – P11


Section 3

Health Room Guidelines


Revised July 2020


Health Room Guidelines Index

Introduction ................................................................................................................ 1

Emergency Situations for Which Rescue Unit is Called .......................................... 1-2

Do Not Resuscitate (DNR) / Advance Directive………………………………………… 2

General Health Room Information ............................................................................. 3

Symptoms Chart ........................................................................................................ 4

Responsibilities of Health Room Personnel ............................................................... 5

Health Room Supplies ............................................................................................... 6

First Aid Kit ................................................................................................................ 7

Yearly Timeline for Health Room ............................................................................ 7-8

Closing the Health Room ...................................................................................... 9-10

Guidelines for Student Health Records (Records Mgmt) ..................................... 10-11

Introduction In accordance with School Health Services Act and Rule 64 F-6.004, these guidelines are designed as a quick reference guide for staff who are responsible for the health and safety of students and others in the setting. This guide does not replace a student specific health plan. It should be easily accessible in the health room for staff members to use at unexpected moments when sudden illness or accidents occur. Additionally, a list of persons currently certified in first aid and cardiopulmonary resuscitation (CPR) will be displayed in the health room, school office, cafeteria, gymnasium, home economics (family and consumer science) classrooms, industrial arts classrooms, and other areas that pose an increased potential for injuries. At least 2 staff members, excluding the health room staff (nurse), will be currently certified in first aid and CPR. (School Health Rules – 64F-6.004)

First Aid is the immediate and temporary care given to an injured or ill person.

When a situation requires first aid, decisions must be made about the severity of the incident and whether referral is needed. If there is uncertainty about the need for further medical attention, it is better to call for EMS (911). Notify principal/designee and parent/guardian when EMS (911) is called.

It is important to notify parent/guardian by utilizing the Health Room Report (FC-600-0998ERS) when first aid is given so that further observation or follow-up can be provided at home.

Documentation of injuries and accidents referred for health care must be documented on the Student Accident/Incident Report (FC-600-0419).

EMERGENCY SITUATIONS FOR WHICH RESCUE UNIT IS CALLED Rescue unit may request that a staff member ride or follow their unit if no parent/guardian is available.

1. Breathing stopped or severely impaired 2. Loss of pulse 3. Unconsciousness (other than short fainting spell) 4. Semi-consciousness 5. Shock (pallor, faintness, rapid pulse, sweating, low blood pressure) 6. Head injury (if injury is accompanied by unconsciousness, semi-

consciousness, nausea or vomiting, unequal pupils or eye difficulties, bleeding from ears)

7. Severe bleeding 8. Severe chest pain 9. Severe back pain or injury 10. Amputations 11. Severe burns 12. Severe eye injury 13. Emergency childbirth

S3 – P1

14. Drug overdoses 15. Accidents which lead to a situation in which the injured person is unable get

up or walk or move body parts after a period of observation (i.e. possible neck fracture or other hidden injury)

16. Seizures lasting over five minutes or seizures in a child who has never experienced a seizure before or per physician’s orders

17. Snake bite 18. Gun shot 19. Knife wound 20. Severe Allergic Reaction/Anaphylactic shock 21. Situations when in doubt

Do Not Resuscitate (DNR) / Advance Directive The Do Not Resuscitate statute is not applicable in the school setting. Properly executed, a DNR is only applicable under certain specified circumstances. The purpose of a DNR is for paraprofessional emergency personnel, emergency medical technicians, paramedics, and health care institutions to lawfully provide only palliative services to a terminally ill patient, and not to administer cardiopulmonary resuscitation. An Advance Directive can only be executed by a competent adult, in which his/her desires are expressed concerning any aspect of his/her health care, including, but not limited to, the designation of a health care surrogate, a living will, or an anatomical gift (section 765.101, Florida Statutes). Advance directives do not apply to minor children and are not intended to be implemented by schools (section 765.109, Florida Statutes). If a student exhibits a medical emergency at school, school officials should call 911 and provide first aid, whether or not that student has a properly executed DNR or Advance Directive. (School Health Administrative Resource Manual, Revised 2017)

S3 – P2

General Health Room Information

• Any school staff member sending a student to the Health Room must complete a Health Room Report (FC-600-0998ERS).

• If EMS (911) must be called, notify principal/designee, parent/guardian and District RN.

• Ice can be applied for 15 minutes, if needed. The ice should not be placed directly on the skin.

• Typically, a student should not remain in the health room longer than 30 minutes.

• A Student Accident/Incident Report form (FC-600-0419) must be completed for each student who has an accident or injury at school. A Head Injury Report - Student form (FC-600-2253E/S) must also be completed for any student who receives a head injury. This includes all extracurricular/after school activities, sports on school property or while the student is in the school district’s custody.

• Parent/guardian must be notified of any significant injury occurring at school.

• Health information pertaining to a student is confidential and is not discussed with anyone unless directly involved with the student’s care.

• School health nurses cannot diagnose. Describe the student’s symptoms and complaints to the parent/guardian. Do not give a diagnosis, suggest a diagnosis or treatment to the parent/guardian.

• A student’s clothing should not be removed as part of a health room evaluation. If clothing removal is necessary for emergency treatment maintain student’s privacy and have a witness present.

S3 – P3

SYMPTOM CHART

This chart lists common symptoms seen in children that could possibly be related to an infectious disease. The chart also indicates when it is necessary to exclude a student exhibiting a particular symptom from school. The parent/guardian should be notified when a student develops symptoms at school. Exclusion should be considered with any illness or symptom if any of the following conditions apply:

• If the student does not feel well enough to participate comfortably in usual activities.

• If the student requires more care than school personnel are able to provide.

• If the student has a high fever, behavior changes, persistent crying, difficulty breathing, lack of energy, uncontrolled coughing, or other signs suggesting a severe illness.

• If the student is ill with a potentially contagious illness and exclusion is recommended by a health care provider, the state or local public health agency, or the following guidelines.

SYMPTOM EXCLUSION GUIDELINES

Cough Exclusion is recommended if the student is experiencing severe, uncontrolled coughing, wheezing, or having difficulty breathing.

Diarrhea - (defined as stools that are more frequent and looser than usual)

Exclusion is recommended if any of the following conditions apply: the student has other symptoms along with the diarrhea (such as vomiting, fever, abdominal pain, etc.), the diarrhea cannot be contained in a toilet or there is blood or mucous in the stool.

Earache No exclusion is necessary. Fever - (defined as a temperature over 100.4°F orally)

Exclusion is recommended if the student has symptoms in addition to the fever, such as rash, sore throat, vomiting, diarrhea, etc.. Fever alone does not require exclusion.

Headache No exclusion is necessary. Mouth sores Exclusion is recommended if the student is drooling uncontrollably. Rash Exclusion is recommended for undiagnosed rash or if the student has

symptoms in addition to the rash such as behavior change, fever, joint pain, bruising not associated with injury, if the rash is oozing or causes open wounds. See S6 – P8 for additional information on rashes.

Stomach ache/ Abdominal pain

Exclusion is recommended for severe pain, pain that begins after an injury or if the student has symptoms in addition to the stomach ache (such as vomiting, fever, diarrhea, etc).

Swollen glands Exclusion is recommended if the student has symptoms in addition to the swollen glands such as difficulty breathing or swallowing, fever, etc.

Vomiting Exclusion is recommended if the student has vomited more than once, the vomit appears green or bloody, the student has a recent head injury, or if the student has other symptoms.

S3 – P4

A STUDENT’S RIGHT TO PRIVACY SHALL BE SAFEGUARDED AT ALL TIMES BY JUDICIOUSLY PROTECTING INFORMATION OF A CONFIDENTIAL

NATURE Responsibilities of Health Room Personnel

• Provide health care to students while being aware of SchoolBoard policy and scope of training.

• Perform medical procedures on students as delegated and trained. • Keep accurate and complete daily records for students seen in the health

room. • Notify the principal/designee immediately of any seriously ill or injured

student. • Notify parent/guardian concerning health problems when indicated. • Notify the District RN of unusual cases, frequent health room visits,

unresolved health problems or symptoms of possible communicable disease. • Submit Student Accident/Incident Report (FC-600-0419) weekly to

Safety, Security and Emergency Management St. Cloud Office. • Maintain a current certification in CPR and first aid from a national

recognized agency. • Remain with an ill or injured student until released to the parent/guardian,

removed by EMS or until directed otherwise by school administration. • Practice infection control techniques to prevent and control the spread of

infection, emphasizing the importance of proper hand- washing, medication handling and the disposal of blood and bodily fluids.

• Keep an adequate supply of non-expired first aid materials on hand. • Maintain first aid kit. • Keep the Health Room space neat and clean and the passageways clear for

emergency access at all times. • Coordinate screening programs and follow-up documentation. • Follow up on all failed student health screening results. • Administer medication to students in compliance with the district’s

medication administration guidelines. • Attend in-service programs designed to develop skills and further

knowledge related to school health. • Keep health records up-to-date as directed by the District RN, Health

Department staff and school administration. • Conduct self in a professional manner respecting the confidentiality of

medical information and the student’s privacy. • Screen, follow-up and give clearance for head lice cases. • Complete monthly reports and submit to the District Health Services and

Health Department School Health. • Maintain updated Student Health Information Sheet on each student.

Attach Student Health Care plan and Physician’s Orders when provided. • Maintain current Florida 680 Immunization form and school physical

for every student. • Keep current on all school health policies and procedures. • Remove any out dated policies, procedures or forms from the School

Health Manual and the Health Room.

S3 – P5

Health Room Supplies Non-Medical Supplies Chairs Computer Cots Desk Flashlight Locked cabinet for medication storage Privacy curtain or screen Refrigerator (locking or locked box) Refrigerator thermometer Rolling lockable file cabinet for records Sink Supply cabinet Telephone Toilet

Medical Supplies Audiometer Alcohol wipes Antibacterial soap Antibacterial spray for cleaning cots and supplies (district approved) Anti-itch lotion (clear) Applicator sticks Band-aids (various sizes) Cotton balls CPR mask Cups Exam gloves (both latex and non-latex) Eye Protective Device – such as goggles Eyewash Gauze (2x2 and 4x4) Ice bags or ice packs Insect sting applicators Medicine cups Paper towels Plain Gauze Scissors Sphygmomanometer Stethoscope Table paper (disposable) Tape Thermometer and probes or sleeves Tissues Tongue blades Vaseline Vision screening equipment

S3 – P6

First Aid Kit – Minimal list of supplies by OSHA Standard • Gloves • Protective eye wear • CPR barrier device • Bandages – Gauze pads & band-aids • Adhesive tape • Antiseptic wipes • Eye wash • Anti-itch lotion (clear) • Absorbent pad • Roller bandage • Antibacterial hand sanitizer • Triangular bandage (arm sling) • Scissors • Blanket • Tweezers • Elastic wrap • Splint

Yearly Timeline for Health Room

Every Month from August thru July

• Vision screening shall be provided, at a minimum, to students in grades kindergarten, 1, 3 and 6 and students entering Florida Schools for the first time in grades K through 5. (FL Rule 64-F-6.003)

• Hearing screening shall be provided, at a minimum, to students in grades kindergarten, 1 and 6; to students entering Florida Schools for the first time in grades K through 5 and optionally to students in grade 3. (FL Rule 64-F-6.003)

• Growth and development screening shall be provided, at a minimum, to students in grades 1, 3 and 6 and optionally to students in grade 9. (FL Rule 64-F-6.003)

• Scoliosis screening shall be provided, at a minimum, to students in grade 6. (FL Rule 64-F-6.003)

• Alert District RN to new physician orders, pending 504/IEP meetings, or health concerns of new or existing students

• Check immunizations for temporary and 30 day waivers • Updated immunization records in FOCUS • Monthly school health reports

S3 – P7

August

• Dispose of all student medication from prior school year. • Collect Student Health Information forms • Set up Medication Log for health room • Check health room supplies and expiration dates • Schedule screening dates and prepare screening forms, location

and volunteers

September • Follow-up on Student Health Information forms for those not

yet returned • Begin screenings • Send out screening follow-up referral letters as needed

October – June • Health screenings for new students • Continue screenings and follow-up referral letters • File screening forms in Cumulative Health folder • Inform District RN of student health referrals and teacher concerns

May - June • Remind parents medication must be picked up by the last day of

school. • Box up the files of those students graduating or promoted (5th, 8th,

and 12th) according to procedures in your individual school. Move up students’ cumulative folders to appropriate grade level. Names of those students being retained in their grade can be obtained from guidance.

• Close up Health Room

S3 – P8

Closing the Health Room

Disposal of Medications

• Notify parent/guardian the medication will be destroyed if not picked up by the last day of school unless student is attending a summer program.

• Health room nurse will attempt to notify parent/guardian two times. • Notification will be documented on the medication sheet. • All medication must be picked up by parent/guardian. Medications

may not be sent home with student. • All medication returned to parent/guardian must be documented

on the Authorization for School Personnel to Administer Medication form (FC-600-1769).

• Medications must be disposed of in accordance with the Florida Department of Environmental Protection. (See section 2 page 6)

• Disposal must be witnessed by one person, designated by the principal and documented on the Medication Disposal Log (FC-600- 2124).

• Call Health Services at 407-891-3170 for red bags and sharps needle containers to be picked up or fax request to 407-957-3567.

Locked File Cabinets

Student Medical Health Records to be maintained in Health Room.

• Individual health care plans • Progress report • Parent letters • Current Physician orders

S3-P9

The Cumulative Health Folder and Student Medical Health Record may only be transferred within the county school district. If the student goes out of the county, both records must be retained at your school. The Cumulative Health Folder contains the white jacket, the 680 form, physical, and screening results. These records are to remain in the locked file cabinet.

Retain (put in a labeled retention box)

• Medication logs • Disposal logs • Health Room sheets • Accident reports (yellow copy) • Monthly reports • PE excuses • Undiagnosed Rash forms • Head lice treatment forms • LPN Documentation of Health Services (T1003) FC-400-2108 • Assistants Documentation of Health Services (T1004) FC-400-2070

Collect and Hold

• All Health Alerts to redistribute the following school year.

Shred • Tally sheets

S3 – P10


Section 4

Specific Conditions and Illnesses


Revised July 2020


Specific Conditions and Illnesses

Abdominal Pain/Stomach Ache .................................................................................. 1

Alcohol Poisoning ....................................................................................................... 1

Allergic Reactions....................................................................................................... 1

Amputation ................................................................................................................. 1

Asthma .................................................................................................................... 1-2

Back or Neck Injuries ................................................................................................. 2

Back Pain – Unrelated to Injury .................................................................................. 2

Bites (Animal, Human, Spider, and Tick) .................................................................... 3

Blisters ....................................................................................................................... 3

Broken Bones (Fracture, Sprain, Dislocation) ......................................................... 3-4

Bruises ....................................................................................................................... 4

Burns .......................................................................................................................... 4

Choking ...................................................................................................................... 5

Cuts ............................................................................................................................ 5

Dental Problems (Toothache, Broken Teeth) ............................................................. 6

Diabetes ..................................................................................................................... 7

Diarrhea ..................................................................................................................... 7

Drug Ingestion ............................................................................................................ 7

Ear Problems ............................................................................................................. 7

Electrical Shock .......................................................................................................... 8

Eyes ........................................................................................................................... 8

Fainting ...................................................................................................................... 9

Fever .......................................................................................................................... 9

Finger Injuries............................................................................................................. 9

Genital Injury ......................................................................................................... 9-10

Headache ................................................................................................................. 10

Head Trauma ........................................................................................................... 10

Heart Attack ............................................................................................................. 11

Heat Illness .............................................................................................................. 12

Hyperventilation ....................................................................................................... 13

Impetigo ................................................................................................................... 13

Menstrual Cramps .................................................................................................... 13

Mouth/Tongue Injury ................................................................................................ 13

Nose Bleeds ........................................................................................................ …. 14

Poisoning ................................................................................................................. 14

Rash ......................................................................................................................... 14

Ringworm ................................................................................................................. 14

Seizures ................................................................................................................... 15

Shock ....................................................................................................................... 15

Snake Bites .............................................................................................................. 15

Sore Throat or Cold Symptoms ................................................................................ 15

Splinters ................................................................................................................... 16

Stings (Bee, Wasp, Hornet, etc) ............................................................................... 16

Stye .......................................................................................................................... 16

Sunburn .................................................................................................................... 16

Tuberculosis ........................................................................................................ 16-17

Unconsciousness ..................................................................................................... 17

Vomiting ................................................................................................................... 17

Fevers and Reduction Options ............................................................................ …. 18

Abdominal Pain/Stomach Ache

1. Check temperature. 2. Ask if he/she has eaten, needs to use the bathroom (when was the last bowel

movement), has nausea, vomiting, cramping, diarrhea or has a tight waistband. Does the student appear anxious or upset?

3. Rest 20-30 minutes if pain is not severe. 4. If temperature is elevated or pain is severe and persists, contact

parent/guardian and send student home. Alcohol Poisoning

1. Ingesting large amounts of alcohol in a short period of time can be life threatening.

2. Call EMS (911). Notify parent/guardian and principal/designee. Allergic Reactions

1. Observe for signs of allergic reaction • Hives – itching, swelling involving skin, nose or eyes • Throat tightness – swelling, itching inside mouth or metallic

taste, hoarseness • Wheezing – difficulty breathing, chest tightness • Pale coloring • Weakness – dizziness, headache or fainting • Abdominal pain – nausea, vomiting or diarrhea

2. Administer authorized emergency medication (i.e. Benadryl®, EpiPen®) if experiencing symptoms.

3. Call EMS (911) if EpiPen® is administered or symptoms are severe. Notify parent/guardian and principal/designee.

Amputation - complete or partial

Call EMS (911). Notify parent/guardian and principal/designee. 1. Control bleeding (see Cuts) 2. Treat for shock (see Shock) 3. If complete amputation, locate dismembered part quickly, seal in plastic bag,

place on ice and give to EMS personnel. Asthma

1. Allow to remain in comfortable position (sitting or standing). 2. Encourage to relax and use belly breathing (purse lips). 3. Follow Student Specific Health Care Plan for peak flow reading, medication

administration and disposition.

S4 – P1

4. If Student Specific Health Care Plan is not available: • Keep student in health room until symptoms relieved. • If breathing does not improve, call parent/guardian. • If in acute distress (altered state of consciousness, nails turn blue, use of

neck muscles to breathe, etc.) CALL EMS (911). Notify principal/designee.

Back or Neck Injury

If you suspect a back or neck (spinal) injury, do not move the affected person. Permanent paralysis and other serious complications can result. Assume a person has a spinal injury if:

• There’s evidence of a head injury with an ongoing change in the person’s level of consciousness

• The person complains of severe pain in his or her neck or back • The person won’t move his or her neck • An injury has exerted substantial force on the back or head • The person complains of weakness, numbness or paralysis or lacks control of his

or her limbs, bladder or bowels. • The neck or back is twisted or positioned oddly.

If you suspect someone has a spinal injury: 1. Call 911 or emergency medical help. 2. Keep the person still. Place heavy towels on both sides of the neck or hold

the head and neck to prevent movement. 3. Provide as much first aid as possible without moving the person’s head or

neck. If the person shows no signs of circulation (breathing, coughing or movement), begin CPR, but do not tilt the head back to open the airway. Use your fingers to gently grasp the jaw and lift it forward. If the person has no pulse, begin chest compressions.

4. If the person is wearing a helmet, do not remove it. 5. If you absolutely must roll the person because he or she is vomiting, choking on

blood or in danger of further injury, you need at least one other person. With one of you at the head and another along the side of the injured person, work together to keep the person’s head, neck and back aligned while rolling the person onto one side. (Mayo Clinic Staff)

Back Pain – Unrelated to Injury

1. Ask about location of pain and when pain began. Ask if experiencing pain/burning upon urination.

2. Apply ice bag to affected area and allow student to rest for a brief period. 3. Notify parent/guardian if discomfort continues.

S4 - P2

Bites - Animal, Human, Spider, Tick

Animal 1. Wash wound with soap and running water for five minutes. 2. Cover with gauze. 3. Notify parent/guardian and advise them to contact family physician for further

treatment. 4. Call Animal Control at 407-742-8000, if bite occurred on school property.

Human

1. Wash wound with soap and running water for five minutes. 2. Cover with gauze. 3. Notify parent/guardian and principal/designee of bite. If the skin is

broken, advise them to contact family physician for further advice. 4. Complete Student Accident/Incident Report (FC-600-0419).

Spider - (Black Widow or Brown Recluse)

1. Wash the area with soap and water. 2. Apply an ice pack or cool wet cloth to relieve pain and swelling. 3. Observe for signs of allergic reaction. (see Allergic Reaction) 4. Call parent/guardian. Obtain immediate medical care.

Ticks May carry serious infections. Notify parent/guardian. Do NOT handle ticks with bare hands.

Blisters - see Burns

1. Do not break blister. 2. Clean with soap and water. 3. Cover with gauze or band-aid.

Broken Bones - Fracture, Sprain, Dislocation

Fractures 1. Assess for pain, swelling discoloration and/or tenderness. 2. Notify parent/guardian and principal/designee. 3. Immobilize affected part and keep student as comfortable as possible. 4. Apply ice to reduce pain and swelling. 5. If the student must be moved, support and splint the injured part. If a splint is not

available, use a pillow, folded blanket or magazine. 6. Treat any bone injury as a suspected fracture. 7. If bone is protruding from the skin, cover with sterile gauze. Do not move student

unless necessary. Treat for shock if indicated. CALL EMS (911).

S4 – P3

Suspected Sprains 1. Assess for swelling, tenderness, and pain upon motion. 2. If the student’s ankle or knee is affected, do not allow him to walk. Loosen

or remove the student’s shoe. 3. Elevate the injured part. 4. Apply ice to reduce pain and swelling. 5. Notify parent/guardian.

Dislocations

1. Assess for swelling, obvious deformity, pain, tenderness, or discoloration. 2. DO NOT attempt to replace dislocation. 3. Support affected part with a sling or splint in a comfortable position. 4. Elevate the affected part. 5. Notify parent/guardian of immediate medical need. Notify principal/designee.

Bruises

1. If skin is broken, treat as a cut (see Cuts). 2. Apply ice. 3. If there is swelling or severe pain, recommend medical attention.

Burns - (NEVER APPLY OINTMENT OR OTHER REMEDY)

First Degree - reddened area only 1. Apply cool compress or submerge in cold water (not ice) for several minutes. 2. Notify parent/guardian.

Second Degree - blisters with redness 1. Rinse with cool water for several minutes. 2. Cover with gauze. 3. Do not break blister(s). 4. Notify parent/guardian.

Third Degree - ashen color, painless 1. Call EMS (911), notify parent/guardian and principal/designee. 2. Treat for shock if present (see Shock). 3. Do not remove clothing adhering to burns. 4. Give nothing by mouth. 5. Try to keep dirt and dust out of burned area. If sterile dressings are not

available, a clean sheet or towel around or over, but not on, the burned area may be used while waiting for EMS.

Chemical - Skin 1. Follow directions on chemical container and call Poison Control Center

1-800-222-1222. 2. If no directions are available, flush skin thoroughly for 15 minutes with cool water. 3. Remove parts of clothing that may have retained chemical. 4. Notify parent/guardian and principal/designee. If further treatment is

recommended, send chemical container with parent/guardian.

S4 - P4

Choking

If student is breathing and can talk, do not interfere with his attempt to dislodge object. 1. If not breathing adequately, may exhibit one or more of the following:

• Unable to talk • Clutching throat • Turning bluish or dusky • Crowing sound/high-pitched sound while breathing in(inhaling) • Unconscious, partial or complete

2. Call EMS (911) 3. Use Heimlich maneuver 4. Repeat Heimlich until object is expelled or until EMS arrives 5. Notify parent/guardian and principal/designee.

Cuts - Abrasions, Lacerations, Punctures and Pencil Wounds

Minor 1. Wash affected area with soap and water. 2. Cover with gauze or band-aid.

Large

1. Use gauze to cover wound. If necessary, apply pressure to stop bleeding. 2. If cut is deep or severe, more dressings may be applied. DO NOT remove

original dressings. 3. Call EMS (911) if necessary 4. Notify parent/guardian and principal/designee.

Punctures

1. Scrub affected area thoroughly with soap and water. 2. Do not probe or squeeze. Do not remove large objects. 3. Cover with clean dressing. 4. If wound is deep or bleeding freely, treat as a large cut.

Pencil Wounds

1. Remove any protruding piece of graphite as you would a splinter. DO NOT probe.

2. Cleanse the wound with soap and water, removing as much graphite dust as possible.

3. Apply band-aid dressing. 4. If imbedded, DO NOT attempt to remove.

S4 – P5

Dental Problems - Toothache, Broken Teeth

Baby Teeth - loose/lost 1. Rinse mouth with water. If bleeding, have child bite on gauze for

several minutes. 2. Send tooth home with student.

Toothaches - check for cause of toothache 1. If cavity is present, rinse mouth vigorously with warm water to clean food

from tooth. 2. If pain from incoming permanent tooth, apply ice chips. 3. Loose baby tooth may ache. 4. If swelling is present, place cold compresses on outside of cheek. 5. Notify parent/guardian.

Broken/Displaced Tooth 1. Gently clean area and mouth with warm water. 2. If tooth has a sharp edge, cover with gauze to prevent cutting lips or cheeks. 3. To decrease pain, keep air from exposed surface by covering with gauze. 4. Place cold compress on face, in the area of the injured tooth, to

minimize swelling. 5. If tooth is displaced or has been pushed up into the gum, do not attempt to pull it

into position or move it. Notify parent/guardian for emergency dental care. Knocked Out – Permanent

1. Locate tooth. 2. If found, grasp by crown (white portion), not root. 3. If tooth is dirty, rinse it gently in running water – do not scrub it. 4. Keep tooth moist in milk, water or wet gauze. 5. Control bleeding and use ice compresses for swelling outside of mouth. 6. Contact parent/guardian for immediate dental care.

Objects Wedged Between Teeth 1. Try to remove the object with dental floss, if available. 2. Do not try to remove with a sharp or pointed instrument. 3. If unsuccessful, notify parent/guardian.

Braces, Orthodontic Problems 1. If wire embedded in cheek, tongue or gum tissue, do not attempt to remove.

Notify parent/guardian for follow-up with dentist. 2. If wire is causing irritation, cover the end of it with a cotton ball, piece of gauze or

wax. Notify parent/guardian for follow-up with dentist. 3. Do not attempt to remove or bend wire. 4. If appliance is loose or breaks notify parent/guardian, (save any broken pieces)

for follow up with dentist.

S4 – P6

Diabetes

Hypoglycemia - Low blood sugar 1. Refer to Individual Student Health Care Plan for students with a history of

diabetes. 2. Symptoms may occur within minutes; headache, shaky, sweaty, pale skin,

confused, drowsy. 3. If in doubt, treat all diabetic reactions as if the person needs sugar. 4. If student can swallow, follow doctor’s orders on Student Health Care Plan. If

orders are not available give concentrated sugar immediately 2 packets or 2 teaspoons of granulated sugar, fruit juice, or carbonated soda 6 oz. (not diet).

5. Student should improve within 15-30 minutes. 6. If unable to swallow due to loss of consciousness, call EMS (911) 7. Notify parent/guardian, principal/designee and District RN.

Hyperglycemia – high blood sugar • Refer to Individual Student Health Care Plan for students with a history

of diabetes. Diarrhea

1. Assist child with hygiene, if necessary, and take temperature. 2. Notify parent/guardian. 3. Monitor for other students in same classroom with similar symptoms.

Drug Ingestion

Symptoms will vary, depending upon substance and amount ingested. 1. If suspected overdose, call EMS (911) 2. If suspected or know ingestion of illegal drugs, refer to School Resource Officer. 3. Call Poison Control (1-800-222-1222) and follow their instructions. 4. Notify parent/guardian and principal/designee.

Ear Problems

Earache 1. Do not apply heat or cold to ear. 2. Take temperature. 3. Examine for drainage or object in ear. 4. Encourage student to rest in the position of comfort. 5. Advise parent/guardian of student’s condition and recommend medical attention.

Objects/Insects

1. Remove only those that are readily accessible and can be easily removed. 2. Notify parent/guardian and recommend medical attention.

S4 - P7

Electrical Shock

1. Turn off source of current, if possible. 2. Do Not touch student until power source has been shut off. Check for breathing

and pulse. If absent, begin CPR. Call EMS (911). Notify principal/designee. 3. If electrical shock seems minor, notify parent/guardian.

Eyes

Irritation/Drainage 1. Check the eye for swelling, tearing, redness, or drainage. 2. Contact parent/guardian to ask history of eye symptoms and whether student has

received treatment. 3. If student has eye drainage and has not received treatment, send student home.

Recommend to parent/guardian that student receive medical attention. Foreign Objects

1. Urge student to avoid rubbing eyes. 2. Flush with sterile eyewash. 3. If particle or pain remains, notify parent/guardian and recommend medical care. 4. If particle seems embedded, do not attempt to remove. With eyelids closed,

cover both eyes loosely with gauze or cloth to restrict eye movement. Notify parent/guardian and encourage immediate medical care.

Chemicals in Eye 1. Follow directions on chemical container. 2. If no directions, flush eye thoroughly for 15 minutes with cool water. Do not use

eye cup. When washing eyes turn head, lift eyelid and pour water gently from nose to outer side. Never wash toward the other eye. Hold eyelid open so that water passes over eyeball.

3. Call Poison Control (1-800-222-1222) and follow their instructions. 4. Notify parent/guardian and principal/designee. Physician should be consulted

regarding need for further treatment. Send chemical container with parent/guardian.

Injuries – blunt trauma 1. Check for blurred vision, pain/discomfort. Notify parent/guardian and encourage

immediate medical care. . 2. Apply cold cloth.

Injuries – penetrating 1. Do not attempt to remove object or wash eye. 2. Cover both eyes loosely with gauze or cloth, or use paper cup for protection of

injured eye. 3. Keep student quiet and call EMS (911). Notify parent/guardian

and principal/designee.

S4 – P8

Fainting

A brief loss of consciousness generally due to excitement or anxiety, responds best to calm waiting. Do not crowd around the student.

1. Student who feels weak or dizzy should lie down or bend over with head at the level of the knees.

2. Loosen clothing around neck and waist. Allow student to lie down with legs elevated 8-10 inches, until fully recovered. Apply cool damp cloth to head.

3. If student fell, examine for injuries. Unless recovery is prompt, seek medical assistance. Observe carefully afterward, fainting may indicate a more serious problem.

4. Notify parent/guardian. Fever - a temperature of 100.4 F degrees or higher

An elevated temperature may be an indication of illness. A communicable disease (cold, flu, etc.) should be suspected when fever and one or more of the following symptoms are present: headache, watery red eyes and nose, cough, skin rash, vomiting or diarrhea.

1. Prevent direct contact with other students or staff. 2. Contact parent/guardian. 3. See page 17 in this section for Fevers and Reduction Options.

Finger Injuries

Torn Fingernails 1. Clip fingernail to edge of nail bed, and smooth edges. 2. If torn into nail bed, clean with soap and water, and apply dry dressing to

protect the nail bed. 3. If there is bleeding, use gentle pressure to stop bleeding. Apply ice pack to

reduce swelling and decrease pain. Finger Trauma Apply ice and elevate hand to reduce swelling and pain, and notify parent/guardian. Finger injuries should be referred for medical evaluation.

Genital Injury

Testicular Torsion – sudden severe pain in one testicle. Symptoms

1. Nausea and vomiting 2. Sudden, generally severe, pain in one testicle 3. Faintness 4. Swelling 5. May have fever

S4 – P9

First Aid 1. Keep student as comfortable and still as possible 2. Emergency medical care is required within a few hours 3. If parent/guardian cannot be contacted, call EMS (911) for emergency transport

and notify principal/designee Trauma to External Genitals

1. If bleeding, have student apply direct pressure, using gauze or clean cloth. 2. If struck with a hard blow, but no bleeding results, have student apply icepack. 3. Notify parent/guardian to seek emergency medical care. 4. If scrotum is struck or penetrated by a sharp object, call EMS (911) and notify

principal/designee.

Headache

1. Check temperature. 2. Rest 15-30 minutes, if pain is not severe. 3. Apply cool compress to forehead and eyes. 4. Ask if student has eaten today and when headache began. 5. Are other symptoms present such as vomiting, blurred vision or fever 6. If temperature is elevated or pain persists or recurs, notify parent/guardian to

take student home. 7. Refer to District RN for recurring headaches.

Warning Signs of serious conditions which require immediate medical or emergency care:

• Abrupt, severe headache, often like a “thunderclap”. Call EMS (911) and notify principal/designee.

• Headache with fever, stiff neck, rash, mental confusion, seizures, double vision, weakness, numbness, or speaking difficulties. Call EMS (911) and notify principal/designee.

• Headache after a recent sore throat or respiratory infection. • Headache increasing in severity after a head injury, even if the injury

appeared to be minor. • Chronic, progressive headaches that worsen after coughing, exertion,

straining, or sudden movement. • Notify parent/guardian to seek medical care.

Head Trauma: First Aid Many head injuries that happen at school are minor. Head wounds may bleed easily and form large bumps. Bumps to the head may not be serious. Head injuries from falls, sports and violence may be serious. (Emergency Guidelines for Schools, 2019 Florida Edition)

S4 – P10

Call 911 if any of the following signs or symptoms are apparent. They may indicate a more serious head injury.

• Excessive nausea or vomiting • Lethargy: is the child extremely sleepy at a time when he/she should not be

sleepy? Can the child be awakened from the sleep? • Mental confusion and disorientation: can the child remember his/her name,

address, age, etc? Does he/she know where he/she is? • Lack of movement: is the child able to move his/her arms or legs properly? • Unequal size of dilation of pupils of the eyes.

If severe head trauma occurs

• Keep the person still. Until medical help arrives, keep the injured person lying down and quiet, with the head and shoulders slightly elevated. Don’t move the person unless necessary, and avoid moving the person’s neck. If the person is wearing a helmet, don’t remove it.

• Stop any bleeding. Apply firm pressure to the wound with sterile gauze or a clean cloth. But don’t apply direct pressure to the wound if you suspect a skull fracture.

• Watch for changes in breathing and alertness. If the person shows no signs of circulation (breathing, coughing or movement), begin CPR.

A Student Accident/Incident Report form (FC-600-0419) must be completed for each student who has an accident or injury at school. A Head Injury Report - Student form (FC-600-2253E/S) must also be completed for any student who receives a head injury. The parent/guardian must be notified. This includes all extracurricular/after school activities, sports on school property or while the student is in the school district’s custody.

Heart Attack

Symptoms 1. Persistent chest pain or discomfort 2. Difficulty breathing – short of breath, rapid breathing 3. Nausea, vomiting 4. Intense sweating 5. Weakness, restlessness, anxiety

First Aid 1. Stop victim’s activity and help victim rest 2. Call EMS (911) and have AED brought to location. Notify principal/designee. 3. Remain calm and reassuring 4. Assist with medication, if prescribed 5. If the victim’s heart stops beating, follow AED protocol. Be prepared to

begin CPR.

S4 – P11

Heat Illness

It is important to recognize and treat the symptoms of heat illness early to prevent the symptoms from progressing to heat stroke (sunstroke). In all heat emergencies, cool the student down.

Heat Cramps

Symptoms 1. Painful muscle cramps 2. Moist, cool skin 3. Heavy sweating First Aid 1. Move to a cool place 2. Give water or sports drink (if available)

Heat Exhaustion

Symptoms 1. Cold and clammy 2. Heavy sweating 3. Weak pulse 4. Shallow breathing 5. Nausea 6. Stomach cramps 7. Weakness, fatigue 8. Headache First Aid 1. Move to cool place 2. Elevate legs 3. Remove sweat-soaked clothing while maintaining privacy 4. Apply cool packs 5. Give water 6. Monitor 7. Notify parent /guardian

Heat Stroke - Life Threatening

Symptoms 1. Hot, dry, red skin 2. Confusion or unconsciousness 3. Little or no sweating 4. Full, rapid pulse First Aid 1. Move to a cool place 2. Immediately cool student by fanning and applying cool compresses 3. Remove any excess clothing 4. Call EMS (911) Notify parent/guardian and principal/designee.

S4 – P12

Hyperventilation

Symptoms 1. Shallow, rapid breathing 2. Short of breath 3. Dizzy or light-headed 4. Tingling in the hands and feet First Aid 1. Remain calm and reassuring 2. Instruct student to relax and breathe slowly, in a comfortable, sitting position 3. Coach student to “breathe in” and “breathe out” 4. If breathing remains too fast, call EMS (911), notify parent/guardian

and principal/designee Impetigo

1. Check for small blister filled with pus that ruptures to produce a yellow-brown crust.

2. Notify parent/guardian. 3. Exclude student from school until the blisters/rash disappears or a medical

provider has determined the condition to be non-infectious or non-contagious. 4. Notify District RN for persistent cases.

Menstrual Cramps

1. Allow student to rest quietly for a short period of time 2. If severe, notify parent/guardian

Mouth/Tongue Injury

1. Assess for difficulty breathing. 2. Place student in sitting position, with head tilted slightly forward, or place on side

to allow blood to drain from mouth. 3. For injuries that penetrate the lip, place a rolled dressing between the lip and

gum. 4. If tongue is bleeding, apply a gauze dressing and direct pressure. 5. Apply ice to lips or tongue to reduce swelling and ease pain. 6. To control bleeding inside the cheek, place folded gauze dressing inside the

mouth against the wound, with folded edges of dressing extruding from the lips. 7. Notify parent/guardian. Encourage medical care.

S4 – P13

Nose Bleeds

1. Position victim in a sitting position with head tilted slightly forward. 2. Apply direct pressure by pinching tip of nostrils together for 15 minutes. 3. If bleeding does not stop continue to pinch nostrils. Apply ice pack to bridge of

nose. 4. Notify parent/guardian. Encourage medical care.

Poisoning

Signs/Symptoms 1. Abdominal cramping or pain 2. Nausea and/or vomiting 3. Diarrhea 4. Burns, stains and odor in and around the mouth 5. Change in consciousness (drowsiness…unconsciousness) 6. Seizures

First Aid 1. Call Poison Control (1-800-222-1222). When you suspect poisoning from:

medicines, insect bites and stings, snake bites, plants, chemicals/cleaners, drugs/alcohol, food poisoning, inhalants, or if you are not sure.

2. Call EMS (911) notify parent/guardian and principal/designee. 3. Save container, labels or vomited material for EMS.

Rash - Many skin rashes occur as a result of allergies or other non-infectious conditions. A student will be allowed to return to school after appropriate evaluation and treatment has begun, usually within 24 hours or rash is completely resolved. When any undiagnosed rash is found on a student, a Notification of Undiagnosed Rash form (FC-600-1311ERS) must be sent home and returned to the school nurse. See Rash information sheet S6 – P9.

Exclusion 1. Symptoms in addition to the rash such as behavior change, fever, joint pain, or

bruising not associated with the injury. 2. Oozing rash or open wounds.

Ringworm

1. Lesions are usually circular with clear center and red, scaly borders. Patches of hair loss maybe noted if on scalp.

2. Notify parent/guardian of suspected ringworm. 3. Lesions should be covered when found and a completed Notification

of Undiagnosed Rash form (FC-600-1311ERS) must be sent home. 4. Skin lesions (unless on scalp) must be covered until completely clear. 5. Until treatment has been initiated, the student should be excluded from the

gym, all contact sports and swimming.

S4 – P14

Seizures

1. Do not restrain movements or place anything between teeth. 2. Protect from injury. Remove nearby objects. 3. Place on side to allow drainage of vomit or secretions. 4. After seizure, allow student to rest. 5. Refer to Individual Health Care Plan for students with history of seizures. 6. If this is a first time convulsive seizure, call EMS (911). Time seizure

and observe body movements. Report details of seizure activity to medical personnel.

7. If repeated or prolonged beyond 5 minutes, call EMS (911). 8. Always notify parent/guardian and principal/designee.

Shock

Symptoms 1. Pale, cool, clammy skin 2. Weak, rapid pulse 3. General weakness

First Aid 1. Keep student lying down 2. Elevate feet (except in cases of head injury or if elevation causes pain or

respiratory distress) 3. Give nothing to eat or drink 4. Give first aid to treat symptoms if needed 5. Call EMS (911), notify parent/guardian and principal/designee

Snake Bites

Do 1. Call EMS (911), notify parent/guardian and principal/designee 2. Calm and reassure the victim 3. Remove jewelry or tight clothing covering bitten extremity 4. Immobilize extremity if possible 5. Keep bitten area at or below heart level 6. Wash gently 7. Be prepared to treat for shock

Don’t 1. Don’t feed the victim 2. Don’t place ice on bitten extremity 3. Don’t make cuts around bitten area 4. Don’t apply a tourniquet

Sore Throat or Cold Symptoms 1. Take and record temperature 2. Assess child for other symptoms. Notify parent/guardian of sore throat

associated with fever, rash, difficulty swallowing or other signs of illness.

S4 – P15

Splinters

1. Remove with tweezers if protruding 2. Cleanse thoroughly with soap and water and apply bandage 3. If embedded, DO NOT USE NEEDLE OR TWEEZERS TO REMOVE

Stings - Bee, Wasp, Hornet, etc.

1. For students with a history of allergic reactions refer to their Individual Health Care Plan and manage accordingly

2. If there is allergic reaction, such as hives, rash, weakness, nausea, vomiting, or difficulty breathing, call EMS (911), notify parent/guardian and principal/designee

3. Scrape out stinger with edge of plastic ID or credit card. DO NOT pull out 4. Wash with soap and water. Apply ice.

Stye

Styes are non-contagious bacterial infections that lead to the obstruction of oil producing glands around the eyelashes or eyelids. Styes are seen as small bumps on the eyelids. Styes are usually harmless and will go away after several days on their own. First Aid

1. Apply warm compress to affected area twice a day. Do not use hot water or heat a wet cloth in the microwave. Place the compress over the closed eye until it begins to cool (5 to 10 minutes). To speed the healing process, use normal saline solution. Students should avoid rubbing eye and wash hands frequently to decrease the spread of infection.

2. Notify parent/guardian if any questions or concerns. Sunburn

1. Check temperature 2. Apply cool compresses to exposed areas 3. Offer fluids 4. For severe sunburn, notify parent/guardian

Tuberculosis

Tuberculosis (TB) is transmitted from person to person through the air by coughing, sneezing, singing or speaking. The bacterium can stay in the air for several hours. People nearby may breathe in the bacteria and become infected. Not everyone infected with TB bacteria becomes sick.

S4 - P16

Latent TB Infection (LTBI) • For most people who breathe in the TB bacteria and become infected, their

body is able to fight the bacteria. They do not feel sick and do not have any symptoms. The only sign of TB infection is a positive reaction to the tuberculin skin test (TST), or Quantiferon TB test (QFT). They are not infectious and cannot spread TB bacteria to others. People with Latent TB Infection can take medicine to prevent them from developing TB Disease.

TB Disease • TB becomes active if the body’s immune system cannot stop the growth of

the bacteria. The general symptoms of TB Disease may include weakness, weight loss, fever, fatigue, decreased appetite, night sweats, prolonged cough, or coughing up blood.

It is required by Florida statue to report tuberculosis disease to the Florida Department of Health. Notify your District RN immediately to file report. Positive tuberculin tests are not reportable.

Unconsciousness

1. Leave person lying down. Move only if in an unsafe area. Check quickly for other symptoms/conditions to determine cause

2. Check for breathing and pulse. If absent, begin CPR and follow AED protocol 3. Call EMS (911), notify parent/guardian and principal/designee

Vomiting

1. Give nothing by mouth 2. Check temperature and assess for stomach pain 3. Position student comfortably on his/her side 4. Unless student is markedly improved after vomiting, notify parent/guardian and

send student home

S4 - P17

Fever

The body temperature can be raised by physical activity, strong emotion, eating, heavy clothing, medications, high room temperature and high humidity as well as a medical condition. This is especially true in children. While fever signals to us that a battle might be going on in the body, the fever is fighting for the person. A fever activates the body’s immune system to make more white blood cells, antibodies and other infection-fighting agents. Fever is an important part of the body's defense against infection. Most bacteria and viruses that cause infections in people thrive best at 98.6°F (37°C). Many infants and children develop high fevers with mild viral illnesses. Although a fever signals that a battle might be going on in the body, the fever is fighting for, not against the person.

Brain damage from a fever generally will not occur unless the fever is over 107.6°F (42°C). Untreated fevers caused by infection will seldom go over 105°F (40.6°C) unless the child is overdressed or in a hot place.

Fever Reduction Options • Drink cool liquids as tolerated • DO NOT bundle up someone who has the chills • Remove excess clothing or blankets • The environment should be comfortably cool (For example, one layer

of lightweight clothing and one lightweight sheet) • A fan may help • Wet head and exposed skin with lukewarm water • DO NOT use cold baths or alcohol rubs. These cool the skin, but often

make the situation worse by causing shivering, which raises the core body temperature

• Prevent child with fever from contacting other students until parent pick-up • DO NOT give aspirin to a child with a fever • DO NOT use ibuprofen in children younger than 6 months old

Information obtained from Medline Plus® a service of the U.S. National Library of Medicine: 23 March 2020

S4 – P18


Section 5

Infection Control


Revised July 2020


Infection Control Index

Standard Precautions for Handling Blood/Body Fluids in School ............................... 1

Hand Washing ........................................................................................................ 1-2

Ways to Avoid Contact with Body Fluids .................................................................... 2

Disposal of Infectious Waste ................................................................................... 3-4

Accidental Exposure .................................................................................................. 4

Prevention Guidelines for Diseases Spread Through Direct Skin Contact ................. 5

Prevention Guidelines for Diseases Spread Through the Intestinal Tract ............... 5-7

Prevention Guidelines for Diseases Spread Through the Respiratory Tract ............ 7-8

Standard Precautions for Handling Blood/Body Fluids in School Occupational Safety and Health Administration (OSHA) Final Bloodborne Pathogens Standard: The following guidelines are designed to protect persons who may be exposed to blood or body fluids. Please refer to the OSHA Occupational Exposure to Bloodborne Pathogens; Final Rule for the most recent requirements.

Anticipating Potential Contact: Anticipating potential contact with infectious materials in routine and emergency situations is the most important step in preventing exposure to and transmission of infections. Use standard precautions and infection control techniques in all situations that may present the hazard of infection. Diligent and proper hand washing, the use of barriers (e.g. latex or vinyl gloves), appropriate disposal of waste products and needles, and proper care of spills are essential techniques of infection control.

Applying the Concept of Standard Precautions: When applying the concept of standard precautions to infection control, all blood and body fluids are treated as if they contain bloodborne pathogens. Bloodborne pathogens such as HIV, Hepatitis B (HBV), and Hepatic C can be found in:

• Blood • Spinal fluid • Synovial fluid • Vaginal Secretions • Semen • Pericardial fluid • Breast milk • Peritoneal fluid • Amniotic fluid • Pleural fluid

HBV (not HIV) is also found in saliva and other body fluids such as urine, vomitus, nasal secretions, sputum and feces. It is not always possible to know whether any body fluid contains bloodborne pathogens therefore, all body fluids should be considered potentially infectious. Thus all students and staff when handling or being exposed to any blood or body fluids should observe standard precautions.

Hand Washing Diligent and proper hand washing are essential components of infection control. Hands should be washed:

• Immediately before and after physical contact with a student (e.g. diaper changes, assisting with toileting, assisting with feeding).

• Immediately after contact with blood or body fluids or garments or objects soiled with body fluids or blood.

• After contact with used equipment (e.g. stethoscope, emesis basin, gloves).

• After removing protective equipment, such as gloves or clothing.

S5 – P1

Hand Washing Procedure • Remove jewelry and store in a safe place prior to initial hand

washing (replace jewelry after final hand washing). • Wash hands vigorously with soap under a stream of running

water for approximately 15-20 seconds. • Rinse hands well with running water, and thoroughly dry with paper

towel. • Use towel to turn off faucet. • If soap and water are unavailable, bacteriostatic/bactericidal wet

towelettes, “hand wipes” or instant hand sanitizer may be used. • When using alcohol based hand sanitizer put enough product in

your palm to cover hands. Rub hands together briskly until dry. Ways to Avoid Contact with Body Fluids

Gloves – When possible, avoid direct skin contact with body fluids. Disposable single use, waterproof, latex, or vinyl gloves should be available in school health rooms. Vinyl gloves should be used with students who have a latex allergy ora high potential for developing a latex allergy, such as students with spina bifida. The use of gloves is intended to reduce the risk of contact with blood and body fluids for the caregiver as well as to control the spread of infectious agents from student to employee, employee to student or employee to employee.

Gloves should be worn when direct care may involve contact with any type of body fluids. Incidents when gloves should be worn include (but are not limited to) caring for nose bleeds, changing a bandage or sanitary napkins, cleaning up spills or garments soiled with body fluids, disposing of supplies soiled with blood or any procedure where blood is visible. Gloves should also be worn when changing a diaper, catheterizing a student, or providing mouth, nose or tracheal care.

Do Not Reuse Gloves – After each use, gloves should be removed without touching the outside of the glove and disposed of in a lined waste container. After removing the gloves, the hands should be washed according to the hand washing procedure.

Protective Clothing – If splattering of body fluids is anticipated, the clothing of the caregiver should be protected with an apron or gown and the face protected with a facemask and eye goggles or face shield. The apron or gown should be laundered or disposed of after it is used and should not be used again until it is clean. The goggles should be cleaned and mask disposed of properly.

Shield for Rescue Breathing – If it is necessary to perform Rescue Breathing, a one-way mask or other infection control barrier should be used. However, Rescue Breathing should not be delayed while such a device is located.

S5 – P2

Disposal of Infectious Waste The Biomedical Waste Plan (in compliance with Chapter 64E-16 Florida Administrative Code) will be available for each school.

Sharps Disposal

1. Do not fill sharp container above fill line or above ¾ full. 2. All schools will have a puncture resistant, leak-proof, biohazard labeled

sharps container. Substitute containers such as coffee cans and bleach bottles are not acceptable in the school setting.

3. All blood contaminated sharp objects such as lancets, needles, syringes and broken glass will be placed in the sharps container. No needles or lancets will be recapped.

4. The sharps container will remain in use until it is filled. Once filled it is to be closed, sealed and dated. Contact Health Services at 407-891-3170 for pick up and exchange of the container.

Disposal of Saturated Materials

1. A material is considered saturated if it is wet to the point of dripping. Gloves must be worn when handling saturated materials.

2. All saturated materials must be placed in the red biohazard waste bag. Once saturated material is placed in the bag it must be dated and disposed of by a biohazard waste company within 30 days.

Disposal of Unsaturated Materials 1. A material is considered unsaturated if it is not wet to the point of dripping.

Gloves must be worn when handling unsaturated materials. 2. All unsaturated materials will be disposed of in a trash can lined with

a standard trash bag. 3. Large amounts of unsaturated materials should be placed in a

separate plastic bag, sealed then place in the lined trash container. 4. Clothing or personal articles must be secured in double plastic bags.

Clean-Up Procedures

1. Wear gloves (See “Ways to Avoid Contact with Body Fluids”). 2. Mop up spill with absorbent material. 3. Wash the area well, using an approved disinfectant cleaner. 4. Dispose of gloves, soiled towels, and other waste in sealed plastic

bags and place in garbage, as already indicated. 5. WASH HANDS.

Routine Environmental Clean-Up Facilities – Routine environmental clean-up facilities (e.g. Health Room and bathrooms) do not require modification unless contaminated with blood or body fluids. If so, the area should be decontaminated using the procedures outlined previously. Regular cleaning of non-contaminated surfaces, such as toilet seats and tabletops, can be done with the standard cleaning solutions. Regular cleaning of obvious soil is more effective than extraordinary attempts to disinfect or sterilize surfaces.

Cleaning Tools – Brooms and dustpans must be rinsed in disinfectant. Mops must be soaked in disinfectant, washed and thoroughly rinsed. The disinfectant solution should be disposed of promptly down the drain.

S5 – P3

Laundry – Whenever possible, disposable barriers (e.g. disposable gloves and gowns) should be used if contamination with blood and body fluids is possible. If sheets, towels or clothing become soiled, they should not be handled more than necessary. Wash contaminated items with hot water and detergent for at least 25 minutes. Presoaking may be required for heavily soiled clothing. The most important factor in laundering clothing contaminated in the school setting is elimination of potentially infectious agents by soap and hot water. It is preferred that only disposable or one use products such as gloves and gowns be used in school Health Rooms. Soiled student clothing should be rinsed using gloves, placed in a plastic bag, and sent home.

Accidental Exposure

An accidental exposure incident is contact with blood or other potentially infectious materials that may include mucous membrane, non-intact skin, or parenteral contact that results from the performance of an employee’s duties.

When a school employee incurs an exposure incident, it should be reported immediately to the school or site administrator. All employees who incur an exposure incident will be offered post-exposure evaluation and follow-up in accordance with the OSHA standard. The school district’s Risk Management department should be notified to arrange for medical evaluation. If the source of the exposure is known, (i.e. student) the parent/guardian should be notified as soon as possible.

Procedure

• Always wash the contaminated area immediately with soap and water. • If the mucous membranes (i.e. eye or mouth) are contaminated by a

splash of potentially infectious material or contamination of broken skin occurs, irrigate or wash the area thoroughly.

• If a cut or needle injury occurs, wash the skin thoroughly with soap and water.

• Notify the principal/designee of accidental exposure immediately. • Notify Risk Management to arrange post-exposure medical evaluation. • Notify parent/guardian if a student is the source of the

accidental exposure. Resources Implementing OSHA Standards in a School Setting; National Association of School Nurses. August 1999.

Occupational Safety and Health Administration – 29 CFR Parts 1910. Occupational Exposure to Bloodborne Pathogens – Needle sticks and other Sharps injuries; Final Rule. January 18, 2001. http://www.Osha-slc.gov/FedReg_osha_pdf/FED20010118A.pdf

CDC National Institute for Occupational Safety and Health. http://www.cdc.gov/niosh/bbppg.html)

S5 – P4

http://www.osha-slc.gov/FedReg_osha_pdf/FED20010118A.pdf

http://www.cdc.gov/niosh/bbppg.html)

Prevention Guidelines for Diseases Spread Through Direct Skin Contact

Overview Infectious diseases that are usually spread through direct skin contact, including those commonly known as impetigo, pink-eye, scabies and ringworm can be spread by direct or indirect transfer of the disease-causing organism (infectious agent). Organisms that cause such diseases include bacteria, parasites and fungi.

Direct transmission of the organisms can occur by direct contact with an infected or infested person (e.g. direct skin-to-skin contact, immediate contact with infected lesions or discharges). Indirect transmission of the organism can occur, though usually to a lesser extent, through contaminated inanimate materials or objects (e.g. shower stalls). For some of the diseases, it is possible to transmit the organism through other modes (e.g. airborne spread).

These diseases are common and when treated are not serious. Because students constantly touch the people around them and their surroundings, these diseases are easily spread among students and staff.

Prevention

1. Follow hand washing and cleanliness guidelines that include: • Make sure staff and students thoroughly wash their hands

after contact with any possible infected areas. • Use liquid soap dispensers whenever possible. • Use disposable tissues or towels for wiping and washing. • Never use the same tissue or towel for more than one student. • Dispose of used tissues and paper towels in a lined and covered

container that is kept away from food and materials. • Wash or vacuum frequently used surfaces (e.g. tables,

counter, furniture and floors) daily. 2. Wash and cover sores, cuts and scrapes and keep infected eyes wiped dry. 3. Report rashes, sores, runny eyes and severe itching to a student’s parent or

guardian so they may contact their health care provider for diagnosis and appropriate treatment.

Prevention Guidelines for Diseases Spread Through the Intestinal Tract

Overview Infectious diseases that are usually spread through the intestinal tract, including those known as campylobacteria, hepatitis A, hepatitis E, pinworms, rotavirus, salmonella, shigella, E coli, giardia, pylori, round worms, whip worms, tape worms and hook worms can be spread from person to person by direct or indirect transfer of the disease-causing organism (infectious agent). Organisms that cause such diseases include bacteria, viruses and parasites.

S5 – P5

Direct transmission of the organisms, for most of the diseases, can occur by hand-to-mouth transfer of the organism from the stool of an infected person (i.e. fecal-oral route), especially in institutions and day care centers. Indirect transmission of the organisms can occur, though usually to a lesser extent for some of the diseases, through contaminated inanimate materials or objects(e.g. ingestion of organism in food, unpasteurized milk, water). For some of the diseases, it is possible to transfer the organisms through other modes (e.g. contact with an infected pet, possible fecal-respiratory route). Some organisms, such as Campylobacter and Salmonella bacteria, must be ingested in larger quantities to cause illness.

Students who have hand-stool contact may facilitate transmission of these organisms. Students with disease-causing organisms in their stool may not act or feel sick or have diarrhea. Laboratory tests are the only means of confirming the presence of this type of organism in a particular stool and may be performed as part of an effort to control an outbreak of disease. Because students who have intestinal tract diseases do not always feel sick or have diarrhea, the best method for preventing spread of disease is to have a constant prevention program in place. In the school setting, this program should include hand washing before preparing or eating food and after using the bathroom. All school bathrooms should have adequate supplies of soap, running water, paper towels and toilet paper.

School Exclusion Guidelines

• When students have uncontrolled diarrhea and fever or vomiting (or have severe or bloody diarrhea) or if diarrhea cannot be contained by diapers (in those students using them), they should be excluded from school until their fever or diarrhea are gone and they have been treated as determined by a health care provider.

• When students have mild diarrhea but are not sick, special precautions should be taken or they should be excluded from school.

• When students or staff who do not prepare food or feed students are found to have infectious diarrhea germs in their stool (positive stool cultures) but have no diarrhea or illness symptoms, special precautions should be taken but they should not be excluded from school. If necessary, make sure they receive appropriate management from a health care provider. During outbreaks a negative stool culture may be required before returning to school.

• When staff who normally prepare food or feed children have positive stool cultures, refer to School District Policy regarding exclusion and return to work.

Return Guidelines Excluded students and staff may come back to school after treatment and when severe diarrhea is gone. During outbreaks, negative stool cultures may be required before excluded students and staff may come back to school.

S5 – P6

Prevention Guidelines 1. Strictly enforce proper hand washing after using the bathroom, diapering

and before preparing or eating food. Hand washing is the best way to prevent spread of infectious diseases caused by organisms that are transmitted by the fecal-oral route.

2. Pay attention to environmental cleaning and sanitation. 3. Keep track of the number of cases of diarrhea. 4. If there is an increase in the number of cases expected in the school, call

the District RN and epidemiology at the Florida Department of Health in Osceola County for guidelines on additional precautionary measures to be taken to ensure the protection of students and staff from further spread of illness.

Prevention Guidelines for Diseases Spread Through the Respiratory Tract

Overview Infectious diseases that are usually spread through the respiratory tract, including those commonly known as chickenpox, common cold, flu, measles, bacterial meningitis and tuberculosis can be spread from person to person by direct, indirect or airborne transfer of the disease-causing organism (infectious agent). Organisms that cause such diseases include bacteria and viruses. When a person infected with such a disease coughs, sneezes, blows their nose, sings, or talks (usually limited to about 1 yard) they can produce infected droplets (large infected particles that settle out of the air) or infected airborne particles (microbial aerosols that do not settle out of the air for a longtime).

Direct transmission of the organisms can occur by direct contact with the mucous membranes of the infected person (e.g. touching or kissing) or direct projection (spray) of the droplets onto the eye, nose or mouth. Indirect transmission of the organisms can occur, for most of the diseases, by hands and articles (e.g. handkerchiefs, toys pencils, books, desks) freshly soiled by droplets, discharges from nose and throat, or secretions from lesions of an infected person. The organisms are transmitted by contaminated hands carrying organisms to the mucous membranes of the eye or nose. Furthermore, transmission of the organisms can occur by inhalation of airborne particles.

Diseases spread through the respiratory tract can be mild (e.g. viral colds) or life- threatening (e.g. bacterial meningitis). People who are infected with such diseases and do not wash their hands after touching their eyes, nose or mouth increase the likelihood of spreading the disease by contaminating articles with discharges from their respiratory tract. The organisms can easily be transferred to others through those contaminated articles. In addition, people who are infected with respiratory disease and do not cover their mouths and nose when coughing or sneezing can increase the likelihood of airborne spread, which can predominate among crowded populations in enclosed spaces (e.g. school buses).

S5 – P7

School Exclusion Guidelines • Most children will not need to be excluded from school for mild respiratory

tract illnesses, because transmissions is likely to have occurred before symptoms developed in the child or is a result of contact with children with asymptomatic infection.

• Exclusion from school of children with respiratory tract symptoms that are due to common cold, croup, bronchitis, pneumonia, sinusitis and/or otitis media probably will not decrease the spread of infection.

• Separation from other children is indicated when one or more of the following conditions exist:

• The illness has a specific cause that requires exclusion or treatment prior to returning to school as outlined under the discussion of the specific illness.

• It interferes with the child’s ability to concentrate and limits the child’s comfortable participation in school activities.

• Results in a need for care from staff members that compromise the health and safety of other children.

Prevention Guidelines 1. Hand washing and other hygiene practices are essential to decreasing

the spread of all respiratory tract diseases. Students and staff should be encouraged to wash their hands after wiping or blowing their noses, after contact with any nose, throat or eye secretions and before preparing or eating food.

2. A supply of tissues should be available in each classroom. Encourage children to cough or sneeze into a tissue and away from other people. Tissues should be properly disposed of and hand washing should follow.

3. Dispose of tissues contaminated with nose, throat or eye discharges in a step-can with a plastic liner. Keep soiled tissues away from food and other classroom materials.

4. Discourage the sharing of food. 5. Surface areas, toys and other inanimate materials and objects shared by

children in the classroom should be properly cleaned.

S5 – P8


Section 6

Communicable Diseases


Revised July 2020


Communicable

Diseases Index

Purpose ................................................................................................................. 1

General Procedure ................................................................................................ 1 Health Procedures for Control of Communicable Diseases ................................... 2

Reporting of Communicable Diseases .................................................................. 2

Reportable Diseases/Conditions ........................................................................... 3

Infectious Disease in School Settings – Summary Chart .................................... 4-7

Rashes .................................................................................................................. 8

Epidemiology Forms ................................................................................... …..9-11

Communicable Diseases Purpose The purpose of these guidelines is to control the spread of communicable diseases in school personnel, parents and students. School personnel DO have the right to exclude students with suspected communicable diseases until such time as a physician states, in writing, the student is no longer contagious OR until the signs and symptoms are no longer apparent (F.S.381.0056).

General Procedure Most common communicable diseases have a sudden onset and similar beginning signs and symptoms. All students with suspected communicable diseases should be sent home until a proper medical diagnosis can be made or the student is symptom free.

Until the student is sent home:

• Take and record temperature • Isolate student – DO NOT SEND STUDENT BACK TO CLASS • Notify the parent/guardian to come for the student • Students frequently exhibiting signs of a possible

communicable disease should be referred to the School District RN or Health Department School Nurse

Questions concerning communicable diseases should be directed to the School District RN and Florida Department of Health in Osceola County Epidemiology Program.

The conditions described in the following section are frequently reported communicable conditions. The materials in the section have been written so that the content is appropriate for sharing with parents/guardians and students. Note that the action by school personnel is covered for each disease.

S6 – P1

Health Procedures for Control of Communicable Diseases

Certain basic hygiene measures are important to reduce the chance of transmission of any communicable disease in schools.

ALL PERSONNEL WILL WEAR DISPOSABLE GLOVES WHEN HANDLING BODY FLUIDS (blood, emesis, urine or feces)

1. Hand washing with soap and running water for 15-20 seconds and drying

with disposable towels is the single most important technique for preventing the spread of disease and should be done frequently.

• Before eating or drinking • Before handling clean utensils or equipment • Before and after using the bathroom • After contact with body secretions and excretions, e.g. blood, urine, feces,

mucus, saliva, drainage from wounds (even if gloves were worn) • After handling soiled diapers, menstrual pads, garments or equipment • After caring for any student, especially those with nose, mouth or

ear discharges 2. The mouthing of toys, pencils and other shared items by students should

strongly discouraged. 3. Daily sanitation of all surfaces involved in food handling or diapering, and of all

surfaces or items which have been mouthed by students (including toys) should be done using the school district’s approved disinfectant.

4. All students should be educated about appropriate hygienic measures to prevent the spread of communicable diseases. Those students who are known carriers of a communicable disease should be educated about the additional control measures for minimizing transmission of the specific disease.

Reporting of Communicable Diseases All cases of the following suspected communicable diseases in school personnel or students shall be reported to Health Services, who will take appropriate action.

All diseases of public significance shall be reported to Florida Department of Health in Osceola County Epidemiology Program at (407) 343-2155 according to Florida Statute 381.0031.

S6 – P2

Amebic encephalitis

Hemolytic uremic syndrome (HUS) Hepatitis A

Herpes B virus, possible exposure

Chikungunya fever, locally acquired

! Outbreaks of any disease, any case, cluster of cases, or exposure to an infectious or non-infectious disease, condition, or agent found in the general

! Haemophilus influenzae invasive disease in children <5 years old • Hansen’s disease (leprosy) Hantavirus infection

• Pesticide-related illness andinjury, acute ! Plague ! Poliomyelitis

community or any defined setting (e.g., hospital, school, other institution) not listed that is of urgent public health

significance + Acquired immune deficiency syndrome (AIDS)

! Anthrax □ Arsenic poisoning ! Arboviral diseases not otherwise listed □ Babesiosis ! Botulism, foodborne, wound, and unspecified □ Botulism, infant ! Brucellosis □ California serogroup virus disease □ Campylobacteriosis

+ Cancer, excluding non-melanoma skin cancer and including benign and borderline intracranial and CNS

tumors □ Carbon monoxide poisoning □ Chancroid □ Chikungunya fever

Chlamydia ! Cholera (Vibrio cholerae type O1) □ Ciguatera fish poisoning + Congenital anomalies □ Conjunctivitis in neonates <14 days old □ Creutzfeldt-Jakob disease (CJD) □ Cryptosporidiosis □ Cyclosporiasis ! Dengue fever ! Diphtheria □ Eastern equine encephalitis □ Ehrlichiosis/anaplasmosis □ Escherichia coli infection, Shiga toxin- producing □ Giardiasis, acute ! Glanders □ Gonorrhea □ Granuloma inguinale

• Hepatitis B, C, D, E, and G • Hepatitis B surface antigen in pregnant women and children <2 years old

• Herpes simplex virus (HSV) ininfants

<60 days old with disseminated infection and liver involvement; encephalitis; and infections limited to skin, eyes, and mouth; anogenital HSV

in children <12 years old + Human immunodeficiency virus (HIV) infection • HIV-exposed infants <18 months old born to an HIV-infected woman • Human papillomavirus (HPV)-

associated laryngeal papillomas or recurrent respiratory papillomatosis in children <6 years old; anogenital

papillomas in children ≤12 years old ! Influenza A, novel or pandemic strains

Influenza-associated pediatric mortality in children <18 years old • Lead poisoning (blood lead level

≥5 µg/dL) • Legionellosis

• Leptospirosis Listeriosis

• Lyme disease • Lymphogranuloma venereum (LGV)

• Malaria ! Measles (rubeola) ! Melioidosis • Meningitis, bacterial ormycotic ! Meningococcal disease • Mercury poisoning • Mumps + Neonatal abstinence syndrome (NAS) Neurotoxic shellfish poisoning

Paratyphoid fever (Salmonella serotypes Paratyphi A, Paratyphi B, and

Paratyphi C) Pertussis

• Psittacosis (ornithosis)

• Q Fever

! Rabies, possible exposure ! Ricin toxin poisoning • Rocky Mountain spotted fever and other spotted fever rickettsioses ! Rubella • St. Louis encephalitis

• Salmonellosis

• Saxitoxin poisoning (paralyticshellfish poisoning) ! Severe acute respiratory disease

syndrome associated with coronavirus infection • Shigellosis

! Smallpox

intermediate or full resistance to

vancomycin (VISA, VRSA) • Streptococcus pneumoniae invasive disease in children <6 years old • Syphilis

Syphilis in pregnant women and neonates • Tetanus

• Trichinellosis (trichinosis)

• Tuberculosis (TB)

! Tularemia Typhoid fever (Salmonella serotype Typhi) ! Typhus fever, epidemic ! Vaccinia disease

• Varicella (chickenpox)

! Venezuelan equine encephalitis

• Vibriosis (infections of Vibrio species and closely related organisms,

excluding Vibrio cholerae type O1) ! Viral hemorrhagic fevers • West Nile virus disease

! Yellow fever ! Zika fever

Rabies, animal or human

Staphylococcal enterotoxin B poisoning Staphylococcus aureus infection,

Reportable Diseases/Conditions in Florida Practitioner List (Laboratory Requirements Differ) Per Rule 64D-3.029, Florida Administrative Code, promulgated October 20, 2016 Florida Department of Health

www.FloridaHealth.gov/DiseaseReporting www.FloridaHealth.gov/CHDEpiContact

Report immediately 24/7 by phone upon initial suspicion or laboratory test order Report immediately 24/7 by phone

• Report next business day + Other reporting timeframe

*Subsection 381.0031(2), Florida Statutes, provides that “Any practitioner licensed in this state to practice medicine, osteopathic medicine, chiropractic medicine, naturopathy, or veterinary medicine; any hospital licensed under part I of chapter 395; or any laboratory licensed under chapter 483 that diagnoses or suspects the existence of a disease of public health significance shall immediately report the fact to the Department of Health.” Florida’s county health departments serve as the Department’s representative in this reporting requirement. Furthermore, subsection 381.0031(4), Florida Statutes, provides that “The Department shall periodically issue a list of infectious or noninfectious diseases determined by it to be a threat to public health and therefore of significance to public health and shall furnish a copy of the list to the practitioners…”

http://www.floridahealth.gov/DiseaseReporting

http://www.floridahealth.gov/CHDEpiContact

INFECTIOUS DISEASE IN SCHOOL SETTINGS – SUMMARY CHART

As mentioned in the introduction of these guidelines, exclusion should be considered with any illness or symptom if any of the following conditions apply:

□ If the student does not feel well enough to participate comfortably in usual activities. □ If the student requires more care than school personnel are able to provide. □ If the student has a high fever, behavior changes, persistent crying, difficulty breathing, lack of energy,

uncontrolled coughing, or other signs suggesting a severe illness. □ If the student is ill with a potentially contagious illness and exclusion is recommended by a health care provider,

the state or local public health agency, or these guidelines

DISEASE/AGENT INCUBATION

PERIOD

TRANSMISSION CONTAGIOUS PERIOD

REPORT

EXCLUSION

Animal Bites/Rabies Rabies virus

Rabies: 9 days-7 years (usually 3-8 weeks)

Saliva of an infected animal

As long as symptoms are present

Yes – (24 hours for animal bites)

None for animal bites

Campylobacteriosis Campylobacter bacteria

1-10 days (usually 2-5 days)

Fecal-oral spread, contaminated

food/water, animals

While diarrhea is present; can spread for a few days after symptoms are gone

Yes (7 days)

Yes – until diarrhea resolves

Chickenpox (Varicella) Varicella-Zoster virus

10-21 days

(usually 14-16 days)

Droplet/infectious discharges, skin

contact

1-2 days before the rash appears until all the

blisters have crusted over

Yes

(7 days)

Yes – until all blisters

have crusted over CMV

Cytomegalovirus

3-12 weeks Body secretions (primarily saliva

and urine)

As long as the virus is present in body secretions

(months or years)

None

None

Common Cold A variety of viruses

1-3 days (usually 48 hours)

Droplet/infectious discharges

1 day before symptom onset until 5 days after

None

None unless symptoms are severe

Cryptosporidiosis Cryptosporidium parvum

parasite

1-12 days (usually 7 days)


food/water, animals

While diarrhea is present, can spread for several weeks

after symptoms are gone

Yes

(7 days)

Yes – until diarrhea

resolves E. coli O157:H7 and other shiga toxin producing bacteria

Escherichia coli bacteria



food/water, animals

While diarrhea is present; can spread for 1-3 weeks after symptoms are gone

Yes

(7 days)

Yes-until diarrhea resolves (diapered

children need 2 negative stool tests)

S6 – P4

DISEASE/AGENT INCUBATION

PERIOD TRANSMISSION

CONTAGIOUS PERIOD

REPORT

EXCLUSION

Fifth Disease Human parvovirus B19

4-21 days


1 week before rash formation None

None

Giardiasis Giardia lamblia parasite



food/water

While diarrhea is present; can spread for months after

symptoms are gone

Yes (7 days)


Hand, Foot and Mouth Disease – Strains of

enteroviruses

3-6 days

Droplet/infectious discharges, fecal-oral

spread

During the first week of illness; virus can be present

in stool 4-6 weeks

None

None unless the student is drooling uncontrollably

Head Lice (Pediculosis) Pediculus

humanus, the head louse

Nits hatch within 10 days, adults live

3-4 weeks

Direct contact with an infested person/object

As long as live lice or viable nits are present

None

Yes-from end of school day until after first

treatment

Hepatitis A Hepatitis A virus

15-50 days (usually 25-30

days)


food/water

Most contagious 2 weeks before symptom onset and slightly contagious 1 week

after jaundice onset

Yes (24 hours)

Yes- until 1 week after symptom onset or

jaundice

Hepatitis B Hepatitis B virus

2-6 months (usually 2-3

months)

Infective blood or body fluids, sexual

transmission

Several weeks before symptom onset and

throughout the illness, some people carry the virus for life

Yes (7 days)

None

Hepatitis C Hepatitis C virus

2 weeks-6 months (usually 6-7 weeks)

Infective blood 1 or more weeks before symptom onset and as long as the virus is present in the blood which can be lifelong

Yes

(7 days)

None

Herpes (Cold sore, fever blisters) Herpes simplex

2-12 days

Direct contact

As long as the sores are present

None

None unless the student is drooling uncontrollably

HIV and AIDS Human

immunodeficiency virus

Variable

Infective blood

Lifelong

Yes (7 days)

None

Impetigo Streptococcal or

staphylococcal bacteria

7-10 days

Skin contact/direct

contact

As long as there is discharge from the affected areas

None

Yes – until 24 hours after beginning treatment

S6 – P5

DISEASE/AGENT

INCUBATION PERIOD

TRANSMISSION

CONTAGIOUS PERIOD

REPORT

EXCLUSION

Influenza Influenza virus

1-4 days (usually 2 days)

Droplet infectious discharges

From slightly before symptom onset to about day 3 of the

illness

Yes (hospitalized cases or deaths in

children < 18 years- 7days)

None

Measles (Rubeola) Measles virus

7-18 days (usually 10-12

days)

Airborne 4 days before rash onset to 5 days after

Yes (24 hours)

Yes – until 5 days after rash onset

Meningitis (Bacterial) Bacteria such as Neisseria

Meningitidis (meningococcal),

Haemophilus influenzae (H. flu), Streptococcus

pneumoniae (pneumococcal)

Depends on the agent

(usually 1-10 days)


Until completing 24 hours of antibiotic treatment

Yes (24 hours for

meningococcal and H. flu)

(7 days for pneumococcal)

Yes – until 24 hours

after treatment

Meningitis (Viral) Several different viruses


Droplet/infectious discharges, fecal-oral

spread


Yes

(7 days)

None

Mononucleosis Epstein-Barr virus

30-50 days Saliva Up to a year after the initial infection

None None

Mumps Mumps virus

12-25 days usually 16-18 days

Droplet/Infectious discharges, saliva

7 days before swelling onset to 9 days after

Yes (7 days)

Yes – until 9 days after swelling onset

Pink Eye (Conjunctivitis) Various bacteria and

viruses, allergies, chemical irritation

Bacterial - 24-72 hours

Viral – 1-12 days Allergies – variable

Bacterial and Viral: Infectious discharge.

Allergies and chemicals: not

contagious

Bacterial: as long as symptoms are present or until

24 hours after treatment Viral: as long as symptoms

are present

None

Yes – (bacterial or viral) until

approved for return by health care

provider or until 24 hours after

Ringworm (Tinea) Several fungi species

Unknown

Skin contact/direct

contact

As long as skin is affected

None

Yes – from end of school day until

after first treatment Must be covered

RSV Respiratory Syncytial Virus



3-8 days after symptom onset None

None

S6 – P6

DISEASE/AGENT

INCUBATION PERIOD

TRANSMISSION

CONTAGIOUS PERIOD

REPORT

EXCLUSION

Rubella (German Measles)

Rubella virus



7 days before rash onset to 7 days after

Yes (24 hours)

Yes – until 7 days after rash onset

Salmonellosis Salmonella bacteria

6-72 hours (usually 12-36 hours)


food/water, animals

While diarrhea is present; can spread for a variable period of time after symptoms are gone

Yes (7 days)


Scabies Sarcoptes scabei, a

mite

2-6 weeks if never infected, 1-4 days if

infected before

Skin contact/direct contact

Until the mites and eggs are destroyed

None

Yes – from end of school day until after first treatment

Shigellosis Shigella bacteria



food/water

While diarrhea is present; can spread for weeks after

symptoms are gone

Yes (7 days)

Yes – until diarrhea resolves (diapered children require 2

negative stool tests) Shingles (Herpes

Zoster) Varicella-zoster virus


Skin contact

Until all the blisters have crusted over

None

No – as long as the blisters are covered

Strep Throat Streptococcus

pyogenes bacteria

2-5 days


Until treated with antibiotics for 24 hours, or 10-21 days for

untreated cases

None

Yes – until 24 hours after treatment

Tetanus Clostridium tetani

bacteria

2 days-months (usually 8-14 days)

Through breaks in the skin

Not contagious

Yes (7 days)

None

Tuberculosis Mycobacterium tuberculosis

mycobacterium

2-12 weeks

Airborne

As long as symptoms are present or until on treatment

Yes (24 hours)

Yes – (active cases) until on treatment and cleared by a

health care provider

Viral Gastroenteritis Various viruses, such

as norovirus

10 hours-4 days (usually 1-2 days)


food/water

While diarrhea or vomiting is present; can spread for several days after symptoms are gone

Yes (7 days)

Yes – until diarrhea and/or vomiting resolves

Whooping Cough (Pertussis)

Bordetella pertussis bacteria



Until after the third week of coughing, or until after 5 days

of treatment

Yes (7 days)

Yes – until 5 days after treatment or until 3 weeks

after cough onset

S6 – P7

RASHES

A rash involves a change in the color and/or texture of skin, and can have many different causes. It can be a symptom of a contagious or non-contagious disease. Contact dermatitis (an inflammation of the skin caused by direct contact with an irritating substance) can occur following an exposure to dyes and chemicals found in clothing, chemicals found in elastic and rubber products, cosmetics, poison ivy, and poison oak. This type of rash usually occurs where the irritating agent touches the skin. Eczema (a chronic hypersensitivity reaction in the skin) can cause a scaly and itchy rash. Medications, foods, or insect bites that cause allergic reactions can also cause a rash. The table below outlines 12 different illnesses that can cause rashes.

ILLNESS APPEARANCE DISTRIBUTION ITCHING COMENTS/EXCLUSIONS

Chickenpox – viral (Varicella)

Blister-like rash that scabs over

More abundant on trunk than extremities

Yes Highly contagious – Immunization is available Exclude until blisters scab over

Duke’s Disease – viral (Entero, Echo, Coxsackieviruses, Fourth Disease)

Flat to bumpy red rash with areas of confluence. May look like hives, blisters or red spots under the skin

Usually generalized; occasionally palms and soles

Sometimes No exclusion necessary

Fifth Disease – viral (Erythema infectiosum, Human Parvovirus)

Red cheeks (slapped cheek) red lace-like rash, may fade & re- appear

Begins on cheeks, spreads to trunk and extremities

Slight, if any No exclusion necessary

Hand-Foot-Mouth – viral (Viral Exanthem)

Small blister-like sores

Hands, feet, mouth and occasionally buttocks

No No exclusion necessary

Impetigo – bacterial Small blisters that burst to reveal red skin

Usually the face, but can occur anywhere

Yes Exclude until 24 hours after appropriate treatment

Measles – viral (Rubeola, Hard Measles)

Bumpy, blotchy red to purplish rash. Rash turns white on pressure

Begins on face, spreads to trunk and extremities

Slight, if any Highly contagious - Immunization is available Exclude for 5 days after rash onset

Ringworm – fungal (Tinea)

Small red bump that spreads outward

A single area or skin

Yes Exclude from the end of day until after the first treatment

Roseola – viral (Exanthem subitum, Sixth Disease)

Small discrete pink spots. Almond shaped flat spots appear on trunk & neck

Begins on chest and abdomen, spreads to entire body

No Most common in children 6 to 24 months of age. No exclusion necessary in most cases

Rubella – viral (German Measles)

Small pink spots, may become confluent but remains pink

Begins on face, spreads to neck, trunk & extremities

No Immunization is available Exclude for 7 days after rash onset

Scarlet Fever – bacterial (Group A streptococci)

Small red bumps; rash turns white on pressure. Pigmented areas in skin creases

Begins on neck and groin, spreads to rest of body

No Strep throat symptoms are present. Exclude until 24 hours after appropriate treatment

Shingles – viral (Herpes Zoster)

Blister-like rash that scabs over, painful in affected area

A single area of skin

Sometimes Reactivation of the chickenpox virus. No exclusion necessary if blisters are covered

Smallpox – viral Deep-seated, hard, round, fluid-filled blisters

Entire body No High contagious - notify public health immediately.

S6 – P8

Florida Department of Health in Osceola County Epidemiology

Section 381.0031 (1,2), Florida Statutes, provides that “Any practitioner, licensed in Florida to practice medicine, osteopathic medicine, chiropractic, naturopathy, or veterinary medicine, who diagnoses or suspects the existence of a disease of public health significance shall immediately report the fact to the Department of Health.”

For all reportable disease, fax this form to: Florida Department of Health in Osceola County, Epidemiology

1875 Fortune Road Kissimmee, FL 34744

Phone: (407) 343-2155, Fax: (407) 343-2145, DO NOT EMAIL

Name of Disease*:

Onset of Symptoms: / /

Symptoms:

Treated by physician: Yes No Unknown If yes, physician name: _

Hospitalized: Yes No Unknown If yes, hospital name:

*If reporting chickenpox (Varicella), vaccine date(s): 1) / / 2) / / mm dd yy mm dd yy

Name of student:

_

Date of birth: / /

Sex: Male Female

Race: White Black American Indian/Alaskan Native Asian/Pacific Islander Other Unknown

Address: Street City State Zip

Home Phone:

Parent/guardian:

Parent/guardian:

Work phone:

Work phone:

Name of school: _

Address: Street City State Zip

Phone:

Reporter’s name:

School Information

Disease Information

Student Information

Form revised 03/29/2016

EPIDEMIOLOGY REPORT RASH ILLNESS

FLORIDA DEPARTMENT OF HEALTH IN OSCEOLA COUNTY EPIDEMIOLOGY PROGRAM 1875 FORTUNE ROAD, KISSIMMEE, FL 34744 Phone: 407-343-2155 Fax: 407-343-2069

FOR EPI USE ONLY

Merlin #

Not Reportable

Lname

FL Disease Code

Date Received: Report Taker’s Initials: Dx Status

Reporter's Name: Phone #:

DISEASE:

PATIENT SPECIFIC INFORMATION Investigator’s Initials:

Imported

Outbreak

NAME: SSN: Epi-Link

IF CHILD, PARENT'S OR GUARDIAN'S NAME:

ADDRESS:

CITY: ZIP: PHONE:

DOB: / / RACE: WHITE BLACK ASIAN AM. INDIAN UNK OTHER

ETHNIC: HISPANIC NON-HISPANIC SEX: MALE FEMALE Adult Occupation Employer Name / Address Phone Student/Child/Infant List DayCare / School / College Phone

PHYSICIAN: PHONE: FAX:

ADDRESS / CENTER: Date MD Visit / /

Hospitilization: Yes No Name: MRNO:

ER Only Admission / / Discharge / / Outcome (E.g., Survived, Died):

SYMPTOMS: Date of onset / /

Fever Onset / / Temp-Max Cough Onset / / Sore Throat Onset / / Runny Nose Onset / / Joint Pain Onset / / Conjunctivitis Onset / / Enlarged Lymph Nodes Yes No Koplik’s Spots Onset / / Other

RASH: Onset / / Where did it start? Generalized (at least Face & Trunk) Last Date Present / /

LABORATORY DATA DATE SPECIMEN ORGANISM

/ / IMMUNIZATION HISTORY: Type Date Administered / / Date / / MEDICATIONS: Medical Risk Factors: Yes No

Name: Merlin # RISK FACTORS SURVEY: Exposed to known rash illness in the 14 days prior to the rash? YES NO _

_

Travel History in the two weeks prior to the rash? _

Notes:

_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

Completed by: Date:

Rash Illness Form Revised 03/29/2016


Section 7

Medical Procedures


Revised July 2020


Medical Procedures

What are Medical Procedures .................................................................................... 1

School Personnel and School Nurse Responsibilities ................................................ 1

Parent//Guardian Responsibilities .............................................................................. 1

Staff Training for Medical Procedures ........................................................................ 2

Physician Orders ........................................................................................................ 2

Parent Consent .......................................................................................................... 2

Use of Automated External Defibrillator (AED) ....................................................... 2-3

Guidelines for Assisting with Medical Procedures in the School Setting The School District of Osceola County recognizes that under some circumstances, it is necessary for the physical health of the student that medical procedures be performed while the student is in school. These guidelines have been established in accordance to Florida Statute 1006.062 and Florida Administrative code64B9-14.001-14.003.

What are Medical Procedures Medical procedures include, but are not limited to the use of AED (Automated External Defibrillator), clean intermittent catheterizations, nebulizer treatments, diabetic monitoring, Epinephrine Auto Injector administration, Diastat, Vagus Nerve Stimulator, gastrostomy tube feeding and medications, tracheostomy care, oxygen administration, oral suctioning, and ostomy care.

A. School Personnel and School Nurse Responsibilities

• Develop a Student Specific Health Care Plan. • Provide a safe, private and accessible space for the procedure. • Provide a student specific trained competent staff person(s) to perform

procedure. • Notify appropriate personnel of a student’s health care needs. • Document procedure on appropriate form. • Notify parent/guardian as indicated. • Call for emergency help, as needed.

B. Parent/Guardian Responsibilities

• Provide physician’s orders for procedure. • Provide new orders from physician if changes in procedure

occur during school year. • Provide school with a signed and notarized Medical Procedure

Affidavit (FC-600-2072E/S). • Notify school of changes in medical management that may affect the

student during the school day. • Provide supplies and equipment (in good working order) necessary

to perform the procedure. • Participate in development of the student’s Health Care Plan. • Accept financial responsibility for EMS 911 call and transportation to

the hospital, if needed. • Meet with appropriate personnel to establish and maintain services. • Provide school with names and telephone numbers of people to

be notified in an emergency.

S7 – P1

Staff Training for Medical Procedures All designated school staff members must be trained annually by a Florida state licensed school nurse. Training must be completed for each individual student and documented on the Student Specific Medical Procedure Training Record (FC-600-2123) for each staff member delegated to perform the procedure.

Physician Orders All medical procedures to be performed in the school setting require a written order from a licensed physician (licensed by the State of Florida). Orders from physicians not licensed by the State of Florida will be accepted on a case-by- case basis. Orders from out of state physicians require a licensure number for verification and will be accepted for up to thirty (30) days with the understanding that obtaining a physician, licensed in the State of Florida, will be accomplished as soon as possible. Others will be accepted from Florida licensed Physician Assistants and/or Advanced Registered Nurse Practitioners when accompanied by the signature of the responsible physician licensed by the State of Florida. Orders will not be accepted from Physician’s Assistants. Orders will not be accepted from Advanced Registered Nurse Practitioners not licensed in the State of Florida.

Parent Consent No medical procedures will be performed on any student without the written consent of the parent/guardian. It is the parent/guardian’s responsibility to complete, sign and have notarized the Medical Procedure Affidavit (FC-600- 2072E/S).

USE OF AUTOMATED EXTERNAL DEFIBRILLATOR (AED)

Training 1. School personnel designed by the principal/designee will be trained in

CPR and the use of an AED. Training in CPR and the use of an AED is arranged by each facility.

2. Training in CPR and AED is done according to the requirements of a nationally recognized certifying agency.

3. A copy of this certification shall be kept on file in the health room or the school office. A list of persons currently certified to provide first aid and cardiopulmonary resuscitation is to be posted in the health room, school office, cafeteria, gymnasium, home economics (family and consumer science) classrooms, industrial arts classrooms, and other areas that pose an increased potential for injuries. (School Health Rules – 64F-6.004)

S7 – P2

Use of the AED 1. Determine unresponsiveness of victim and activate Emergency Response

Plan. • If a victim is unresponsive, call 911 and get AED. • Look for no breathing or only gasping. • Initiate CPR, if required, while the AED is brought to the

victim’s side. • The public address system will be used to activate responders

and indicate location of victim. • Designate an individual to wait at the facility entrance to direct

the EMS to victim’s location. 2. Upon arrival, place the AED near head of victim, close to AED operator. 3. Prepare to use the AED.

• Turn the power on. • Bare and prepare chest for AED use. • Attach the AED to the victim. • Stop CPR while the device analyzes the heart rhythm. • Follow the machine prompts for further action. If a shock

is indicated, be sure all rescuers are “clear” before shock is administered.

4. Upon arrival, EMS shall take charge of victim. • Provide victim information, name, age, known medical

problems, time of incident. • Provide information as to current condition and number of shocks

administered. After Use of AED

The AED will be removed from service until it is returned to a readiness state.

• Restock AED per AED inventory. • Clean AED if needed according to manufacturer recommendations. • Document readiness on AED Weekly Maintenance Checks

form (FC-600-2432).

S7 – P3


Section 8

Screenings


Revised July 2020


Screenings

Authorization .............................................................................................................. 1

Vision Screening ..................................................................................................... 1-2

Hearing Screening .................................................................................................. 2-3

Scoliosis Screening ................................................................................................. 3-5

Growth, Development, and Body Mass Index Screening ........................................ 5-6

Population Based School Health Screening Programs Authorization Florida Statue 381.0056 School Health Services Program and Florida Administrative Code 64F 6.003 defines screening as presumptive identification of unknown or unrecognized diseases or defects by the application of tests that can be given with ease and rapidity to apparently healthy persons.

Florida Administrative Code 64F 6.003 states:

1. Vision screenings shall be provided, at a minimum to students in grades kindergarten, one, three, and six and students entering a Florida school for the first time in grades kindergarten through five.

2. Hearing screenings shall be provided, at a minimum to students in grades kindergarten, one and six and students entering a Florida school for the first time in grades kindergarten through five and optionally to students in grade three.

3. Growth and development screenings including Body Mass Index (BMI) screenings shall be provided, at a minimum to students in grades one, three and six and optionally to students in grade 9.

4. Scoliosis screenings shall be provided, at a minimum to students in grade six.

Parents are informed of these screenings at the beginning of each year.

This type of screening is population-based and completed on all students designated to receive these screening services, except in the event of parental refusal. Individual screening requests by parents or teachers are handled on a one-on-one basis.

Vision Screening The purpose of vision screening program is to administer a standardized vision test to identify those students who may have a vision problem and refer those who fail the screening for a complete, professional eye examination.

Vision Screening Guidelines Using the Snellen Chart

Equipment • 10 or 20 Foot Snellen Symbol Chart • 10 or 20 Foot Snellen Letter Chart • Illuminated eye test cabinet

Setting Up Screening Area

• Place eye chart at eye level of average student to be screened and at recommended distance.

S8 – P1

Preparing the Student • Instruct the student to stand at the marked line facing the Snellen

chart. • Explain the screening materials to be used and the correct

method of responding. • Inquire if the student wears glasses or contacts. (If the student

does wear glasses or contacts but does not have them at school, reschedule the screening).

Screening Procedure

1. When screening grade level using the symbol chart, test both eyes first on a few symbols to be sure the student knows how to respond and to determine if the student can be screened.

2. Each eye should be tested separately, right eye first, then left eye. A standardized routine avoids confusion and facilitates recording.

3. Occlude the left eye with occluder provided. Remind the student to keep both eyes open during the screening.

4. To pass a line the student must be able to identify more than half of the symbols or letters.

5. If the first line is identified correctly, proceed to the next smaller line.

6. Continue the procedure until the acuity score has been determined. 7. Repeat the procedure for the left eye. 8. Record visual acuity (i.e. smallest) line read correctly in order given

(right eye, left eye) on screening form. 9. A failure occurs if the results are 20/50 or above if the student is 5

years of age or younger and 20/40 if the student is 6 years or older.

10. For vision failure a referral letter is sent to the student’s parent/guardian recommending follow-up.

11. Referrals to Florida’s Vision Quest requires a 2ndscreening. 12. All information concerning the referral, follow-up and outcome is

recorded in the student’s cumulative health record. Hearing Screening The purpose of the hearing screening program is to administer a standardized hearing test to identify those students who may have hearing impairments and refer those who fail the screening to appropriate resources for follow up care.

Equipment

Audiometer Tympanometer

Preparing the Student

• Explain how the audiometer will be used to screen hearing. • Let the student listen to the tones at a higher decibel than the

one used for screening.

S8–P2

• Explain how to put the headphones on reminding the student that the headphones will fit snugly.

• Instruct the student to raise either hand as soon as he/she hears the tone demonstrated earlier and to lower the hand as soon as he/she no longer hears the tone.

Screening Procedure

1. Set up equipment in a quiet area. 2. Place earphones according to directions (red on right ear, blue

on left ear). Be sure that earphones fit snugly and directly over the ears and that nothing interferes with placement, which would inhibit the passage of sound (i.e. earrings, barrettes, glasses).

3. Have student face away from the audiometer. 4. Set the hearing threshold level (HTL) at 20dB and the

frequency at 1000HZ. 5. Present the tone (1000HZ) for one or two seconds, right ear first.

The tone may be presented twice to make sure the student hears the tone and understands what is supposed to be heard.

6. Proceed to 2000HZ at 20dB, then to 4000HZ at 20dB. 7. Repeat the procedure in the left ear. 8. Vary the length of the tone and pauses to prevent

established rhythm. 9. Record the results on the student’s cumulative health record. 10. Re-screen in 10 to 14 days any student failing to respond to 20 dB

HL in either ear and record numerical results on Audiological Referral form (FC-400-0556).

11. Notify District Health Services for follow-up with Tympanometer, prior to referral to Audiologist.

12. Send audiological referral form FC-400-0556 with Tympanometer and numerical failing screening results to audiologist.

13. Audiologist will follow-up with further screening as deemed necessary.

14. Audiologist will contact parent for either audiological or medical follow-up with physician.

15. Audiologist and/or nurse will continue to contact parent until referral is complete.

16. All information concerning the referral, follow-up and outcome is recorded in the student’s cumulative health record.

Scoliosis Screening The purpose of spinal screening is to identify scoliosis, which initially is a symptom-free lateral curvature of the spine and tends to appear shortly before and during adolescence more commonly in girls than boys. Some cases (difficult to predict except when another family member has scoliosis) become progressively worse, especially in girls. In the early stages correction is usually possible without extensive and costly surgery. Early detection and adequate treatment can prevent severe deformity.

S8 - P3

Equipment • A chair positioned 5-8 feet from a horizontal tape marking where

the student is to stand.

Setting Up the Area • Setting an area with as much privacy as possible. • Explain how the procedure will be performed and the correct

method of responding.

Screening Procedure With lightweight clothing on, every child should be screened in each of the Following positions:

1. Back view: (The screener should be seated 5-8 feet from the tape mark on the floor). The student should stand erect with back to the screener, toes placed on the tape, feet together, knees straight and weight evenly distributed on both feet. Arms should be at the sides and relaxed. Students should be encouraged to avoid slouching or standing at “attention”.

Normal • Head centered over mid-buttocks • Shoulders level • Shoulder blades level with equal prominence • Hips level and symmetrical (equal distance between arms

and body). Possible Scoliosis

• Head alignment to one side of mid-buttocks and one shoulder higher.

• One hip more prominent than the other or waist crease deeper on one side than the other.

• Unequal distance between arms and body

2. Forward Bend Test: The student should stand facing away from the screener. The student should bend forward at the waist 90 degrees, feet inches apart, knees straight and toes even. Palms of the hands are held together or facing each other and arms hang down and are relaxed. The head is down.

Normal • Smooth symmetrical even arc of the back.

Possible Kyphosis (Round Back) • Lack of smooth arc with prominence of shoulders and

round back. • Accentuated prominence of the spine (angular kyphosis

of spine). • Grossly accentuated swayback (when in upright position).

S8 – P4

3. Frontal View: Have the student turn and face the screener and repeat the Forward Bend Test.

Normal • Even and symmetrical on both sides of the upper and lower

back. Possible Scoliosis

• Unequal symmetry of the upper back, lower back or both.

4. Left Lateral View: Have the student turn and stand with his/her left side toward the screener and repeat lateral view test.

Referral and Follow-up

1. A referral letter (Scoliosis School Screening Follow-up form FC-600- 0017B) is sent to the parents for signs indicating abnormal results recommending a professional evaluation by their health care provider.

2. All information concerning a referral, follow-up and outcome is recorded in the student’s cumulative health record.

Growth and Development and Body Mass Index Screening The purpose of accurate height and weight measurements is to provide insight into the student’s physical growth and development. If taken at regular intervals and recorded on charts or grids, this information will allow for comparison with past measurements and standards for age and weight for height. Comparison of these measurements to accepted norms is the baseline for nutritional assessment. Currently, growth and development screening is required for students in grades 1, 3, 6, and optionally 9.

In addition to measuring students’ height and weight, Body Mass Index (BMI) calculation is required. This calculation indicates if a child is in the normal range for height and weight, or is outside the norm and has increased potential to develop certain chronic diseases during childhood or adulthood. BMI is the recommended screening method for children and adolescents. It is based upon a child’s age and gender.

Screening Guidelines

BMI for age - cutoffs • >95th percentile Overweight • 85th to 95th percentile Risk of Overweight • <5th percentile Underweight

Equipment (one of the following)

• Standard scale • Standing height should be measured against a wall

mounted measuring tape/board or a rigid free standing device.

S8 – P5

Setting Up the Screening Area • Choose a location that has a flat, level and hard surface. • Assure privacy. Do not verbalize results near other students.

Preparing the Student • Explain the screening equipment. • Take all the measurements with the student in minimal indoor

school clothing. • Remove any objects that will interfere with measurements.

Screening Procedure

1. Instruct student to stand straight on scale with both feet together, arms down by their side and looking straight ahead.

2. Lower the measuring bar and record height. 3. If using wall marking of measuring tape method the student should

stand with back of both feet touching the wall. Mark and record height in chart.

4. Measure and record the weight. 5. Obtain the student’s date of birth from the health record, and calculate age

to the nearest month. 6. Plot the student’s height and weight on appropriate growth chart. 7. The following conditions warrant a referral by the school nurse for follow-

up care: • Weight for height or for age is more than 95thpercentile. • Weight for height, weight for age or height for age is less than the

5th percentile. • Student’s growth pattern changes dramatically, for example, a

student who has been consistently at the 50th percentile drops to the 10th percentile or rises to the 90thpercentile.

8. A referral letter is sent to the parent/guardian if any of the above conditions are noted during the screening recommending follow-up with a professional evaluation.

9. All information concerning screening results, referral, follow-up and outcome is recorded in the student’s cumulative health record.

BMI Calculation Procedure The formula to calculate BMI is (weight in pounds) / (height in inches squared) times 703. You may use the CDC Tables for calculating BMI ora WEB calculator. Select the proper growth chart based on the student’s gender. After recording the measurements, calculate the BMI and plot the results on the graph.

S8 – P6


Section 9

Delegation


Revised July 2020


Delegation

Purpose ..................................................................................................................... 1

Requirements ............................................................................................................ 1

Responsibility ............................................................................................................. 2

Guidelines for Delegation of Nursing Responsibilities in School Setting Purpose The purpose of these guidelines is to provide the School District of Osceola County Registered Nurses and Florida Department of Health in Osceola County School Health Nurses guidelines for delegation of nursing responsibilities in the school setting.

Requirements The School District Registered Nurse (RN) is responsible and accountable for the quality of nursing care provided to each student receiving care in school, and to his/her family, whether the nurses provide the care directly or through delegation.

Appropriate Delegations of Nursing Activities to an Unlicensed Assistive Personnel (UAP)

• Within the area of responsibility of delegating RN • Within the knowledge skills and abilities of delegating RN • Routine procedure, repetitive nature, not requiring

nursing judgment, • Task is reasonable and prudent • Consistent with health and safety of the student • Successful student specific training annually for each

delegated nursing activity. Reasons Not to Delegate to an UAP

• No qualified delegate available • You or delegatee are unfamiliar with the work environment • Confidentiality issues • Skill requires nursing knowledge and/or judgment • Lack of training or documented skills • Goals and outcomes are not identified • The student is newly diagnosed and the Individual Health Care

Plan (IHCP) has not been completed • Student is not medically stable

The School District RN is the only member of the education team who can legally delegate nursing activities to UAPs. The School District RN shall assure that the UAP can competently perform the task and is willing to assume the responsibility of performing the task.

Five Rights of Delegation

• Right task • Right circumstances • Right person • Right communication/direction • Right feedback/supervision

S9 – P1

Responsibility of the School District RN The decision to delegate shall be based on the District RN’s assessment of the following:

• Student’s nursing care needs including, but not limited to, complexity and frequency of the nursing care, stability of the student’s health concern and degree of immediate risk if task is not carried out.

• UAP’s observed knowledge, skills and abilities. • Nature of tasks being delegated including, but not limited to degree

of invasiveness, complexity, irreversibility, predictability of outcome and potential for harm given student-specific characteristics.

• Available and accessible resources such as appropriate equipment, adequate supplies and appropriate other healthcare related personnel (e.g. school psychologist, school social worker, school counselor, health education, EMS system) to meet the student’s/family’s nursing care needs.

• The availability for adequate supervision of the school UAP The District RN shall instruct the UAP in the delegated task and verify the UAP’s competence to perform the nursing task for an individual student. The UAP will be instructed on potential complications that might occur.

The District RN shall evaluate on an ongoing basis the following:

• The degree to which the nursing care needs of the student are being met.

• The performance by the UAP of the delegated task. • The UAP’s need for further general or student-specific instruction. • The need to withdraw the delegation.

Documentation Training records will be kept on file indicating the type of training received by the UAP. The original will be sent to the District RN and a copy will be kept in the school health room. Documentation of training by the District RN includes:

• Summary of training techniques employed (e.g. demonstration, lecture, written instructions).

• Dates of nurse’s evaluation of UAP’s training. • The nurse’s and UAP’s signatures to verify training.

S9 - P2


Section 10

Head Lice Guidelines


Revised July 2020


Head Lice Guidelines

Head Lice Screening .................................................................................................. 1

Classroom Management ............................................................................................ 1

Screening Practices ................................................................................................... 1

Head Lice Procedures ............................................................................................ 1-2

CDC Fact Sheet ...................................................................................................... 3-7

Head Lice Guidelines 1. Head Lice Screening

• Inspect any student’s hair that has observable signs and symptoms of head lice.

• If lice or viable nits are detected, notify parent/guardian. • Prior to the end of the day, inspect the hair of all siblings in

the school. • Consult with principal/designee to determine placement of

the student for the remainder of the school day. • The student may remain in school for the remainder of the

day. • Document findings on Health Room Report (FC-600-0998ERS). • Send Head Lice Treatment form (FC-600-2375 E/S) home with the

student. 2. Classroom Management

• Screen hair of all classmates, preferably at the end of the school day. If time does not permit, classroom should be screened by the end of the following day.

• Provide educational materials to the classroom for possible practices that promote the spread of lice and make recommendations to classroom teacher.

• Student belongings must be stored separately. 3. Screening Practices

• Gloves are not necessary to perform head lice screenings. • Screener may opt to use fingers, applicator stick, or student’s pencil

to separate hair. • If fingers are used, clean hands with hand sanitizer or soap and

water between each student’s head check. 4. Head Lice Procedures

• Health room staff trained to identify head lice and nits, will do ahead check and verify lice infestation.

• If lice or viable nits are found, health room staff will inform the parent/guardian of the infestation by the end of the day.

• Students who are infested with head lice or viable nits will not be allowed to attend school until all head lice and viable nits are removed. Viable nits are defined as those nits found less than one fourth (1/4) inch from the scalp on the hair shaft.

• Students will be allowed three (3) days excused absence for the treatment and removal of lice and viable nits.

S10 – P1

• Health room staff will give the parent/guardian the CDC fact sheet on treating head lice for the student, family and home.

• Parent/guardian will be instructed to remove all viable and as many other nits as possible before the student returns to school.

• To be re-admitted to school, the student must be checked by the health room staff and have no live lice or viable nits. A statement must be signed by the parent/guardian stating the appropriate treatment has been completed. If live lice or viable nits are found, the student will not be re-admitted and the entire process will be repeated.

• Once cleared to return to class, the student will be re-checked in eight (8) to ten (10) days for live lice or viable nits.

• If a student is sent home for lice treatment and has not returned to school after three days, the school staff will attempt to contact the parent/guardian and encourage prompt treatment and a quick return to school.

S10-P2


Section 11

Student Health Care Plan


Revised July 2020


Student Health Care Plan

Definition .................................................................................................................... 1

Beginning of the Current School Year ........................................................................ 1

Dissemination of Information...................................................................................... 1

Guidelines for Student Health Care Plans The purpose of this document is to provide the Osceola County school nurses with guidelines for completing and disseminating information for Student Health Care Plans on students with health conditions that could potentially impact the safety and/or educational progress of students in Osceola County, Florida schools.

Student Health Care Plan – A confidential medical record, prepared by a registered nurse, which is a written guideline for student care within the school setting. The Health Care Plan is to be attached to the student’s health information form.

Beginning of the Current School Year

1. Student Health Information forms (FC-600-1963E/S) will be sent home with each student for the parent/guardian to update or complete, listing any health conditions, medications, or activity limitations that may affect the student safety or school performance.

2. Student Health Information forms will be separated alphabetically in the Health Room.

3. The District RN will review the Student Health Information forms with health conditions and contact the parent/guardian, as needed, to obtain the necessary information to complete a Student Health Care Plan.

Dissemination of Information on Student Health Care Plans to School Staff All information on Student Health Care Plans is confidential and may only be disseminated on a need to know basis.

□ The RN completes the original Student Health Care Plan that

outlines the care provided and/or monitored by the school nurse relating to the student’s care in the school setting. A copy of the current Student Health Information sheet and the original Student Health Care plan is kept by the District RN.

□ A Student Health Alert will be completed that outlines any information necessary for the student’s safety and/or educational progress. The Student Health Alert will include an emergency plan (if needed), type of medications with possible side effects, and any other information that the District RN determines necessary for dissemination to school personnel.

□ A Student Health Alert will be provided to appropriate school district personnel on a need to know basis, such as; classroom teacher, bus driver, coach, etc., as determined appropriate by the District RN. A copy of each Student Health Alert will be kept in the clinic for review by the clinic personnel.

S11 – P1


Section 12

Approved School Health and District Forms


Revised July 2020


Approved School Health Forms

Scoliosis Referral…………………………………………..FC-600-0017ERS (Rev. 05/12/11) Parent/Guardian Field Trip Consent………………….....FC-600-0214ERS (Rev. 03/13/18) Vision Referral.................................................................FC-600-0266ERS (Rev.03/30/12) Student Accident / Incident Report ..........................................FC-600-0419 (Rev. 9/24/19) Health Room Report .......................................................FC-600-0998ERS (Rev. 04/06/20) Notification of Undiagnosed Rash ...................................FC-600-1311ERS (Rev. 03/30/12) Authorization to Administer Medication......................... FC-600-1769E/S (Rev. 04/06/20) Student Health Information............................................. FC-600-1963E/S (Rev. 02/03/20) Student Specific Physician’s Orders.................................... FC-600-2034 (Rev. 04/06/20) Medical Procedure Affidavit ............................................ FC-600-2072E/S (Rev. 03/30/12) Notice of Incomplete Immunization Record....................FC-600-2079ERS (Rev. 06/11/18) Medication Administration Training ..................................... FC-600-2121 (Rev. 06/11/18) Medication Disposal Log……………………………………..……FC-6002124 (Rev. 03/30/12) Student Specific Training ..................................................... FC-600-2123 (Rev. 06/05/18) Medication Administration Error............................................ FC-600-2125 (Rev. 05/07/18) Diabetes Medical Management Plan-Diabetes Only…..…..FC-600-2127(Rev.5/3/19) Health Care Plan Worksheet ................................................. FC-600-2233 (Rev. 03/25/04) Student Health Care Plan………………………………………….. FC-600-2247-1 (06/11/18) Blood Glucose Monitoring Log ............................................. FC-600-2249 (Rev. 07/14/10) Monthly Reporting Form ........................................................FC-600-2250 (Rev. 01/08/20) Head Injury Report – Student ......................................... FC-600-2253E/S (Rev. 03/30/12) Frequent Visits Notice ..................................................... FC-600-2254E/S (Rev. 03/30/12) Medication Sign-out Log for Field Trips................................ FC-600-2274 (Rev. 07/26/04) Physician’s Statement for a Possible Section 504 Plan………….…FC-600-2330 (07/19/06) EpiPen® Student Checklist .............................................. FC-600-2360E/S (Rev. 04/06/20) Blood Glucose Skills Checklist............................................... FC-600-2363 (Rev. 04/28/10) Annual Documentation of Medical Skills ............................... FC-600-2367 (Rev. 03/30/12) Physician’s Order for Diastat® ............................................... FC-600-2370 (Rev. 02/24/14) Seizure Monitoring Form........................................................ FC-600-2371 (Rev. 02/22/07) Head Lice Treatment ..................................................... ..FC-600-2375E/S (Rev. 06/22/16) Medication Refrigerator Temperature Log..................................... FC-600-2378 (03/30/12) Student Medication Transfer Log................................................... FC-600-2410 (09/22/08) Medication Cabinet Key Log ......................................................... FC-600-2411 (03/30/12)

AED Weekly Maintenance Checks .........................................................FC-600-2432 (04/06/20) Physician’s Order for Vagus Nerve Stimulation……………….………….FC-600-2473 (05/12/11) Physcian’s Order for G-Tube/J-Tube………………………….…………..FC-600-2474 (03/30/12) Staff Acknowledgement of Training for the Administration of Diastat® FC-600-2524 (12/10/13) Student Specific Checklist for Administration of Diastat®….…………..FC-600-2525 (07/14/14) District RN Monthly Reporting Form………………………….…………..FC-600-2532 (02/13/14) Audiological Referral..........................................................................FC-400-0556 (Rev. 04/02) Progress Report........................................................................... FC-400-0558E/S (Rev. 04/02) Medication Log.................................................................................. FC-400-2069 (Rev. 02/03) LPN Documentation of Health Services ............................................. FC-400-2108 (Rev. 11/04) Special Dietary Request Form ...............................................................FC-230-2390 (03/17/08) Out-of-State or Overnight Field Trip Checklist………………….……FC-700-1780 (Rev. 03/14/19) Field Trip Request - Other Transportation .................................... FC-700-1908 (Rev. 03/14/19) In-State Day Field Trip Checklist………………………….….…..…………FC-700-2567 (03/26/19) Field Trip Educational Purpose…………………………….………………..FC-700-2568 (03/26/19) Field Trip Roster………….….………………….………………… ….FC-850-1455(Rev.03/26/19) Chaperone List for Field Trip………………….…………………..…FC-850-2531 (Rev. 03/26/19)

THE SCHOOL DISTRICT OF OSCEOLA COUNTY, FLORIDA SCOLIOSIS REFERRAL

Student Name DOB ID#

Date School School Year

Dear Parent(s),

Through the joint efforts of the Osceola County Health Department and The School District of Osceola County, a Scoliosis Screening Program for the grade has been completed.

It is recommended that you have your child checked by your family doctor or pediatrician, and he/she may refer you to an orthopedic physician for evaluation and treatment.

SCOLIOSIS, WHAT'S THAT? WHAT IS SCOLIOSIS? The dictionary tells us it is a lateral curvature of the back.

WHAT ELSE? Well, it's not supposed to be there. Normally, the backbone, the spine, curves in and out. In Scoliosis, the spine also bends from side to side.

IS SCOLIOSIS A DISEASE? Not in the sense you may be thinking. You don't catch it, and it doesn't develop as a result of anything you or your parents did or failed to do. It is a disorder usually found during the beginning of your teens.

HOW IS IT NOTICED? One common sign of Scoliosis is a high shoulder or a high hip. The upper back may be more prominent on one side. These signs are not always pronounced and may be easily camouflaged by the bad posture habits common to teenagers. Often, the first indication that something is wrong is an awareness that clothing doesn't fit properly.

IS SCOLIOSIS VERY COMMON? We do not have accurate statistics, but we can estimate that in the United States some 10,000 growing children are currently under treatment for Scoliosis. However, the condition is often so mild that treatment will never be needed.

ARE THERE DIFFERENT TYPES OF SCOLIOSIS? Eighty-five percent (85%) of the time, the condition falls in the category known as Idiopathic Scoliosis. This simply means a curvature of the spine which is not due to another disease. Fifteen percent (15%) of the Scoliosis is caused by something else. Polio, for instance, used to be a fairly common cause of Scoliosis. Since there are different types and different causes, it is important that the reason for Scoliosis be diagnosed by a doctor. The doctor will want to be certain that it is not a symptom of something more serious.

CAN SCOLIOSIS HAPPEN TO ANYBODY? For some reason nobody understands, Scoliosis is about eight times more common in girls than it is inboys.

CAN SCOLIOSIS BE CURED? Well, there aren't any magic medicines around for treating Scoliosis. Scoliosis is a condition that calls for correction. Correction means doing one's best to straighten out the bend that shouldn't be there.

RESEARCH IN SCOLIOSIS? At the present time, doctors the world over are involved with the problems of Scoliosis. Some are looking for clues to its cause, others are working on methods to improve treatment. Scoliosis is a complex problem and there is a great deal of work to be done.

Health Care Assistant/Nurse’s Signature/Title Date

An Equal Opportunity Agency FC-600-0017ERS (Rev. 05/12/11)

THE SCHOOL DISTRICT OF OSCEOLA COUNTY, FLORIDA REFERIDO POR ESCOLIOSIS

Nombre del Fecha de Estudiante Nacimiento #ID

Fecha Escuela Año Escolar

Estimado(s) Padre(s),

Por medio de los esfuerzos del Departamento de Salud del Condado Osceola y el Distrito Escolar del Condado Osceola, se ha completado un Programa de Exámenes para Detectar la Escoliosis para el grado.

Recomendamos que su hijo(a) sea examinado(a) por el médico o pediatra de la familia y que él/ella pueda referirlo a un médico ortopeda para evaluación y tratamiento.

ESCOLIOSIS, ¿QUÉ ES ESO? ¿QUÉ ES LA ESCOLIOSIS? El diccionario nos dice que es una curvatura lateral en la espalda.

¿QUÉ MÁS? Bueno, no se supone que se encuentre ahí. Normalmente, la columna vertebral, la espina, está encorvada hacia dentro y hacia afuera. En la Escoliosis la espina también se curva de lado a lado.

¿ES LA ESCOLIOSIS UNA ENFERMEDAD? No en el sentido en el que pueda estar pensando. Usted no la contrae y no se desarrolla como resultado de algo que ustedes o sus padres hicieron o dejaron de hacer. Es un trastorno que por lo general se detecta al comienzo de su adolescencia.

¿CÓMO SE MANIFIESTA? Una señal común de la Escoliosis es un hombro alto o una cadera alta. La espalda superior puede ser más prominente en un lado. Estas señales no son siempre pronunciadas y pueden ser fácilmente encubiertas por los hábitos de mala postura comunes en los adolescentes.

¿ES MUY COMÚN LA ESCOLIOSIS? No tenemos estadísticas exactas, pero calculamos que en los Estados Unidos unos 10,000 niños en desarrollo están actualmente bajo tratamiento por la Escoliosis. Sin embargo, la condición es a veces tan leve que nunca se necesitará un tratamiento.

¿HAY DIFERENTES TIPOS DE ESCOLIOSIS? El ochenta y cinco (85%) por ciento de las veces, la condición seclasifica bajo la categoría conocida como Escoliosis Idiopática. Esto significa simplemente una curvatura de la espina que no se debe a otra enfermedad. El quince por ciento (15%) de la Escoliosis es ocasionado por algo más. Por ejemplo, el polio solía ser una causa bastante común de Escoliosis. Ya que hay diferentes tipos de causas, es importante que el motivo de la Escoliosis sea diagnosticado por un médico. El médico deseará estar seguro de que no es un síntoma de algo más serio.

¿LE PUEDE DAR ESCOLIOSIS A CUALQUIER PERSONA? Por algún motivo que nadie entiende, la Escoliosis es ocho veces más común en las niñas que en los niños.

¿PUEDE SER CURADA LA ESCOLIOSIS? Bueno, no existe ningún medicamento mágico para tratar la Escoliosis. La Escoliosis es una enfermedad que requiere de una corrección. La corrección significa hacer lo posible por enderezar la curva que no debería estar allí.

¿QUÉ INVESTIGACIONES HAY SOBRE LA ESCOLIOSIS? Actualmente, los médicos en todo el mundo están involucrados en los problemas de la Escoliosis. Algunos están buscando los indicios de su causa, otros están trabajando en los métodos para mejorar el tratamiento. La Escoliosis es un problema complejo y hay una gran cantidad de trabajo por hacer.

Firma/Título del Asistente del Cuidado de la Salud/Enfermera(o) Fecha

Una Agencia con Igualdad deOportunidades

FC-600-0017S MED (05/23/11) (Rev. 05/12/11)

THE SCHOOL DISTRICT OF OSCEOLA COUNTY, FLORIDA PARENT/GUARDIAN FIELD TRIP CONSENT

_SCHOOL

I, the parent/guardian of grade _hereby give my consent for

my child to participate in a field tripto:

Trip date(s) Time of departure Time of return_

Teacher in charge Cost

Mode of transportation: Check one: School Bus Common Carrier Private Vehicle Walking

NOTICE OF HAZARDOUS ACTIVITY. THIS FIELD TRIP WILL INCLUDE THE ACTIVITY OF RIDING ON AN AIRBOAT. WHILE THIS ACTIVITY IS THRILLING, IT IS INHERENTLY DANGEROUS. PARENT/GUARDIAN WANTS THE STUDENT TO EXPERIENCE AIR BOATING ON THIS FIELD TRIP, AND BY SIGNING BELOW THE PARENT/GUARDIAN ACKNOWLEDGES THAT THIS POTENTIALLY DANGEROUS ACTIVITY CARRIES A RISK OF INJURY OR DEATH, AND RELEASES THE SCHOOL BOARD AND ALL AGENTS AND EMPLOYEES OF THE SCHOOL DISTRICT FROM ALL CLAIMS, LAWSUITS AND ACTIONS FOR DAMAGES OR OTHER RELIEF ARISING OUT OF PARTICIPATION IN OR DURING OR AS A RESULT OF RIDING ON AN AIR BOAT, INCLUDING THE DECISION TO INCLUDE THIS ACTIVITY ON THIS OUTING AND ANY OTHER MATTER RELATING TO AIR BOATING.

□ Please be aware that while travel insurance is an option, if you choose not to purchase the additional coverage, the school and

the district are not liable for any lost funds.

By this consent, I hereby release and discharge the School District of Osceola County, Florida, from all liabilities, claims, and demands of whatever kind or nature that may arise or be connected with the child's participation in, traveling to or returning from such activity, that is caused by the act or omission of persons other than agents or employees of the School District. This consent does not release the School District from any liabilities, duties or responsibilities for the acts or omissions of its own agents or employees imposed by any laws, regulations or policies.

I also understand that if my child becomes a discipline problem while on any trip, he/she will be sent home by the quickest means and at my expense.

I authorize a representative of the school named above to see that my child receives any emergency medical treatment that may become reasonably necessary, while child is on said field trip in/out of Osceola County. Payment of all charges incurred for medical treatment is guaranteed by me or the insurance company providing coverage for my child.

My child has the following medical conditions. If none, state “None"

Treatment for above

My child is has the following allergies. If none, state "None"

Date of child's last Tetanus booster.

Check one: I do not have medical insurance to cover treatment

I have medical insurance with company/provider name

Policy/Group number

Parent/guardian home phone # work phone #

Emergency contact if parent/guardian cannot be reached:

Name Relationship

Home phone # work phone_

Parent/guardian signature Date


THE SCHOOL DISTRI CT OF OSCEOLA COUNTY, FLORIDA PERMISO DEL PADRE/TUTOR PARA EXCURSIONES ESCOLARES

ESCUELA

Yo, padre/tutor de _, grado _consiento que mi hijo/a participe en la

excursión escolar a: _

Fecha(s) de la excursión Hora de Salida Hora de Regreso _

Maestro(a) Encargado(a) Precio _

Modo de Transporte: Marque uno: Autobús Escolar Transporte Alquilado Vehículo Privado Caminando

AVISO DE ACTIVIDAD PELIGROSA. UNA DE LAS ACTIVIDADES INCLUIDAS EN ESTA EXCURSIÓN ES NAVEGAR EN UN DESLIZADOR. ESTA ACTIVIDAD ES MUY EMOCIONANTE, PERO A SU VEZ, MUY PELIGROSA. EL PADRE/TUTOR DESEA QUE SU HIJO(A) PARTICIPE DE LA ACTIVIDAD DE NAVEGAR EN UN DESLIZADOR DURANTE ESTA EXCURSIÓN Y AL FIRMAR ABAJO EL PADRE/TUTOR RECONOCE QUE ESTA ES UNA ACTIVIDAD POTENCIALMENTE PELIGROSA CON RIESGO DE LESIÓN O MUERTE. EL PADRE/TUTOR EXIME A LA JUNTA ESCOLAR, TODOS LOS AGENTES Y EMPLEADOS DEL DISTRITO ESCOLAR DE TODAS LAS RECLAMACIONES, DEMANDAS Y ACCIONES POR DAÑOS U OTRA COMPENSACIÓN QUE PUEDAN SURGIR EN O DURANTE O COMO RESULTADO DE NAVEGAR EN EL DESLIZADOR, INCLUYENDO LA DECISIÓN DE TENER ESTA ACTIVIDAD EN LA EXCURSIÓN O CUALQUIER OTRO ASUNTO RELACIONADO CON LA ACTIVIDAD DE NAVEGAR EN UN DESLIZADOR.

□ Por favor tenga en cuenta que, aunque el seguro de viaje es opcional, si usted escoge no comprar la cobertura adicional, la escuela y el distrito no son responsables por ninguna pérdida de fondos.

A través de este consentimiento, yo eximo y libero al Distrito Escolar del Condado de Osceola de todas las obligaciones, exigencias y demandas de cualquier tipo o clase que puedan ocurrir o se relacionen con la participación del niño(a) en, viajando a, o volviendo de dicha actividad, que sea causada por la acción o el descuido de personas que no sean agentes o empleados del Distrito Escolar. Este consentimiento no exime al Distrito Escolar de ningunas exigencias, obligaciones o responsabilidades por las acciones o los descuidos de sus propios agentes o empleados impuestos por leyes, reglas opolíticas.

También entiendo que si mi hijo(a) fuera un problema de disciplina estando en la excursión, el/ella será enviado(a) a la casa de la manera más rápida y a expensas mías.

Yo autorizo a un representante de la escuela antes mencionada para asegurar que mi hijo(a) reciba cualquier tratamiento médico de emergencia que sea razonablemente necesario, mientras dicho (a) niño(a) esté en una excursión escolar dentro/fuera del Condado de Osceola. El pago de todos los cargos por el tratamiento médico está garantizado por mí o por la casa aseguradora que provee el seguro al estudiante antes mencionado.

Mi hijo(a) tiene los siguientes problemas de salud. Si ninguno, escriba “Ninguno”

Tratamiento para dichoproblema

Mi hijo(a) tiene las siguientes alergias. Si ninguna, escriba “Ninguna”

Fecha del último refuerzo de la vacuna de tétano del niño(a).

Marque uno: No tengo seguro médico que cubra el costo del tratamiento.

Tengo seguro médico con casa aseguradora/ nombre del suministrador _

Número de la Póliza/Número de Grupo _

#de tel. de la casa del Padre/Tutor #de tel. del trabajo_

Otra persona a notificar en caso de emergencia:

Nombre Relación _

#de tel. de la casa #de tel. del trabajo_ _

Firma del Padre/ Tutor _Fecha

Una Agencia de Igualdad de Oportunidades MED (05/18/10) FC-600-0214S (Rev.03/13/18)

THE SCHOOL DISTRICT OF OSCEOLA COUNTY, FLORIDA

VISION REFERRAL

Date School

Student Name Grade (Last) (First) (M.)

According to the Vision Screening Test taken in school, the vision of the student above appears to be deficient. It is recommended that you arrange for a more complete examination as soon as possible. If you have any questions, please call the nurse at .

Signature, Health Care Assistant/Nurse

THE SECTION BELOW MUST BE COMPLETED BYDOCTOR Please return completed form to:

The above named student has been examined by me and REQUIRES glasses or treatment.

DOES NOT REQUIRE further vision testing at this time. RETESTING RECOMMENDED on

Doctor Signature Date

An Equal Opportunity Agency FC-600-0266ERS (Rev.03/30/12)


VISION REFERRAL

Date School

Student Name Grade (Last) (First) (M.)

According to the Vision Screening Test taken in school, the vision of the student above appears to be deficient. It is recommended that you arrange for a more complete examination as soon as possible. If you have any questions, please call the nurse at .

Signature, Health Care Assistant/Nurse

THE SECTION BELOW MUST BE COMPLETED BYDOCTOR Please return completed form to:

The above named student has been examined by me and REQUIRES glasses or treatment.

DOES NOT REQUIRE further vision testing at this time.

RETESTING RECOMMENDED on

Doctor Signature Date

An Equal Opportunity Agency FC-600-0266ERS (Rev.03/30/12)

THE SCHOOL DISTRICT OF OSCEOLA COUNTY, FLORIDA REFERIDO PARA EVALUACIÓN DE LA VISIÓN

Fecha Escuela

Nombre del Estudiante Grado (Apellido) (Nombre) (Inicial)

De acuerdo a la evaluación hecha en la escuela, la visión del estudiante arriba mencionado parece estar deficiente. Se recomienda que usted haga lo necesario para hacerle una evaluación más completa lo más pronto posible. Si tiene alguna pregunta, favor de llamar al enfermero al .

Firma del asistente médico / enfermero

ESTA SECCIÓN DEBE SER COMPLETADA POR EL MÉDICO Favor de devolver el formulario completado a:

El estudiante arriba mencionado ha sido evaluado por mí y REQUIERE espejuelos o tratamiento. NO REQUIERE evaluación posterior en este momento. RECOMIENDO QUE SEA REEVALUADO en

Firma del médico Firma

MED Una Agencia con Igualdad de Oportunidades FC-600-0266S (Rev. 05/15/12) (Rev. 03/30/12)

THE SCHOOL DISTRICT OF OSCEOLA COUNTY, FLORIDA REFERIDO PARA EVALUACIÓN DE LA VISIÓN

Fecha Nombre del Estudiante

Escuela

Grado (Apellido) (Nombre) (Inicial)

De acuerdo a la evaluación hecha en la escuela, la visión del estudiante arriba mencionado parece estar deficiente. Se recomienda que usted haga lo necesario para hacerle una evaluación más completa lo más pronto posible. Si tiene alguna pregunta, favor de llamar al enfermero al .

Firma del asistente médico / enfermero

ESTA SECCIÓN DEBE SER COMPLETADA POR EL MÉDICO Favor de devolver el formulario completado a:

El estudiante arriba mencionado ha sido evaluado por mí y REQUIERE espejuelos o tratamiento. NO REQUIERE evaluación posterior en este momento. RECOMIENDO QUE SEA REEVALUADO en

Firma del médico Firma

MED Una Agencia con Igualdad de Oportunidades FC-600-0266S (Rev. 05/15/12) (Rev. 03/30/12)

Email to Risk Management -([email protected]) Email to School Athletic Director Electronic form completed by Athletic Trainer Coach

THE SCHOOL DISTRICT OF OSCEOLA COUNTY, FLORIDA STUDENT ACCIDENT / INCIDENT REPORT

PLEASE USE BLACK INK AND PRINT ALL INFORMATION. ALL INFORMATION MUST BE LEGIBLE. This form is to be initiated by the first staff member that witnessed or is notified of an accident/incident. This includes any accident/incident occurring during school, or during participation in a before or after school activity, such as an athletic program, extended day, etc.

SECTION 1

Date of accident/incident

Time occurred AM PM

Date staff notified of accident/incident

Time staff notified AM PM

Student Name_ _ Address City Zip _

School _ Sex M F Age _ I.D.# Grade_ _

Place of To/From School accident/ School building/grounds as indicated below: incident: Athletic Field

Auditorium

Bathroom Cafeteria

Classroom # Hall #

Gymnasium Home Ec.

Laboratory Locker Rm.

Pool Shop

Showers Other:

Elsewhere:

Name of staff in charge when accident/incident occurred: Present at scene of accident/incident? Yes No DESCRIPTION OF ACCIDENT/INCIDENT What type of injury/illness occurred:

Part of body affected (if applicable, indicate right or left hand, foot,etc.):

How did the accident/incident happen? What was the student doing? List specifically unsafe acts and unsafe conditions existing. Specify any tool, machinery, or equipment involved.

SECTION 1 completed by Staff (print name) Signature

SECTION 2 First aid treatment given

by (name)

Sent to first aid room by (name) 911 called by (name) Was parent/guardian notified of accident/incident?

Yes - on Date Time AM PM at phone # by staff name

No - reason:

Name of parent/guardian notified Relationship to student

Student released to at AM PM Print Name Time

SECTION 2 completed by Staff (print name) Signature

Principal or Designee Signature: Date: SECTION 3 – ATHLETIC INJURY ONLY

(2014-15 School Year -- www.schoolinsuranceofflorida.com)

White: Safety, Security and Emergency Management Yellow: School An Equal Opportunity Agency FC-600-0419 (Rev. 06/11/18)

Athletic Injury - Fax to 407-798-0296 Email to Insurance Co, [email protected] Email Principal

mailto:[email protected]

THE SCHOOL DISTRICT OF OSCEOLA COUNTY, FLORIDA HEALTH ROOM REPORT

Complete form and send to Health Room. Student will return yellow copy to teacher upon dismissal from Health Room. Teacher, please send pink copy home to parent/guardian.

Date Time am / pm Teacher Teacher Initials

Student Name Grade ID# School Last First M.

Student sent to the Health Room for the following reason(s) checked (√) below: Medication Upset stomach/Vomiting Insect Bite Earache Head Injury Bathroom Accident Headache Abrasion/Scratch Head Lice Nose Bleed Sore Throat Breathing Problems Cough Cold Symptoms Rash Pain/Injury Other:

Care provided for above: Took medication Vaseline/Lips Sting relief Rash form sent home Temperature Applied ice Bathroom Head Injury form sent home Washed injury Rested on cot Gargle/salt Head Lice treatment information sent home

Band aid/Bandage Anti-itch lotion Eye wash Other:

Student sent back to class: Time: am / pm

Excuse from PE today only

Student should return to Health Room if problem persists or worsens

Parent/Guardian contact Name Phone #

Student to be sent home # #

SCHOOL DISTRICT STAFF SIGNATURE: White: Health Room Yellow: Teacher Pink: Send home to Parent/Guardian An Equal Opportunity Agency FC-600-0998ERS (Rev. 04/06/20)

THE SCHOOL DISTRICT OF OSCEOLA COUNTY, FLORIDA HEALTH ROOM REPORT

Complete form and send to Health Room. Student will return yellow copy to teacher upon dismissal from Health Room. Teacher, please send pink copy home to parent/guardian.

Date Time am / pm Teacher Teacher Initials

Student Name Grade ID# School Last First M.

Student sent to the Health Room for the following reason(s) checked (√) below: Medication Upset stomach/Vomiting Insect Bite Earache Head Injury Bathroom Accident Headache Abrasion/Scratch Head Lice Nose Bleed Sore Throat Breathing Problems Cough Cold Symptoms Rash Pain/Injury Other:

Care provided for above: Took medication Vaseline/Lips Sting relief Rash form sent home Temperature Applied ice Bathroom Head Injury form sent home Washed injury Rested on cot Gargle/salt Head Lice treatment information sent home

Band aid/Bandage Anti-itch lotion Eye wash Other:

Student sent back to class: Time: am / pm

Excuse from PE today only

Student should return to Health Room if problem persists or worsens

Parent/Guardian contact Name Phone #

Student to be sent home # #

SCHOOL DISTRICT STAFF SIGNATURE: White: Health Room Yellow: Teacher Pink: Send home to Parent/Guardian An Equal Opportunity Agency FC-600-0998ERS (Rev. 04/06/20)

THE SCHOOL DISTRICT OF OSCEOLA COUNTY, FLORIDA INFORME DE LA CLÍNICA DE LA ESCUELA

Llene el formulario y envíe a la clínica. El estudiante devolverá la copia amarilla al maestro tan pronto sea despachado de la clínica. Maestro: favor de enviar la copia rosa al padre/tutor.

Fecha Hora am/pm Maestro Iniciales del Maestro

Nombre del Estudiante Grado ID# Escuela Apellido Nombre Inicial

El estudiante ha sido enviado a la clínica por el/los motivo(s) marcado(s) a continuación (√) : Medicamento Malestar estomacal/vómito Picada de insecto Dolor de oídos Lesión en la

cabeza Episodio de incontinencia

Dolor de cabeza Abrasión/ rasguño Piojos en la cabeza Sangrado nasal Dolor de garganta

Problemas respiratorios

Tos Síntomas de resfriado Sarpullido Dolor/lesión Otro:

Cuidados proporcionados por las condiciones antes mencionadas: Se administró medicina Vaselina/labios Alivio para picaduras Formulario enviado al hogar para notificar sarpullido Se tomó la temperatura Se aplicó hielo Baño Formulario enviado al hogar para notificar lesión en la cabeza

Lavado de la lesión Descansó en la camilla Gárgara/sal Formulario enviado al hogar para notificar piojos

Tirita adhesiva/vendaje Loción contra picazón Lavado de ojo Otro:

El estudiante fue enviado de regreso a clases: Hora: am / pm

Excusado de Educación Física solo por hoy

El estudiante debe regresar a la clínica si el problema persiste o se empeora

Información de Contacto del Padre/Tutor Nombre No. teléfono

El estudiante debe ser enviado a casa. # #

FIRMA DEL PERSONAL DEL DISTRITO ESCOLAR: Blanco: clínica Amarillo: Maestro/a Rosa: Enviar al Padre/Tutor Una Agencia con Igualdad de Oportunidad FC-600-0998ERS (Rev. 04/06/20)

THE SCHOOL DISTRICT OF OSCEOLA COUNTY, FLORIDA INFORME DE LA CLÍNICA DE LA ESCUELA

Llene el formulario y envíe a la clínica. El estudiante devolverá la copia amarilla al maestro tan pronto sea despachado de la clínica. Maestro: favor de enviar la copia rosa al padre/tutor.

Fecha Hora am/pm Maestro Iniciales del Maestro

Nombre del Estudiante Grado ID# Escuela Apellido Nombre Inicial

El estudiante ha sido enviado a la clínica por el/los motivo(s) marcado(s) a continuación (√) : Medicamento Malestar estomacal/vómito Picada de insecto Dolor de oídos Lesión en la

cabeza Episodio de incontinencia

Dolor de cabeza Abrasión/ rasguño Piojos en la cabeza Sangrado nasal Dolor de garganta

Problemas respiratorios

Tos Síntomas de resfriado Sarpullido Dolor/lesión Otro:

Cuidados proporcionados por las condiciones antes mencionadas: Se administró medicina Vaselina/labios Alivio para picaduras Formulario enviado al hogar para notificar sarpullido Se tomó la temperatura Se aplicó hielo Baño Formulario enviado al hogar para notificar lesión en la cabeza

Lavado de la lesión Descansó en la camilla Gárgara/sal Formulario enviado al hogar para notificar piojos

Tirita adhesiva/vendaje Loción contra picazón Lavado de ojo Otro:

El estudiante fue enviado de regreso a clases: Hora: am / pm

Excusado de Educación Física solo por hoy

El estudiante debe regresar a la clínica si el problema persiste o se empeora

Información de Contacto del Padre/Tutor Nombre No. teléfono

El estudiante debe ser enviado a casa. # #

FIRMA DEL PERSONAL DEL DISTRITO ESCOLAR: Blanco: clínica Amarillo: Maestro/a Rosa: Enviar al Padre/Tutor Una Agencia con Igualdad de Oportunidad FC-600-0998ERS (Rev. 04/06/20)

THE SCHOOL DISTRICT OF OSCEOLA COUNTY, FLORIDA NOTIFICATION OF UNDIAGNOSED RASH AND/OR POSSIBLE CONTAGIOUS CONDITION OF STUDENT

PARENT/GUARDIAN NOTIFICATION

Student Name Date

ID # Grade School

An undiagnosed rash and/or the possible contagious condition (example: pink eye, ringworm, etc.) of

your student has warranted this notification and the dismissal of your student from school.

Location of possible contagious condition

Your student is required to remain out of school until the rash and/or the possible contagious

condition disappears. -OR- A physician has determined the condition to be non-infectious or non-

contagious.

Name of School Personnel Signature

School Phone #


PHYSICIAN EXAMINATION ANDRESPONSE

I have examined on

and find him/her:

free from an infectious and/or contagious condition. He/she may return to school.

not free from an infectious and/or contagious condition at this time. He/she may not return to school

until date_ _ .

Physician Name

Physician Signature

Office Address Telephone

THE SCHOOL DISTRICT OF OSCEOLA COUNTY, FLORIDA NOTIFICACIÓN DE UNA ERUPCIÓN NO DIAGNOSTICADA Y/O

POSIBLE CONDICIÓN CONTAGIOSA DEL ESTUDIANTE

NOTIFICACIÓN A LOS PADRES /TUTORES:

Nombre Del Estudiante Fecha

# De Id. Grado Escuela

La razón de esta notificación y de despachar a su hijo de la escuela, es debido a una erupción no

diagnosticada y/o una posible condición contagiosa (ejemplo: conjuntivitis, tiña, etc.)

Lugar de la posible condición contagiosa

Es requisito que su hijo esté fuera de la escuela hasta que la erupción y/o la posible condición contagiosa

desaparezca. -O- Que un médico haya determinado que la condición no sea infecciosa o contagiosa.

Nombre Del Representante de la Escuela Firma

Teléfono de la Escuela

Una Agencia con Igualdad de Oportunidades FC-600-1311S (Rev. 03/30/12)

RESULTADO DEL EXAMENMÉDICO

He examinado a el

y encuentro que:

no tiene infección y/o condición contagiosa. Él / ella puede regresar a la escuela.

en este momento tiene infección y/o condición contagiosa. Él / ella no puede regresar a la escuela

hasta: .

Nombre del médico

Firma del médico

Dirección de la oficina Teléfono

THE SCHOOL DISTRICT OF OSCEOLA COUNTY, FLORIDA AUTHORIZATION FOR SCHOOL PERSONNEL TO ADMINISTER MEDICATION

AUTORIZACIÓN AL PERSONAL DE LA ESCUELA PARA ADMINISTRAR MEDICAMENTOS Amount of medication received by school log, Medication administered to student log

Cantidad de medicamentos recibida en el registro de la escuela, Registro de medicamento administrado al estudiante

Student Name___________________________________________ DOB__________ ID#_____________ School________ Grade________ Nombre del estudiante Fecha de Nacimiento N° de Identificación Escuela Grado

School District personnel will not administer medication unless authorization is complete. All medication (prescription and over-the-counter) must be hand-delivered by a responsible adult to the school. Prescription and over the counter medication must be received in its original container. Students may not bring medication to school and notes from home regarding medication administration will not be accepted. (El personal del Distrito Escolar no administrará medicamentos a menos que la autorización esté completada. Todo medicamento (con receta o sin receta) deberá ser entregado a mano en la escuela por un adulto responsable. El medicamento con receta o sin receta debe ser recibido en su envase original. Los estudiantes no pueden traer medicamentos a la escuela y las notas escritas traídas del hogar referente a la administración de medicamentos no serán aceptadas).

I, __________________________________________________, am the parent/guardian of the student named above and I authorize the school principal or principal’s designee, to administer the medication described below to my child. I understand that school personnel will not be held responsible for possible side effects from the administration of the medication and school personnel may contact the physician if there are concerns about the medication.

Yo, ______________________________________________________________, soy el padre/tutor del estudiante arriba mencionado y autorizo al director de la escuela o la persona designada por el director, a administrarle a mi hijo el medicamento descrito a continuación. Entiendo que el personal de la escuela no será considerado responsable por posibles efectos secundarios [causados] por la administración del medicamento y el personal de la escuela puede ponerse en contacto con el médico si hay preocupaciones sobre el medicamento.

Name of Medication______________________________ Date to begin administering medication _________ Date to end__________ Nombre del medicamento Fecha para empezar a administrar el medicamento Fecha para Terminar

Administer by mouth ear - left/ right/ both eye - left/ right/ both skin area_____________ other____________ Administrar: por boca oreja - izquierda/ derecha/ ambas ojo - izquierdo/ derecho/ ambos área sobre la piel Otro

Purpose of medication______________________ Amount to be given __________________ Time(s) to be given ________________

Propósito del medicamento Cantidad a ser administrada Veces a ser administrado

Parent/guardian home phone______________________ Work phone______________________ Cell phone_____________________ Teléfono del hogar del padre/tutor Teléfono del trabajo Teléfono celular

Parent/guardian signature ____________________________________________ Initials_______ Date _______________ Firma del padre/tutor Iniciales Fecha

Amount of medication received by school log Cantidad de medicamentos recibida en el registro de la escuela

Amount of medication returned by school log Cantidad de medicamentos devuelta en el registro de la escuela

Date med. received

Name of medication received

Amt. rec’d

Rec’d by initials

Rec’d from initials

Exp. Date

Date med. returned

Name of medication returned

Amt. ret’d

Ret’d by initials

Ret’d to initials

Fecha en que se recibió el

medicamento

Nombre del medicamento recibido

Cantidad recibida

Recibido por iniciales

Recibido de iniciales

Fecha de Expiración

Fecha de devolución del medicamento

Nombre del medicamento devuelto

Cantidad devuelta

Devuelto por iniciales

Devuelto a iniciales

Nurse/Principal/designee Signature____________________________________________ Initials_____ Title____________________ Firma del enfermero/director/designado Iniciales Título



Page 1 of 2

An Equal Opportunity Agency/Una Agencia con Igualdad de Oportunidad FC-600-1769E/S (Rev. 04/06/20)

Student Name____________________________________________ DOB___________________ Id#_________________________ Nombre del estudiante Fecha de Nacimiento N° de Identificación

Name of medication_________________________________________________________ School ______________Date _________ Nombre del medicamento Escuela Fecha

* All prescribed PRN medications must be counted weekly* Todos los medicamentos PRN prescritos deben contarse semanalmente

Date Fecha

Time of

administration/absent or refusal

Hora administrada/ausente

o rechazo

Daily count remaining

Conteo diario

restante

Staff Initials

Iniciales del personal

Student Initials Iniciales de el estudiante

Date Fecha

Time of

administration/absent or refusal

Hora

administrada/ausente o rechazo

Daily count remaining

Conteo diario

restante

Staff Initials Iniciales del personal

Student Initials Iniciales de estudiantes

Dates and phone # called to Parents (fechas de llamadas a los padres) #1 #2

Date Disposed (Fecha cuando se desechó)

Signature of Disposer (Firma de la persona que la desechó)

Signature of Witness (Firma del testigo)

Page 2 of 2 An Equal Opportunity Agency/Una Agencia con Igualdad de Oportunidad FC-600-1769E/S (Rev. 04/06/20)

THE SCHOOL DISTRICT OF OSCEOLA COUNTY, FLORIDA STUDENT SPECIFIC PHYSICIAN’S ORDERS

This information is not to be released to any other agency without prior approval of the Parent/Guardian

Student School Name: ______________________________DOB: ____________ ID#: ________________ School_________________________Year_________ Diagnosis: _________________________________________________________________ ICD-10 Code: ____________________

Medication to be administered at school Name of Medication Dosage Time(s) Route Date to Begin / End ____________________________ _____________ ___________ _____________ ___________________________ ____________________________ _____________ ___________ _____________ ___________________________ ____________________________ _____________ ___________ _____________ ___________________________

___ Dietary restrictions_______________________________________________________________________________________

___ Clean Intermittent Catheterization___________________________________________________________________________ ___ Respiratory Care/Treatments________________________________________________________________________________ _______________________________________________________________________________________________________ ___ Student may carry metered dose inhaler on his/her person while in school or school activity. (Student is responsible for inhaler and self-dosing.) ___ Physical Education / Recess / Activity Limitations_______________________________________________________________ ___ EpiPen administration for signs and symptoms of anaphylaxis/ Parental authorization required. (911 must be called if EpiPen is

administered.) ___ Student may carry EpiPen and self-administer by auto injector while in school, participating in school sponsored activities, or in

transit to or from school or school sponsored activities. ___ Special Health Monitoring _________________________________________________________________________________ ___ Seizures Monitoring _______________________________________________________________________________________ ___ Other ___________________________________________________________________________________________________ Non-medically licensed personnel trained by a District Nurse, excluding tracheotomy care and insulin administration according to FS 1006.062, may administer prescribed procedure(s).

*Orders are valid for 1 year unless otherwise stated. Physician Name_______________________________________________ Telephone ____________________________________ Physician Signature_____________________________________________________________ Date ________________________ District Registered Nurse Review Signature__________________________________________ Date_________________________ Parental Authorization (Required for carrying/self-administering EpiPen.) _____________________________Date ______________ Original: District RN Copy: Health Room An Equal Opportunity Agency FC-600-2034 (Rev. 04/06/20)

THE SCHOOL DISTRICT OF OSCEOLA COUNTY, FLORIDA MEDICAL PROCEDURE AFFIDAVIT

DECLARACIÓN JURADA DE PROCEDIMIENTOMÉDICO

This form must be signed in front of and notarized by a Notary Public / Este formulario debe ser firmado en frente de y certificado por un Notario Público State of County of

Before me this day personally appeared , who being duly sworn, deposes andstates:

Print Parent/Legal Guardian Name

I / Yo Print Parent/Legal Guardian Name (Last, First, M.) Escriba en letra de molde el nombre del padre / tutor legal (Apellido, Nombre, Inicial)

Parent/Legal Guardian Address / Dirección del padre / tutor legal City / Ciudad State / Estado Zip Code / Código Postal

have enrolled my child / he matriculado a mi hijo(a):

at / en Print Student Name (Last, First,M.) School name Escriba en letra de molde el nombre del estudiante (Apellido, Nombre, Inicial) Nombre de la escuela

It is necessary for my child to have a medical procedure performed during school hours. Name of procedure: Es necesario que mi hijo(a) se someta a un procedimiento médico a llevarse a cabo durante horas de clase. Nombre del procedimiento:

I have provided a physician’s order from (Physician’s name) for this medical procedure to be kept on file at the school. I agree to have this order updated upon changes in procedure or annually at the beginning of each new school year. I specifically request that The School District of Osceola County, FL staff members be trained in accordance to F.S.1006.062 to perform this procedure as designated by the completion of the Student Specific Medical Procedure Training Record. With the signing of this document, I give my consent for all staff members with appropriate documentation of training to perform this procedure on my child. I hereby release all claims, demands, damages, actions, causes of action or suits at law or in equity, of whatsoever nature against the School Board or any employees for following this request.

He proporcionado una orden del médico (nombre del

médico) para este procedimiento, para que sea archivada en la escuela. Estoy de acuerdo que esta orden sea actualizada cuando existan cambios en el procedimiento o anualmente, al comienzo de cada año escolar. Solicito, específicamente, que los empleados del Distrito Escolar del Condado Osceola, FL estén entrenados para administrar este procedimiento de acuerdo con el Estatuto de Florida,1006.062, designado así al completar el formulario del Registro de Entrenamiento del Procedimiento Médico Específico para Estudiantes. Al firmar este documento, doy mi consentimiento para que todos los miembros del personal escolar, que tengan la documentación apropiada sobre el entrenamiento, le practiquen este procedimiento a mi hijo(a). Por la presente, renuncio a todo tipo de reclamos, demandas, daños, acciones legales, procedimientos legales, o acciones en el régimen de equidad, de cualquier naturaleza en contra de la Junta Escolar o cualquier empleado, por cumplir con esta petición.

I understand this signed affidavit will remain in effect as long as my child is a student in The School District of Osceola County, FL and staff will be trained as the need changes. I acknowledge the selection of staff to work with my child is a decision for The School District of Osceola County, FL. I have no right to insist upon any particular person to be assigned to work with my child, although I may communicate my request to the appropriate School District personnel. I understand I may withdraw consent (in writing) for specific staff members to perform this procedure should I feel it is necessary. I further understand that if I withdraw consent and there is not another documented trained staff member, it will be necessary for me to come to the school to perform the procedure until such time as another staff member can be trained. In such an event, I understand my assistance is subject to all the rules and procedures of The School District of Osceola County, FL including those rules regarding background checks and my conduct on campus. I may be removed from a school facility and my services may be terminated if the Superintendent, building administrator, or designee, determines it is in the best interest of The School District of Osceola County, FL or if my services are no longer needed.

An Equal Opportunity Agency Una Agencia con Igualdad de Oportunidades Page 1 of 2 MED (06/07/12) FC-600-2072 E/S (Rev. 03/30/12)

THE SCHOOL DISTRICT OF OSCEOLA COUNTY, FLORIDA MEDICAL PROCEDURE AFFIDAVIT

DECLARACIÓN JURADA DE PROCEDIMIENTOMÉDICO

Entiendo que, esta declaración jurada firmada, permanecerá vigente mientras mi hijo/a sea un estudiante en el Distrito Escolar del Condado Osceola, FL y que el personal será entrenado mientras sea necesario y ocurran cambios. Entiendo que, la selección del personal para trabajar con mi hijo/a, es una decisión del Distrito Escolar del Condado Osceola, FL. No tengo el derecho de insistir en que se asigne a una persona en particular para que trabaje con mi hijo/a, aunque puedo dejarle saber mi petición a la persona apropiada del Distrito Escolar. Comprendo que puedo remover mi consentimiento (por escrito) para que ciertos miembros del personal, en específico, administren el procedimiento, si así yo lo considero necesario. Además, entiendo que si remuevo mi consentimiento y no hay otro miembro del personal que esté entrenado, será necesario que yo acuda a la escuela para hacer el procedimiento, hasta tanto haya un miembro del personal que pueda entrenarse. En tal caso, entiendo que mi ayuda está sujeta a todas las normas y procedimientos del Distrito Escolar del Condado Osceola, FL incluyendo aquellas normas sobre revisión de antecedentes y mi conducta en el recinto escolar. Puedo ser removido de las instalaciones de la escuela y mis servicios pueden ser terminados si el Superintendente, el administrador del edificio o su designado, determina que es para beneficio del Distrito Escolar del Condado Osceola, FL o si no necesitan de mis servicios.

I also understand that if there is special equipment, and/or medication needed to perform this procedure, it will

be my responsibility to deliver the equipment to the school in working order and that school personnel will assume no responsibility for the proper maintenance or delivery of the special equipment necessary for this procedure. If medication is needed; I understand that I am solely responsible for supplying the medication to the school and insuring that the medication is up-to-date and not expired. I also understand that I am solely responsible for replacing the medication as required by the student’s physician.

También, entiendo que, si se necesita un equipo especial y/o medicamentos para llevar a cabo este procedimiento, será mi responsabilidad entregar diariamente a la escuela el equipo en buen funcionamiento y que el personal de la escuela no asumirá la responsabilidad por el mantenimiento apropiado o por la entrega del equipo especial necesario para este procedimiento. Si se necesitan medicamentos, entiendo que soy el único responsable de proporcionar los medicamentos a la escuela y de asegurar que éstos estén vigentes y no hayan caducado. También, comprendo que, soy el único responsable de reemplazar los medicamentos según como lo requiera el médico del estudiante.

List all equipment and/or medication to be supplied by parent/guardian Enumere todo equipo y/o medicamento que debe proporcionar el padre / tutor legal

Parent/Legal Guardian (affiant) Signature Date Firma del Padre / Tutor Legal (declarante) Fecha Signed and sworn (or affirmed) before meon by

He/she is personally known to me Parent/Legal Guardian(affiant)

or has produced as identification.

Notary Signature Name of Notary typed, printed orstamped

An Equal Opportunity Agency Una Agencia con Igualdad de Oportunidades Page 2 of 2 MED (06/07/12) FC-600-2072 E/S (Rev. 03/30/12)

THE SCHOOL DISTRICT OF OSCEOLA COUNTY, FLORIDA NOTICE OF INCOMPLETE IMMUNIZATION RECORD

Parent/Guardian: Your immediate attention to this matter is required. Immunization non-compliance will result in student’s exclusion from school as per Florida law, Statutes 1003.22.

Date

Dear Parent/Guardian of Student ID#

According to our school health records, your child’s immunization record, Florida Certificate of Immunization Form DH 680:

1. is incomplete and requires the following:

A. DTaP/DTP - Diphtheria, Tetanus, Pertussis 1st dose 2nd dose 3rd dose 4th dose 5th dose

B. Td – Tetanus, Diphtheria Booster/Tdap – Tetanus, Diphtheria, Pertussis

C. Polio 1st dose 2nd dose 3rd dose 4th dose

D. MMR – Measles, Mumps, Rubella 1st dose 2nd dose

E. Hepatitis B series 1st dose 2nd dose 3rd dose

F. Varicella (chicken pox) 1st dose 2nd dose or indicate date child had disease

G. Physical Exam

2. will expire / has expired as of (date) and MUST be up-dated by (date) or your child WILL NOT be allowed to attend school as per Florida law, Statute 1003.22.

In accordance with Florida law, Statute 1003.22 – Immunization Against Communicable Diseases/School Entry Health Examination, immunizations must be up-to-date or your child will NOT be allowed to enter/attend school. According to Florida Statute 1003.22:

(4) The school board of each district shall establish and enforce as policy that, prior to admittance to or attendance in a public school, grades pre-school through 12, each child present must have on file with the school a certification of immunization for the prevention of those communicable diseases for which immunization is required by the Department of Health. Such certification shall be made on forms approved and provided by the Department of Health and shall become a part of each student’s permanent record, to be transferred when the student transfers, is promoted, or changes schools.

(10) The school board of each district shall: (a) Refuse admittance to any child otherwise entitled to admittance to kindergarten, or any other initial entrance into a Florida

public school, who is not in compliance with the provisions of subsection (4). (b) Temporarily exclude from attendance any student who is not in compliance with the provisions of subsection (4).

Parents/guardians are responsible for assuring that the child is in compliance. Please schedule an appointment with your private physician or the Health Department and take this letter, as well as any immunization records you have, with you.

Florida Department of Health in Osceola County 1875 Fortune Rd. Kissimmee, FL (407) 343-2000

All immunizations provided by the Department of Health for children under the age of 18 are free!

If you have any questions, please call the Health Room at . Thank you.

Sincerely,



AVISO SOBRE EXPEDIENTE DE INMUNIZACIÓNINCOMPLETO Padre/Tutor: Se requiere su atención inmediata en este asunto. El incumplimiento de inmunización tendrá como resultado la exclusión del estudiante de la escuela de acuerdo al Estatuto 1003.22, de la ley de Florida.

Fecha_

Estimado Padre/Tutor de

N° de identificación del estudiante

De acuerdo a nuestros expedientes de salud de la escuela, el expediente de inmunización de su hijo(a), formulario DH 680 de Certificado de Inmunización de Florida:

1. está incompleto y requiere lo siguiente:

A. DTaP/DTP - Difteria, Tétanos, Tos ferina 1a dosis 2da dosis 3a dosis 4a dosis 5a dosis

B. Td – Renovación/Tdap para Tétanos - Difteria - Difteria, Tétanos, Tos ferina

C. Polio 1a dosis 2da dosis 3a dosis 4a dosis

D. MMR – Sarampión, Paperas, Rubeola 1a dosis 2da dosis

E. Series de Hepatitis B 1a dosis 2da dosis 3a dosis

F. Varicela 1a dosis 2da dosis o indique la fecha en que su hijo(a) tuvola enfermedad

G. Examen médico físico

2. vencerá / ha vencido a partir del (fecha) y DEBE ser actualizado a más tardar el (fecha) o NO se permitirá que su hijo(a) asista a la escuela de acuerdo al Estatuto 1003.22, de la ley de Florida.

De acuerdo al Estatuto 1003.22, de la ley de Florida – sobre las Inmunizaciones Contra las Enfermedades Contagiosas/el Examen de Salud para Ingreso a la Escuela, las inmunizaciones deben estar actualizadas o NO se permitirá que su hijo(a) ingrese/asista a la escuela.

De acuerdo al Estatuto de Florida 1003.22:

(4) La junta escolar de cada distrito deberá establecer y hacer cumplir como política que, antes de la admisión o asistencia a una escuela pública, desde pre escolar hasta 12mo grado, cada niño presente debe tener en el archivo de la escuela un certificado de vacuna para la prevención de aquellas enfermedades contagiosas para la cual se requiere una vacuna del Departamento de Salud. Tal certificado deberá estar hecho en formularios aprobados y provistos por el Departamento de Salud y deberá ser parte del expediente permanente de cada estudiante, para ser transferido cuando el estudiante se traslade, sea promovido o cambie deescuelas.

(10) La junta escolar de cada distrito deberá:

(a) Declinar la asistencia a cualquier niño que no esté en cumplimiento con las estipulaciones del inciso (4), aunque tenga derecho a ser admitido al jardín de infantes o cualquier otra entrada inicial a una escuela pública de Florida.

(b) Excluir temporalmente la asistencia a cualquier estudiante que no cumpla con las estipulaciones del inciso (4).

Los padres/tutores son los responsables de asegurar que el niño/a esté en cumplimiento con tal disposición. Por favor haga una cita con su médico privado o con el Departamento de Salud y lleve consigo esta carta, así como cualquier expediente de inmunización que tenga.

Departamento de Salud de Florida en el Condado Osceola 1875 Fortune Rd., Kissimmee, FL (407) 343-2000

¡Todas las inmunizaciones proporcionadas por el Departamento de Salud son gratuitas para los niños menores de 18 años!

Si tiene alguna pregunta, favor de llamar al salón de enfermería al . Gracias. Atentamente,

Una Agencia de Igualdad de Oportunidad MED (06/11/18) FC-600-2079S (Rev. 06/11/18)


MEDICATION ADMINISTRATION AT SCHOOL ACKNOWLEDGEMENT OF TRAINING

Trainee Print Name Last First Middle

Job Title ID#

Department/ School Date

Trainer Print Name Signature Title

I hereby acknowledge that The School District of Osceola County, FL has provided me training concerning the appropriate policies, procedures, and applicable forms documentation authorizing me to administer medication at school and I understand this training is valid for two years.

Further, I understand and acknowledge that I MUST follow the guidelines provided by The School District of Osceola County, FL in accordance with the School Health Services Manual and with Section 1006.062, F.S.

Trainee Signature Date

Original: Trainer An Equal Opportunity Agency FC-600-2121 (Rev. 06/11/18)

THE SCHOOL DISTRICT OF OSCEOLA COUNTY, FLORIDA STUDENT SPECIFIC MEDICAL PROCEDURE TRAINING RECORD


Student Name DOB ID# School

Health Condition Asthma/Respiratory Disease (493.9) Disability Requiring Assistance with Activities of Daily Living (ADL’s)(93.83)

Diabetes (250.0) Severe Allergy to Food (995.60) Bites/Stings (989.5)

Cerebral Palsy (343.9 Spina Bifida (741.9)

Seizure Disorder Other

Skills Trained G-Tube Feeding (43.0)

Trainee / Trainer

#1 /

Trainee / Trainer

#2 /

Trainee / Trainer

#3 /

Trainee / Trainer

#4 /

Activities of Daily Living (93.83) / / / /

Nebulizer Treatment (93.94) / / / /

Diabetic Monitoring (250.0) / / / /

Epi-Pen Administration / / / /

Clean Catheterizations (57.94) / / / /

Oxygen Administration (93.96) / / / /

Oral Suctioning (93.83) / / / /

Chronic Health Care Management (93.83) / /

/ /

Tracheostomy (31.1) / /

/ /

VNS/Seizure Precautions and Monitoring / / / /

Medication Administration / / / /

Inhaler / /

/ /

Other / / / /

/ / #1 Trainee Name (Please Print) Initials Trainee Signature Date




/ District RN (Please Print) District RN Signature Date

Training Reviewed/Updated Annually

/ / / / Trainer Initial Trainee Initial Date Trainer Initial Trainee Initial Date

/ / / / Trainer Initial Trainee Initial Date Trainer Initial Trainee Initial Date

Original: District RN An Equal Opportunity Agency FC-600-2123 (Rev. 06/11/18)

THE SCHOOL DISTRICT OF OSCEOLA COUNTY, FLORIDA REPORT OF MEDICATION ADMINISTRATION ERROR

Student Name ID# Last First M.I.

DOB School Grade

Type of Error: Wrong Medication Wrong Dose Wrong Time Wrong Student Wrong Route

Date of Error: Accident/Incident Report Done

Error Made By: Print Name Title

Name of Medication and Dosage Prescribed:

Describe the Circumstances Leading to Error:

Describe Action Taken:

Persons Notified of Error: NAME DATE TIME

Principal/Designee:

Parent:

Physician:

District RN:

Poison Control Phone Number (800) 222-1222

Print Name of Person Completing Report Signature

Principal/Designee Signature Date

Follow-up Information (if applicable):

Follow-up completed by: Print Name Signature

Original: Principal Copy: District RN An Equal Opportunity Agency FC-600-2125 (Rev. 06/11/18)

THE SCHOOL DISTRICT OF OSCEOLA COUNTY, FLORIDA DIABETES MEDICAL MANAGEMENT PLAN

STUDENT/CONTACT INFORMATION

Student Name: DOB: Diabetes Type: Type 1 Date Diagnosed:

School Year: - Effective Date : School: Grade:

Parent/Guardian #1: Primary #: Secondary #: Email:

Parent/Guardian #2: Primary # Secondary #: Email:

Other Emergency Contact: Primary # Secondary #: Relationship:

Diabetes Healthcare Provider: Phone #: Fax #:

DIABETES MONITORING AT SCHOOL Blood Glucose Ketones: Urine Blood N/A Continuous Glucose Monitoring: N/A

Before Breakfast Check ketones If blood glucose over mg/dL.

Brand:

Before Mid-AM Snack High Glucose Alert Setting: mg/dL Low Glucose Alert Setting: mg/dL Before Lunch

Before Afternoon Snack Check ketones for complaints of abdominal pain, nausea/vomiting.

CONFIRM CGM SENSOR GLUCOSE WITH BG CHECK BEFORE CORRECTIVE ACTION. Before Physical Activity

Other times to check ketones: After Physical Activity Before Dismissal Note: Normal blood ketones below

0.6mmol/L Check BG for signs/symptoms of high/low glucose regardless of CGM value. Signs/Symptoms of High/Low Blood Glucose

Other BG Check: Notify parent if ketones *(to pick Notify parent if CGM site painful, draining/ bleeding, inflamed, irritated.* up child if urine ketones mod-lg or blood

ketones > 1mmol/L). Notify parent if BG over mg/dL*

Delay exercise if: BG below 70, over _, ketones , or . *Diabetes Healthcare Provider will be contacted if unable to reach parent within 30 minutes.

DIABETES MEDICATION AT SCHOOL Insulin Delivery Method: n/a Pen Syringe/Vial Pump – Brand/Model:

Rapid-Acting Insulin Brand: Humalog Novolog Apidra May substitute brand if needed

Fixed Rapid-Acting Insulin Dose to be given with meals: n/a Add Correction below

Fixed Meal Scale (Meal + High BG Dose) Times:

Correction Only Scale Times:

Correction Only Formula (Instead of Scale) Times:

If blood glucose: Insulin Dose If blood glucose: Insulin Dose Target BG = mg/dL

to give units to give units Correction (Sensitivity) Factor mg/dL

to give units to give units (Blood Glucose-Target BG) ÷ Correction Factor = # units to correct high BG. i.e., (Current BG - ) ÷ = units to give units to give units

to give units to give units Give correction dose if over hours since last dose &/carbohydrate intake

to give units to give units Add correction dose to Flexible Carb Coverage per “Meals/Snacks” below.

to give units to give units Round to nearest 0.5 1 unit

to “HI” give units to “HI” give units Always round fraction down.

Other Insulin(s) to be taken at school (Type/Dose/Time) n/a

Parent can adjust insulin dose as follows: n/a

Other routine diabetes medication(s) to be taken at school: n/a (Type/Dose/Time)

Original: Student Treatment Record An Equal Opportunity Agency FC-600-2127 (Rev. 06/21/16)

DIABETES MEDICAL MANAGEMENT PLAN Student Name:

MEALS/SNACKS

Meal/Snack Time Carbohydrate Target As desired

Flexible Carb Coverage (Insulin : Carb Ratio +/- Correction)

Breakfast grams 1 unit: grams Add Correction

MidAM Snack grams 1 unit: grams Add Correction

Lunch grams 1 unit: grams Add Correction

MidAftn Snack grams 1 unit: grams Add Correction Before/After Physical Activity grams 1 unit: grams Add Correction

Other: grams 1 unit: grams Add Correction Meal/snack should be timed at least hours after last meal/snack if BG to be checked.

Pre-meal insulin can be given after meal based on pre-meal BG if student’s carbohydrate intake is unpredictable.

HIGH BLOOD GLUCOSE (HYPERGLYCEMIA) MANAGEMENT Student’s Usual Signs and Symptoms (Mark all that apply):

High Blood Glucose:

(Over mg/dL)

Increased thirst

and/or urination

Hunger

Headache

Fatigue/ drowsiness

Dry skin

Weakness/ muscle aches

Blurred

vision

Very High Blood Glucose:

(Over mg/dL)

Nausea/vomiting/

abdominal pain

Dizziness

Extreme

thirst

Fruity breath

odor

Altered

breathing

Other:

High Blood Glucose Treatment: See correction insulin instructions under “Diabetes Medications at School” on pg. 1. Check “Ketones” (see Diabetes Monitoring). If urine ketones are negative to trace (blood 0-1mmol/L) without symptoms, give insulin correction dose (see Diabetes Medications), give oz. sugar-free fluid/hour, and send back to class with frequent bathroom privileges. Re-check blood glucose in hours. Delay next meal/snack until blood glucose below mg/dL. If urine ketones are moderate to large (blood over 1 mmol/L) notify parent and call diabetes healthcare provider for insulin dose instructions. Give sugar-free liquids/water if not vomiting and stay with student. Call parent if high blood glucose accompanied by symptoms of illness. Child to go home for moderate to large ketones (blood ketones over 1mmol/L or high blood glucose with symptoms of illness.

LOW BLOOD GLUCOSE (HYPOGLYCEMIA) MANAGMENT Low Blood Glucose = Blood Glucose below mg/dL Not applicable

Student’s Usual Signs and Symptoms (Mark all that apply):

Shakiness Sweating Paleness Rapid Heartbeat

Numbness/ Tingling

Irritability/ Mood Change Fatigue

Headache Inattention/

Confusion Slurred

Speech Poor Coordination

Seizure Loss of

consciousness

Other:

Low Blood Glucose Treatment: If student is awake and able to swallow/controlairway, give grams fast-acting carbohydrate- e.g oz. fruit juice glucose tablets oz. regular soda oz. milk 15gm tube glucose gel Re-check blood glucose every 15 minutes and re-treat until blood glucose is over mg/dL.

If student has severe hypoglycemia (is unresponsive/having seizure/unable to control airway): Call 911 or send another to do so.

Trained personnel to give Glucagon/Glucagen subq/IM - ½mg 1mg Contact parent/guardian if glucagon given or if low blood glucose treatment is ineffective. Calldiabetes healthcare

provider if unable to reach parent within 20minutes. ADDITIONAL CONSIDERATIONS FOR STUDENT WITH AN INSULIN PUMP

If blood glucose over mg/dL times in a row or any bG over check ketones. Follow high blood glucose instructions BUT give correction dose with syringe or pen and have student change infusion set. Notify parent if assistance needed. Inspect pump site, tubing/pod in event of alarms, high blood glucose, or student complains of pain at infusion site. Contact parent if pump site dislodged or leaking. If student experiences severe hypoglycemia, suspend/remove pump or cut tubing. Send non-disposables with EMS to hospital.


DIABETES MEDICAL MANAGEMENT PLAN Student Name:

ADDITIONAL TIMES TO NOTIFY PARENT/GUARDIAN/PROVIDER Student refusing medication. Unusual reaction to any diabetesmedication. Correction dose given after pm. Student unavoidably detained atschool. Other: .

SUPPLIES TO BE FURNISHED BY PARENT TO SCHOOL

BG strips, meter, lancets, lancing device

Snacks: carb and carb-free

Insulin pen/ cartridges, pen needles

Glucagon/ Glucagen

Pump Infusion Sets/Pods

Spare batteries Meter/pump/CGM

Ketone strips +/- meter

Juice, glucose tabs/ gel or regular soda

Insulin vial/syringe Other prescribed

diabetes med

Pump reservoirs / cartridges

Other:

DISASTER PLAN In case student’s normal diabetes management routine and support is disrupted by unexpected emergency: Re-unite student as soon as safely possible with diabetes supplies/emergency kit and trained caregiver/parent. Keep student as well-hydrated as possible and keep rapid-acting carbohydrate with student.

Use correction only scale every 3 hours (if at least 3 hours since last insulin/carb intake). Switch to rapid acting insulin injections if pump/site fails and unable to restart.

Use insulin:carb ratio + correction formula every 3+ hours. Student able to self-manage during disaster conditions unless incapacitated.

Contact parent/diabetes team for additional instructions. DIABETES SELF-CARE ASSESSMENT

Task

N/A Needs

Assistance Needs

Supervision

Independent (requires no help/supervision for routine care,

can carry meds/supplies) Performs and Interprets Blood Glucose Checks

Calculates Carbohydrate Grams

Determines Correction Dose of Insulin for High Blood Glucose

Determines Insulin Dose for Carbohydrate Intake

Administers Insulin by pump or injection

Troubleshoots alarms and malfunctions if using insulin pump

Disconnects/reconnects pump if needed

Programs pump basal rates/sets temporary rates if needed

Changes insulin pump infusion site if needed

Responds to CGM alarms

SIGNATURES/PARENTAL CONSENT This Diabetes Medical Management Plan has been approved by: OFFICE STAMP HERE

Diabetes Healthcare Provider Signature:

Date:

I (parent/guardian) understand that all treatments and procedures may be performed by the student and/or trained unlicensed assistive personnel within the school or by EMS in the event of loss of consciousness or seizure. I also understand that the school is not responsible for damage, loss of equipment, or expenses utilized in these treatments and procedures. I have reviewed this medical management plan and agree with the indicated instructions. This form will assist the school health personnel in developing a nursing care plan.

I consent to the release of the information contained in this Diabetes Medical Management Plan to all school staff members and other adults who have responsibility for my child and who may need to know this information to maintain my child's health and safety.

I also give permission to the school nurse or authorized school personnel to contact my child's diabetes healthcare provider when necessary.

Parent Signature: Date:

School RN: Date:


THE SCHOOL DISTRICT OF OSCEOLA COUNTY, FLORIDA Health Care Plan Procedure(s) Worksheet

(School Health Registered Nurse Use Only)

Student Name DOB ID# School

Diagnosis RN Signature Date

Procedure(s) to be done at school:

D Nebulizer Treatment D Diabetic Care (Finger stick Blood Sugar, Glucagon Administration, Ketone Testing, Insulin Administration, etc.) D EpiPen Administration D G-Tube Feedings D Tracheostomy Care D Clean Intermittent Catheterizations D Other

Documentation Needed for Procedure(s):

D Physician Orders

D Notarized Medical Procedure Affidavit

D Training Record for each staff member trained

D Medication Authorization (if applicable)

Nursing Notes:

An Equal Opportunity Agency FC-600-2233 (03/25/04)

Signature Date Signature Date

Date of Initiation: Signature Date Signature Date

Signature Date Signature Date

Student

THE SCHOOL DISTRICT OF OSCEOLA COUNTY, FLORIDA STUDENT HEALTH CARE PLAN


Name: DOB: ID#: School

Description of Condition:

Nursing Assessment: Severity of episodes: Mild Moderate Severe Life-threatening (requires 911 to be called)

Known trigger: Modification (s): Other:

Notes:

Medications: Name of Medication Dose: Times given: Side effects:

Diagnosing/treating physician: phone #:

Nursing diagnoses: 1. 2. 3.

Other:

Nursing goals: 1. 2. 3.

Other:

THIS IS CONFIDENTIAL INFORMATION Original: Student Treatment Record An Equal Opportunity Agency Page 1 of 3 FC-600-2247-1 (Rev. 06/11/18)

Student



Name: DOB: ID# School

Nursing Interventions:1. 2. 3. 4.

Other:

Goals for school year: 1. 2. 3. 4.

Other:

FOLLOW-UP Follow-up: Changes in medication:

Date Name of Medication Dosage Time of Administration

Other changes:

_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

THIS IS CONFIDENTIAL INFORMATION Original: Student Treatment Record An Equal Opportunity Agency Page 2 of 3 FC-600-2247-1 (Rev. 06/11/18)

Student



Name: DOB: ID# School

STUDENT HEALTH ALERT

If You See This: Do This:

Medications: Possible Side Effects:

If you observe, or student complains of, any of the following, please notify the school nurse:

THIS IS CONFIDENTIAL INFORMATION Return this document to the Health Aide at the end of the school year

Original: Student Treatment Record An Equal Opportunity Agency Page 3 of 3 FC-600-2247-1 (Rev. 06/11/18)

Alert issued to:

Health Alert Issued/Reissued Signature: Date:

THE SCHOOL DISTRICT OF OSCEOLA COUNTY, FLORIDA BLOOD GLUCOSE MONITORING LOG

School School Year

Student Name: Date:

DOB: ID #

Type of Emergency Glucose: Before lunch Other

DATE TIME READING ACTION TAKEN* INITIALS DATE TIME READING ACTION TAKEN* INITIALS

INITIALS NAME (Please Print) *CODES FOR ACTION TAKEN

_ G = Emergency glucose CC = Carb Count H = Sent home PB = Pump Bolus

_ N = Notified parent R = Returned to class O = Out of glucose source S = Snack given

_ I = Insulin administered 911 = Emergency Services

called K = Ketone testing L = Sent to lunch

An Equal Opportunity Agency FC-600-2249 (Rev. 07/14/10)


SCHOOL HEALTH ROOM MONTHLY REPORTING FORM

School Month/Year

Total # of students visits to first aid room Staffing ESE Child (5052)

Elementary (5061) First Aid Administration (5031)

Middle (5062) Complex Medical Procedure (5032)

High (5063) Immunization follow-up (5033F)

Other-Upgraded (5064) ______________________ Child Specific Training (8080) ____________ Preventative Dental (6610F) Classroom Instructions: __________________

School Nurse Assessment & Intervention (4050) # Classes (8020) # Students

School Health Staff Consultation (5051) Record review new enrollees (0598)

# Medication Administration (5030) # Sent Home_________# Returned to Class_________

# of students seen on a daily basis for Medication _________ 911 Calls_____________

Measles Mumps Rubella

Scarlet Fever Chicken Pox Fifth Disease

Pinkeye Ringworm Dog Bites

ILI* Acute Asthma Episode Rash

* Influenza Like Illness – Fever of 100.4 or higher with cough and/or sore throat.

Original: Health Care Assistant/Nurse Page 1 of 2 Copies: Fax to District RN & Osceola County Health Dept. An Equal Opportunity Agency FC-600-2250 (Rev. 01/08/20)

Student Accident/Incident Report Information Only # Accidents

# Sent Home

# Intentional

# Unintentional

THE SCHOOL DISTRICT OF OSCEOLA COUNTY, FLORIDA SCHOOL HEALTH ROOM MONTHLY REPORTING FORM

School Month/Year

Screenings Grade Level

# Screened

# Re-screened

# Referred

# Completed

Grade Level

# Screened

# Re-screened

# Referred

# Completed

Vision Pre-K (PK) Middle (0510) M6

K (KG) M7 E1 M8 E2 High E3 H9 E4 H10 E5 H11 H12

Hearing Pre-K (PK) Middle (0515) M6


Ht/Wt Pre-K (PK) Middle (0520) M6


BMI Screening Make-up

Only

Healthy Under- weight

Over- weight

Obese

(0521) (0522) (0523) (0524) Middle M6

Grades M7 1st M8 3rd High 6th H9

H10 H11

Lice or Scabies

PK-12 H12 (0571) Scoliosis

(0561) M6

Original: Health Care Assistant/Nurse Page 2 of 2 Copies: Fax to District RN & Osceola County Health Dept. An Equal Opportunity Agency FC-600-2250 (Rev. 01/08/20)

THE SCHOOL DISTRICT OF OSCEOLA COUNTY, FLORIDA HEAD INJURY REPORT – STUDENT

REPORTE DE LESIÓN EN LA CABEZA - ESTUDIANTE

Dear Parent/Guardian: Today at school, your child received an accidental injury to his/her head. Estimado Padre/Tutor: Hoy en la escuela, su hijo sufrió una lesión accidental en lacabeza.

Date: Student Name: Fecha Nombre del estudiante

School: Teacher: Grade: Escuela Maestro Grado

Time of incident: Nature of injury: Hora del incidente Tipo de lesión

Treatment given: Tratamiento que se le dio

Due to the inconsistent nature of head injuries, children who have received even what is seemingly a slight bump on the head should be closely observed for at least 24 hours after the incident occurs. Many times symptoms indicating a head injury do not occur for several hours or until the following day. The severity of the blow to the head does not always determine whether a particular child will or will not sustain a head injury. Debido a la naturaleza inconsistente de las lesiones en la cabeza, los niños que hayan recibido lo que podría parecer un golpe leve en la cabeza, deben ser observados muy de cerca por lo menos 24 horas después de ocurrido el incidente. Muchas veces los síntomas que podrían indicar una lesión en la cabeza no surgen sino hasta después de varias horas o hasta el día siguiente. La severidad del golpe en la cabeza no siempre determina si un niño en particular sufrirá o no sufrirá una lesión en la cabeza.

If your child receives a blow to his/her head, he/she should be observed for the following symptoms: Si su hijo recibe un golpe en la cabeza, deberá observarse si ocurren los siguientessíntomas:

• Excessive nausea or vomiting / Náuseas o vómitos enexceso • Lethargy: is the child extremely sleepy at a time when he/she should not be sleepy? Can the child

be awakened from the sleep? / Letargo: ¿está el niño muy soñoliento en momentos cuando no deberíaestarlo? ¿Puede despertar al niño de su sueño?

• Mental confusion and disorientation: can the child remember his/her name, address, age, etc? Does he/she know where he/she is? / Confusión mental y desorientación: ¿puede el niño recordar sunombre, dirección, edad, etc.? ¿Sabe dónde se encuentra?

• Lack of movement: is the child able to move his/her arms or legs properly? / Falta de movimiento: ¿puede el niño mover sus brazos o piernas de formaapropiada?

• Unequal size of dilation of pupils of the eyes. / Tamaño desigual de dilatación de las pupilas de losojos.

Should any of the above symptoms develop, you should consult with your physician immediately. Si se desarrolla cualquiera de estos síntomas, usted debe consultar con su médico inmediatamente.

Health Care Assistant/Nurse / Ayudante Médico / Enfermero

An Equal Opportunity Agency / Una Agencia con Igualdad de Oportunidades MED (05/16/12) FC-600-2253E/S (Rev. 03/30/12)

Parent/Guardian Notification / Notificación alPadre/Tutor

Name of person notified: Relationship to student: Persona a quien se notificó Parentesco con el estudiante

Date notified: Time notified: Teacher notified: Fecha de notificación Hora de notificación Maestro a quien se notificó

Reporting person: Addendum: Persona que hace el reporte Anexo

THE SCHOOL DISTRICT OF OSCEOLA COUNTY, FLORIDA NOTICE OF FREQUENT VISITS TO THE HEALTHROOM

AVISO DE VISITAS FRECUENTES A LA CLÍNICA

Date / Fecha

Dear Parent/Guardian: / Estimado Padre/Tutor:

It has come to my attention that your child , grade_____, Se me ha informado que su hijo(a) grado

school , has been visiting the Health Room frequently for the following reason(s): escuela ha estado visitando la clínica con frecuencia debido a la(s) siguiente(s) razón(es):

General complaints, (frequently) Quejas generales, (frecuentes)

We want you to be aware that when students visit the health room more than three (3) times in a short period of time, it may be an indication of a more serious medical problem. We are concerned that the frequent visits to the health room might be masking more serious symptoms.

For the safety of the student, we ask for assistance in communicating with your child the seriousness of this matter.

If you have any questions or would like to discuss this further, please contact the Health Room at your child’s school.

Deseamos informarle que cuando los estudiantes visitan la clínica más de tres (3) veces durante un corto período de tiempo, esto podría indicar la existencia de un problema médico más serio. Nos preocupa que las visitas frecuentes a la clínica, puedan ocultar síntomas másserios.

Por la seguridad de su hijo, le pedimos que dialogue con él / ella sobre la seriedad de este asunto.

Si tiene alguna pregunta o desearía dialogar más sobre este tema, favor de comunicarse con la clínica de la escuela de su hijo.

Sincerely / Atentamente,

Health Care Assistant/Nurse Ayudante Médico / Enfermero

MED (05/16/12) FC-600-2254E/S (Rev. 03/30/12)

An Equal Opportunity Agency / Una Agencia de Igualdad de Oportunidades


Medication Sign-out Log for Field Trips

School Name School Year

Student Name ID# DOB

Date

Name of Medication(s)

Print Teacher Name Meds Checked Out to: (sign / date)

Meds Returned By: (sign / date)

An Equal Opportunity Agency FC-600-2274 (07/26/04)


PHYSICIAN’S STATEMENT FOR A POSSIBLE SECTION 504 PLAN

Date

To (Physician)

Student Name Date of Birth

Parent(s) School

I give my consent for you to release the following information about my child to the School District of Osceola County, Florida.

Parent(s) Signature Date The School District of Osceola County, Florida requests information from you for the purpose of educational planning for the above-referenced student. Please complete the requested information, sign, and return the form to the designated school agent listed below.

Diagnosis

Medications prescribed

Dosage Expiration Date

Limitations

Suggested accommodations Physician’s Signature Date

Please return this form to the following school personnel:

An Equal Opportunity Agency

FC-600-2330

(07/19/06)


STUDENT CHECKLIST FOR SELF-ADMINISTRATION OF AUTO-INJECTOR FOR ALLERGIC REACTIONS LISTA DE COTEJO DEL ESTUDIANTE PARA AUTO ADMINISTRARSE EL AUTO INYECTOR PARA REACCIONES

ALÉRGICAS

___________ __________ ________ Student Last Name First Name M.I. DOB ID # School Apellido del estudiante Nombre Inicial Fecha de nacimiento Escuela

Yes/Sí No Student is consistently able to /El estudiante puede de manera consistente ____ ____ Give the name of the medication./Proveer el nombre de la medicina.

____ ____ Tell why he/she needs the medication./Indicar por qué necesita la medicina.

____ ____ Tell why 9-1-1 needs to be called./Indicar por qué se debe llamar al 9-1-1.

____ ____ Give his/her symptoms of an allergic reaction./Informar sus síntomas de la reacción alérgica. ____ ____ Demonstrate the correct procedure for using an auto-injector./Demostrar el

procedimiento correcto para usar un auto inyector. ____ Remove from the storage unit./Sacarlo de la unidad de almacenaje.

____ Remove the gray cap./Quitar la tapa gris.

____ Understand that auto-injector can be used through clothing./ Comprender que el auto inyector puede utilizarse a través de la ropa.

____ Press tightly against the thigh until a clicking sound is heard./ Apretar fuertemente contra el muslo hasta oir un sonido que haga clic.

____ Hold in place for length of time per prescribed instructions./Sostenerlo en el lugar durante el tiempo según las instrucciones prescritas. ____ Remove from the thigh./Quitarlo del muslo.

____ Rub/massage thigh for length of time per prescribed instructions./Frotar / masajear el muslo durante el tiempo según las instrucciones prescritas.

____ Notify teacher/adult to call 9-1-1./Notificar a un maestro / adulto para que llame al 9-1-1.

____ Give Epinephrine Auto Injector to EMS personnel./Dar el Auto Inyector de Epinefrina al personal de EMS.

The student agrees to follow the safety precautions in handling the medication and to have medication on his/her person or safely nearby at all times. / El estudiante está de acuerdo en cumplir con las precauciones de seguridad en el manejo de la medicina y mantener la medicina consigo o cerca y de manera segura en todo momento. Student Name/Signature / Nombre y firma del estudiante Date/Fecha Parent/Guardian Name/Signature / Nombre y firma del padre / tutor Date/Fecha School Nurse Name/Signature / Nombre y firma de la enfermera de la escuela Date/Fecha Review Dates: Fechas de revisión Original: Health Room/Clínica An Equal Opportunity Agency/Una agencia con igualdad de oportunidad Copy/Copia: Principal/Designee - Director/Designado FC-600-2360E/S (Rev. 04/06/20)


BLOOD GLUCOSE MONITORING AND MANAGEMENT SKILLSCHECKLIST

Student’s Name Last First M.I. DOB School

Nurse’s Name (please print) School Year

*S = Satisfactory U = Unsatisfactory Demo Date Performance

*S/U Remediation

Date A. States name/purpose of procedure B. Procedure (student may self monitor)

1. Wash hands 2. Put lancet in holder removing tip 3. Do finger stick or puncture after cleansing area with alcohol swab or soap and water 4. Apply blood to strip 5. Record reading 6. Dispose of lancet, strip and alcohol swab in sharps container 7. Record on medication log and blood testing/insulin injection log 8. Provide a daily log to the health room nurse for glucose checks performed outside

the health room (if applicable)

C. Procedure (self management) Insulin Pen

1. Wash hands 2. Assembles equipment 3. Screws the needle tightly 4. Taps the pen to release air bubbles 5. Releases a few drops of insulin into the air 6. Re-tightens the needle if no insulin appears 7. Dials the appropriate amount of insulin on pen 8. Cleanses injection site with alcohol swab 9. Inserts needle into site and injects insulin by pushing pen’s button

10. Leaves needle in for 5 seconds to ensure insulin administration 11. Slowly removes pen 12. Notifies parent/guardian and school nurse of any unusual circumstances

Insulin syringe 1. Assembles equipment 2. Gently mixes insulin by rolling bottle in hands 3. Wipes rubber stopper on bottle 4. Uses a sterile insulin syringe 5. Draws plunger back to units of air 6. Pierces center of the bottle with needle 7. Turns bottle upside down and injects air into bottle 8. Withdraws units of insulin according to sliding/intensive schedule 9. Cleanses injection site with alcohol swab

10. Inserts needle into site and injects insulin 11. Notifies parent/school nurse of any unusual circumstance Insulin pump 1. Enter the blood glucose value into the pump 2. Count the number of carbohydrates to be or that have been eaten 3. Enter the number of carbohydrates into the pump 4. Deliver the bolus dose by pressing the designated buttons on the pump 5. If blood sugar is less than 70 mg/dl, wait to give the bolus until after eating 6. Document all dosages given on the Pump Therapy Log

Signature of Student Date

Signature of Nurse Date

An Equal Opportunity Agency FC-600-2363 (Rev. 04/28/10)

THE SCHOOL DISTRICT OF OSCEOLA COUNTY, FLORIDA DOCUMENTATION OF NECESSARY MEDICALSKILLS

Nurse’s Name: School:

Instructions: Annual clinical review for competency on medical procedures for students. Key Code: S = Satisfactory U = Unsatisfactory NI = Needs Improvement

PROCEDURES Key Code Nurse Initials/Date RN Initials/Date

Catheterization Male Female Suprapubic Blood Glucose Monitoring Glucagon Administration Urine Ketones Insulin Injections Bolus Pump Ear Eye Inhalants Injections IM/SQ PO Rectal Topical Dressing Change Replacement Suctioning Vagus Nerve Stimulation Therapy (VNS) Colostomy Other: Other: Other: Other: CPR Expiration Date: First Aid Expiration Date:

Comments:

Health Care Assistant/Nurse Signature Initials Date

District RN Initials Date

Original: District RN Copy: Health Care Assistant/Nurse

An Equal Opportunity Agency

FC-600-2367 (Rev. 03/30/12)

THE SCHOOL DISTRICT OF OSCEOLA COUNTY, FLORIDA PHYSICIAN’S ORDER FOR DIASTAT®

Date: _ School Year: -

Student Name:

School:

DOB:

ID #:

The above student is enrolled in the Osceola County School District. His/Her medical condition has necessitated the need for seizure monitoring and the use of Diastat® for emergency seizure control. It is Osceola County Schools’ policy that the use of any emergency medication requires activating the Emergency Medical Services (911). This needs to be done before Diastat® can be administered. Please outline in detail when the use of Diastat® is indicated.

Diastat® Indicated: For use with Generalized Tonic Clonic (Grand Mal) seizures lasting longer than

minutes.

For use with Absence (Petit Mal) seizures lasting longer than minutes.

Cluster seizure activity: ∆ Repeated seizure activity up to minutes/hours apart Occurrence: more than times

Non-medically licensed personnel trained by a District Nurse, excluding tracheotomy care and insulin administration according to FS 1006.062, may administer prescribed procedure(s).

Other considerations:

Medical Diagnosis:

Current Medications: Name Dose Frequency Times 1. 2. 3.

Physician Name:

Address:

Phone number:

Fax:

Physician’s Signature:

District RN:

Original: District RN Copy: Health Care Assistant/Nurse An Equal Opportunity Agency FC-600-2370 (Rev. 02/24/14)

THE SCHOOL DISTRICT OF OSCEOLA COUNTY, FLORIDA SEIZURE MONITORING FORM

Student Name: ID#: Date:

School

Time Seizure Started: Time Seizure Ended:

Pre-seizure Activity:

Unusual Circumstances:

DESCRIPTION OF SEIZURE (Circle all that apply):

Flexed Rigidity: right arm left arm right leg left leg

Extended Rigidity: right arm left arm right leg left leg

Jerking: right arm left arm right leg left leg

Twitching: right arm left arm right leg left leg

Head: turned right turned left nodded fell forward

Eyes: staring blinking rapidly rotating (up-down-right-left)

pupils larger pupils smaller bloodshot

Breathing: rapid slow erratic stopped for seconds difficult

Color: Change in: face nail beds lips tongue Use letter to indicate color changed to: (A) bluish, (B) reddish, (C) grayish, (D) pale

Other: Unconscious Unusual drooling Shoulders forward Nausea/vomiting

Loss of bladder Loss of bowel Inappropriate Chewing control control laughing

Lip smacking Tongue biting Lip biting Crying aloud

Other (specify):

Post Seizure Activity:

Returned to pre-seizure activity Drowsy Deep sleep

Inappropriate laughing Irritable Crying aloud

Injuries during seizure:

Signature Title Nurse’s Signature or Name of Nurse Notified Original: Student Health Record An Equal Opportunity Agency FC-600-2371 (02/22/07)


HEAD LICE TREATMENT TRATAMIENTO PARA LOS PIOJOS DE LA CABEZA

Head Lice (pediculus humanus capitis) are insects found on heads of people. Head lice live only on humans. They live on the hairs of the head especially behind the ears and back of the head. They cannot fly or jump but only crawl. Head lice are not a health hazard and do not spread disease. Head lice move from one person’s head to another by one of the following: a child’s head with lice touches a head without lice, or a child shares hair brushes, combs, hats, towels, clothing or bedding with someone who has lice. (Los piojos de la cabeza (pediculus humanus capitis) son insectos que se encuentran en las cabezas de las personas. Los piojos de cabeza viven solamente en los seres humanos. Viven en los cabellos de la cabeza especialmente detrás de las orejas y en la parte posterior de la cabeza. No pueden volar ni saltar sino solo arrastrarse. Los piojos de la cabeza no son un peligro contra la salud y no propagan enfermedades. Los piojos de cabeza se mueven de la cabeza de una persona a la de otra persona de la manera siguiente: la cabeza con piojos de un niño toca otra cabeza que no tiene piojos, o un niño comparte el uso de cepillos para el pelo, peines, sombreros, toallas, ropa o lencería con alguien que tiene piojos).

To avoid head lice from spreading, please encourage your child not to share combs, brushes, pillows, hats, towels, coats or other clothing. (Para evitar que se propaguen los piojos de cabeza, por favor aliente a su hijo a no compartir peines, cepillos, almohadas, sombreros, toallas, abrigos u otra ropa).

Head lice are treatable. Various shampoos (pediculicides) are available over the counter without a doctor’s prescription. Directions need to be followed according to individual products. Combs and hair brushes should be soaked in hot water at least 130° for 5 - 10 minutes. Disinfecting furniture and using insecticide sprays are not necessary or recommended. (Los piojos de cabeza pueden ser tratados. Existen varios productos para lavar el pelo (pediculicidas) que se pueden comprar sin receta médica. Debe seguir las instrucciones para su uso según cada producto individual. Los peines y cepillos para el pelo deben ser remojados en agua caliente a una temperatura de por lo menos 130°de 5 a 10 minutos o lavados con champú contra piojos. No es necesario ni se recomienda desinfectar muebles ni usar insecticidas en aerosol).

---------------------------------------------------------------------------------------------------------------------

PLEASE RETURN THIS TO SCHOOL (FAVOR DE DEVOLVER ESTA PARTE A LA ESCUELA)

This signed statement is to verify that I have treated my child for head lice. I understand I must accompany my child to the health room for re-admission to school. He/she will be checked by the health room staff to verifythere are no live lice or viable nits. (Esta declaración firmada es para verificar que he dado tratamiento a mi hijo contra los piojos de cabeza. Entiendo que debo acompañar a mi hijo al salón de enfermería para que sea readmitido a la escuela. Él/ella será examinado por el personal del salón de enfermería para verificar que no haya piojos vivos ni liendres viables).

Student Name (Nombre del estudiante) Last (Apellido) First (Primer nombre) MI (Inicial) DOB (Fecha de nacimiento) School (Escuela)

Parent/Guardian Signature Date (Firma del padre/tutor) (Fecha)

An Equal Opportunity Agency (Una agencia de igualdad de oportunidad)

MED (07/23/14) FC-600-2375E/S (Rev. 06/22/16)

THE SCHOOL DISTRICT OF OSCEOLA COUNTY, FLORIDA MEDICATION REFRIGERATOR TEMPERATURE LOG

School

REFRIGERATOR TEMP – Keep Refrigerator Between 35°F to 46°F (2°C to8°C) Record Once Daily

Month/Year Month/Year

/ School Personnel (Please Print) Init

/ School Personnel (Please Print) Init

Original: Health Room An Equal Opportunity Agency FC-600-2378 (Rev.03/30/12)

Date Time Temp Initials 1 2 3 4 5 6 7 8 9

10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31

Date Time Temp Initials 1 2 3 4 5 6 7 8 9

10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31

THE SCHOOL DISTRICT OF OSCEOLA COUNTY, FLORIDA STUDENT MEDICATION TRANSFER LOG

THIS IS CONFIDENTIAL INFORMATION

Student Name: DOB:_ ID#: School

Medication Refer to Student Health Care Alert

Month

Date

AM Bus Personnel

(Initial)

School Personnel

(Initial)

PM Bus Personnel

(Initial)

Parent/ Guardian

(Initial)

Comments

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31

/ /

School Personnel (Please Print) Initial Parent/Guardian (Please Print) Initial

/ Bus Driver/Attendant (Please Print) Initial

/ Other (Please Print)

Initial

Original: Health Room An Equal Opportunity Agency FC-600-2410 Copy: District RN (09/22/08)

THE SCHOOL DISTRICT OF OSCEOLA COUNTY, FLORIDA MEDICATION CABINET KEY LOG

SCHOOL Month Year

Date Key Out

(Time/Initial) Returned (Time/Initial)

Key Out (Time/Initial)

Returned (Time/Initial)

Key Out (Time/Initial)

Returned (Time/Initial)

1 2 3 4 5 6 7 8 9

10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31

/ / School Personnel (Please Print) Initial School Personnel (Please Print) Initial

/ /

School Personnel (Please Print) Initial School Personnel (Please Print) Initial

/ / School Personnel (Please Print) Initial School Personnel (Please Print) Initial

Original: Health Room Copy: District RN An Equal Opportunity Agency FC-600- 2411(Rev. 03/30/12


PHYSICIAN’S ORDER FOR VAGUS NERVESTIMULATION

Date School School Year /


If the student is having a seizure as described on the Seizure Monitoring Form (FC-600-2371), the following actions are to be taken.

1. At the start of the seizure, remove the magnet from its storage device.

2. Swipe the magnet slowly over the generator located in the left upper chest, moving it fromthe: left shoulder to the right shoulder upper left shoulder in a downward motion towards the student’s left foot

3. Wait one minute for a response.

4. If no response, the process can be repeated times.

5. If the seizure activity lasts longer than minutes, call 911. Notify parent/guardian.

6. Additional Information

Physician’s Name Phone Fax

Physician’s Signature Date

District RN’s Signature Date

Original: District RN Copy: Health Care Assistant/Nurse An Equal Opportunity Agency FC-600-2473 (05/12/11)


PHYSICIAN’S ORDER FOR G-TUBE/J-TUBE

Date School School Year /


The above named student is enrolled in the Osceola County School District. His/her G-tube/J-tube requires aspiration precautions and individualized physician orders. Please outline the details of his/her care while at school.

Gastrostomy tube size FR cm

Formula Name

Feeding method/amount bolus gravity drip feeding pump (type of pump ) rate

Frequency

Flush yes no amount cc

Eats/drinks by mouth yes no

Medications via G-tube yes no

Per parent regimen yes no

Other considerations

Physician’s Name Phone Fax

Physician’s Signature Date

District RN’s Signature Date

Original: District RN Copy: Health Care Assistant/Nurse An Equal Opportunity Agency FC-600-2474 (Rev. 03/30/12)


STAFF ACKNOWLEDGEMENT OF TRAINING FOR THE ADMINISTRATION OF DIASTAT®

Date School

I am an employee of The Osceola County School District and have been designated by the principal/designee listed below and trained by the school nurse listed below to administer emergency Diastat® to the following student for the school year. I have current CPR and First Aid Certification.


Before administering Diastat®, the school nurse has:

Informed me of the student’s medical background and seizure care information.

Reviewed the Physician’s Order for Diastat® (FC-600-2370) for this student with me.

Provided me with a written procedure for administering Diastat®.

Trained me on all steps for the administration of Diastat®, demonstrated the procedure twice and observed my successful return of two demonstrations.

Informed me of the medical risks of the procedure to the student.

Answered all of my questions and concerns. I understand that the training for the administration of emergency Diastat® applies only to this student and that I cannot transfer this task to an untrained staff member. I believe I am capable to perform this procedure as trained.

Employee Signature/Title Date Trained

Employee Signature/Title Date Trained

Principal/Designee Signature/Title Date

District RN Signature Date

Original: District RN Copy: Health Room An Equal Opportunity Agency FC-600-2524 (12/10/13)


STUDENT SPECIFIC CHECKLIST FOR ADMINISTRATION OF DIASTAT®

Student Last Name First Name M.I.

DOB ID # School School Year

Trainee is consistently able to Yes No List the five rights of medication administration. Prior to administering Diastat® activate EMS (911). Notify parent/guardian and principal/designee.

Provide privacy curtain or drape. Obtain school personnel witness to stand by student. Put student on their side where they cannot fall. Get medicine (Diastat® kit) and gloves. (Do not leave student unattended.) Get syringe from kit. Push up with thumb and pull or remove protective cover from syringe.

Lubricate rectal tip with lubricating jelly. Turn person on side facing you. Bend upper leg forward to expose rectum. Separate buttocks to expose rectum. Gently insert syringe tip into rectum. Slowly count to 3 while gently pushing plunger in until it stops. Slowly count to 3 before removing syringe from rectum. Slowly count to 3 while holding buttocks together to prevent leakage. Keep student on side facing you, note time given, and continue to observe. Monitor circulation, airway, breathing.

The trainee agrees to follow the safety precautions in handling the medication.

Trainee’s Signature Date

District Registered Nurse Signature Date

Original: District RN An Equal Opportunity Agency FC-600-2525 (Rev.07/14/14)


DISTRICT RN MONTHLY REPORTING FORM

District RN Month/Year

TOTAL NUMBER OF SCHOOLS VISITED Elementary (5061) Staffing ESE Child (5052)

Middle (5062) First Aid Administration (5031)

High (5063) Complex Medical Procedure (5032)

Other-Upgraded (5064) Immunization follow-up (5033F)

School Health Staff Consultation (5051) (504 Meeting)

# Medication Administration (5030)

Record review new enrollees (0598)

Care Plans (5053) RN Evaluation & Intervention (5000)

Classroom Instructions:

# Classes (8020) # Students

Original: District RN Copies: Fax to Osceola County Health Dept. An Equal Opportunity Agency FC-600-2532 (02/13/14)

THE SCHOOL DISTRICT OF OSCEOLA COUNTY, FLORIDA REFERRAL FOR AUDIOLOGICAL

PART I: To be completed by referring person

Assessment Evaluation

Student # Student DOB Sex Last First M.

Date School Exceptionality Grade

Parent/Guardian Phone: Home Business

Address City Zip

1st Hearing Screening 2nd Hearing Screening

Date Date

Examiner Examiner

Results: pass fail Results: pass fail

Validity: consistent inconsistent Validity: consistent inconsistent

Observations: cold Observations: cold runny nose runny nose mouth breather mouth breather ear drainage ear drainage

Reason for referral:

Consent obtained: Yes. If yes, attach copy. No

Comments

PART II: To be completed by Audiologist

Parent Notification:

Date Method Note

Date Method Note

Date Method Note

Date Method Note

Date Method Note

Original: ESE office Copies: Cumulative folder FC-400-0556

Audiologist (Rev. 04/02) An Equal Opportunity Agency

Hz 1000 2000 4000

RE

LE

Hz 1000 2000 4000

RE

LE

THE SCHOOL DISTRICT OF OSCEOLA COUNTY, FLORIDA PROGRESS REPORT

REPORTE DE PROGRESO

Student # Student N° de Estudiante Estudiante Last/ Apellido First/ Nombre M./Inicial

Date DOB School Grade Fecha Fecha de Nacimiento Escuela Grado

Teacher Therapist (Name) Maestro/a Terapeuta (Nombre)

Physical Speech Language Adapted PE Vision Other Ocupacional Físico del Habla Lenguaje EF Adaptada Vista Otro

Original: ESE office / Oficina ESE FC-400-0558E/S Copies/Copias: Cumulative folder /Expediente Acumulativo (Rev.03/99)

Parent/Guardian / Padre/Tutor LI627 (04/02)

An Equal Opportunity Agency Una Agencia de Igualdad de Oportunidades

THE SCHOOL DISTRICT OF OSCEOLA COUNTY, FLORIDA MEDICATION LOG

Student #

Name:

School:

DOB: GR #

Care Giver: MTS#

Date Time Medication (Name)

Dosage (ie. 12mg/10 ICU)

Form (route) (pill, teaspoon, injection)

RX Signature/Title Billing #

ESE Office Use

Date: Date: Date: Date: Date:

Unit: Unit: Unit: Unit: Unit:

Other: Other: Other: Other: Other:

Original: Student Record FC 400-2069 Copy: Medicaid An Equal Opportunity Agency (Rev. 02/03)

THE SCHOOL DISTRICT OF OSCEOLA COUNTY, FLORIDA LPN DOCUMENTATION OF HEALTH SERVICES (T1003)

Signature Date

Title

Nursing Services Codes 1- Mobility Assistance 6-Tube Feedings 11-Blood Sugar Monitoring 15-Minor Emergency Management 2-Bowel/Bladder Care/Diapering 7-Nutritional/PO Feedings 12-Oral Suctioning 16-Consultation and Coordination with otherHealth 3-Skin Care 8-Maintenance/Suctioning ofTracheotomies/Ventilator 13-Management/Coordination of Chronic Health Care Care Staff, Parents, Teachers, Physicians, and 4-Cleaning/Hygiene 9-Oxygen Administration/Humidifier TXM Care 14-Crisis Intervention Documentation/Process Review 5-Urinary Catheterization 10-Nebulizer TXM

Date

Time of Service Beginning/Ending

Service Code

Place of Service check one

Length of Service in minutes

Student’s Reaction to Service

Notes/Comments with initial

Home Bus School

Normal

Abnormal

Home Bus School

Normal

Abnormal

Home Bus School

Normal

Abnormal

Home Bus School

Normal

Abnormal

Home Bus School

Normal

Abnormal

Home Bus School

Normal

Abnormal

Home Bus School

Normal

Abnormal

Home Bus School

Normal

Abnormal

Original: Student Chart Page 1 of 2 Copy: Medicaid FC 400-2108

(Rev. 11/04) An Equal Opportunity Agency

Date

Date

Date

Date

Date

Units

Units

Units

Units

Units

Student #

Name:

School:

DOB: Grade:

Nurse (print):

THE SCHOOL DISTRICT OF OSCEOLA COUNTY, FLORIDA LPN DAILY DOCUMENTATION OF HEALTH SERVICES (T1003)

Student Name Student ID# DOB Last First M.

Signature Date

School Grade

Nursing Services Codes 1- Mobility Assistance 6-Tube Feedings 11-Blood Sugar Monitoring 15-Minor Emergency Management 2-Bowel/Bladder Care/Diapering 7-Nutritional/PO Feedings 12-Oral Suctioning 16-Consultation and Coordination with other Health 3-Skin Care 8-Maintenance/Suctioning of Tracheotomies/Ventilator 13-Management/Coordination of Chronic Health Care Care Staff, Parents, Teachers, Physicians, and 4-Cleaning/Hygiene 9-Oxygen Administration/Humidifier TXM Care 14-Crisis Intervention Documentation/Process Review 5-Urinary Catheterization 10-Nebulizer TXM

Date

Time of Service Beginning/Ending

Service Code

Place of Service check one

Length of Service in minutes

Student’s Reaction to Service

Notes/Comments with initial

Home Bus School

Normal

Abnormal

Home Bus School

Normal

Abnormal

Home Bus School

Normal

Abnormal

Home Bus School

Normal

Abnormal

Home Bus School

Normal

Abnormal

Home Bus School

Normal

Abnormal

Home Bus School

Normal

Abnormal

Home Bus School

Normal

Abnormal

Home Bus School

Normal

Abnormal

Home Bus School

Normal

Abnormal

Home Bus School

Normal

Abnormal

Home Bus School

Normal

Abnormal

Original: Student Chart Page 2 of 2 Copy: Medicaid FC 400-2108

(Rev. 11/04) An Equal Opportunity Agency


SPECIAL DIETARY REQUEST FORM

7 CFR 210.18(g)(2) and 7 CFR 220.8(a) under USDA Federal Regulations states that meals served to students must contain all meal components. Special dietary requests may be made but it must be supported by a statement which explains the food substitution that is requested. It must be signed by a recognized medical authority.

The medical statement must include:

• An identification of the medical or special dietary condition which restricts the child’s diet • The food or foods to be omitted from the child’s diet • The food or choice of foods to be substituted

We need you to provide for us the food item to replace the food the child is to avoid (for example, child is lactose intolerant – no milk – what would you recommend as a substitute).

Student’s Name

Date of Birth ID#

Teacher’s Name

School Name Special Diet or Dietary Restrictions

Food Allergies or Intolerances

Food Substitutions

Foods Requiring Texture Modification:

The above student has been identified by me as having a food intolerance/allergy. The determination of the appropriate food to substitute for this intolerance is listed above.

White: School Nurse An Equal Opportunity Agency FC-230-2390 (03/17/08) Yellow: Campus Grille Pink: Food Service Manager

Signature of Physician or Medical Authority:

Name

Telephone

Fax Date:

For School Use Only Date: Manager’s Signature


Section 13

Immunizations Immunization guidelines for Florida schools are reviewed and updated annually by the Florida Department of Health. The current information will be available in the Rules of Enrollment on the School District’s website www.osceola.k12.fl.us. Go to “Parent Links” then “Registration Information” to view and/or print the current “Rules of Enrollment”.


Revised July 2020

http://www.osceola.k12.fl.us/


Section 14

Abuse Reporting Procedure

Please follow the Abuse Reporting Procedure and contact your Administrator to access the new electronic version of the

Child Abuse and Incident Referral Report


Revised July 2020


Section 15

Procedures for Threat to Self or Others


July 2020


Protocol for Threat Assessments ...................................................................... 1

Protocol for Threat Assessments

Threat Assessment to Others Threat Assessment to Self Paperwork –Comprehensive School Threat Assessment

Form (CSTAG) Paperwork - Columbia Suicide Severity Rating Scale and Student

Services Forms (FC600) Initiated by – Person receiving or witnessing the threat.

Report immediately verbally, in person or by phone to Admin or Dean.

Initiated by – Person receiving or witnessing the threat. Report immediately verbally, in person or by phone to Counselor, Social Worker, or School Psychologist for evaluation. Once the Counselor believes there may be a threat, they should consult with 1 other Counselor. If both feel there is a threat to self, they must alert Principal and SRO to convene the TA Team.

Conducted by – Person who is working with the threat (dean or administrator) & TA Team

Conducted by – Counselor, Social Worker, School Psychologist & TA Team

If Team Determines Transient – Complete CSTAG and the TA Team should develop any necessary Behavior or Monitoring Plan. Discipline if determination is made by Admin.

If Team Determines Yellow or Orange–and not a Threat to Self - complete paperwork (Call or meet with Parents) and notify administrator and SRO. If Team Determines Yellow or Orange and there is a threat to self, they must alert Principal and SRO to convene the TA Team.

If Team Determines Substantive or Serious Substantive –TA Team completes CSTAG including Behavior Intervention Plan & Mental Health Referral as prescribed by the CSTAG Guidelines Handbook.

If Team Determines Red –TA Team determines Release to Parent or Baker Act

If a Threat to Self becomes a Threat to Others, complete the CSTAG paperwork including the mental health status

All participants of the Threat Assessment should sign paperwork

All participants of the Threat Assessment should sign paperwork

Upload Threat Assessment Form to My Resources School.IDNumber.Date

Upload Colombia and District Paperwork (Parent Consultation Form, Release to Parent, or Release to Law Enforcement) to My Resources School.IDNumber.Date

Place Forms in Blue Threat Assessment Folder in Principal’s Office

Place Forms into Blue Threat Assessment Folder in Principal’s Office

Make appropriate notations in Counselor or Social Work Notes

Make appropriate notations in Counselor or Social Work Notes.

THINGS THAT ARE IMPORTANT

Signatures of everyone involved and dates must be on the form

Notify Administrators and SRO with Threat Assessment to Others and/or Threat Assessment to Self

Upload all forms to My Referrals, Threat Assessment folder and place in Blue Folder in

Principal’s office.

12/09/2019

The School District of Osceola County, Floridamaterosc.entest.org/School Health Manual Revision...

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