Nurse Services Department

Sarena Muzzi
 

Colfax Elementary Website -Departments & Services -Add: Nursing Services or Health Services 

3 Different Sections: Vaccine Information, IHCP Information, Medication Information.

Vaccine Information 

What are the diseases tetanus, diphtheria and whooping cough (pertussis)? 

  • Tetanus – (also called lockjaw) causes painful tightening of the muscles. It can lead to “locking” of the jaw so the person cannot open his/her mouth or swallow. 
  • Diphtheria – is a throat infection that can lead to breathing problems, paralysis, heart failure and death. 
  • Whooping cough – (also called pertussis) is a contagious disease that causes violent coughing fits that make it hard to breathe. It spreads easily when someone with the disease coughs or sneezes. Symptoms can last for months. Whooping cough is very dangerous for young babies. 

When should my child get vaccinated? 

Now's the time! A large number of students need a Tdap and other shots to start school. Keep documentation of your child’s vaccinations in a safe place. Your child will need proof of immunization. 

Can my child be exempted? 

Yes, but it is not recommended. There are several means by which a parent can exempt their child. Please check in at your school office for more information. 

Why should my child get vaccinated? 

In addition to it being a requirement for school, children who get a Tdap booster shot will be better protected during their school years. Immunization also helps to protect others within the home, in the community, and at school. 

Where can my child get vaccinated? 

Children should visit their regular doctor or health care provider to get a vaccination. Children 18 years old and younger who are uninsured or underinsured may qualify for the Vaccines for Children Program. To find a provider near you, call 1-877-243-8832. 

Where can I go for more information? 

Visit the California Department of Public Health, Immunization Branch website at https://www.cdph.ca.gov/Programs/CID/DCDC/Pages/immunize.aspx

 

ICHP Information 

What is an IHCP? 

IHCP stands for individualized health care plan. It is a document that is created to support your student and their health in the educational environment. 

Who should have one? 

Students with mild to severe health care needs and require frequent nursing services at school, or students who have health conditions that have the potential to result in a medical emergency. Each IHCP is individualized to meet the needs of the student. 

What is the purpose of an IHCP? 

The IHCP helps assure consistent and safe health care for the student, and sets procedural guidelines that provide specific directions about what to do in a particular emergency. IHCPs are provided to your student’s teachers each school year. 

Conditions that merit an IHCP: 

Seizures, Asthma, Diabetes, Irritable bowel syndrome (ex: Crohn’s Disease or Ulcerative Colitis), Heart related issues, Severe Allergic Reactions (ex: bee stings, food allergies), History of fainting, Bleeding, Blood issues, Concussions. 

Conditions that IHCP is not created for: 

ADHD/ ADD, mental illness or mental issues. 

What to do if you think your student needs an IHCP: 

Contact the school nurse with your concerns or if you just want the nurse’s opinion. Email: smuzzi@colfax.k12.ca.us

 

Medication at School 

Can my student take medication at school? 

Yes, but with certain limitations. Designated school personnel may administer prescription or over-the-counter medication to a student upon written request of the student’s parent/guardian and health care provider only when the medication is in the original container and clearly labeled. 

What medications is my student allowed to carry themselves? 

Students who self-carry medication are still required to have completed paperwork turned in. Students are only permitted to carry the following medications: asthma inhalers, insulin, glucagon, and Epi-Pens. Students are not permitted to carry any other prescribed OR over-the-counter medication on a school campus. 

What is the process for obtaining permission for my student to take medication? 

First check with your student’s doctor that it is recommended for your child to receive this medication at school. Your student’s doctor will need to fill out our district medication authorization form and complete all areas. Once the form is fully completed, please bring a copy of the form along with your student’s medication in a clearly labeled container to the office. 

Where do I get a copy of the medication authorization form? 

You can find an electronic version of the form below. If you are unable to access the electronic version, we always have hard copies of the form in the front office.

 

ADA Text Version of Medication Authorization Form below:

 

 

COLFAX ELEMENTARY SCHOOL DISTRICT

24825 Ben Taylor Road, Colfax, CA 95713 (530) 346-2202 FAX (530) 346-2205

 

ADMINSTRATION OF MEDICATION BY SCHOOL PERSONNEL

PHYSICIAN’S ORDERS MUST BE RENEWED ANNUALLY

 

DESIGNATED SCHOOL PERSONNEL MAY ADMINISTER PRESCRIPTION OR OVER-THE-COUNTER MEDICATION TO STUDENTS UPON WRITTEN REQUEST OF THE STUDENT’S PARENT/GUARDIAN AND PHYSICIAN ONLY WHEN THE MEDICATION IS IN THE ORIGINAL CONTAINER.

 

PARENT REQUEST: AS THE PARENT/GUARDIAN OF                                                                                                                

Name of Student

DATE OF BIRTH                                                       , I REQUEST THAT MEDICATION BE ADMINISTERED TO MY CHILD IN ACCORDANCE WITH HIS/HER PHYSICIAN’S INSTRUCTIONS.

 

Print Physician’s Name                                                                            Physician’s Phone                                  Physician’s FAX                                    

I grant permission for an authorized district representative to communicate directly with this student's authorized health care provider and pharmacist, as may be necessary, regarding the authorized health care provider's written statement or any other questions that may arise with regard to the medication

 

I understand how district employees will administer or otherwise assist this student in the administration of medication and that I may terminate consent for such administration at any time.

 

I acknowledge and understand my responsibilities to enable district employees to administer or otherwise assist the student in the administration of medication including, but not limited to, the parent/guardian's responsibility to provide a written statement from the authorized health care provider, to ensure that the medication is delivered to the school in a proper container by an individual legally authorized to be in possession of the medication, and to provide all necessary supplies, equipment and information.

 

Print Parent/Guardian’s Name                                                                              Parent/Guardian’s Signature                                                                                                                    

 Date:                                                        

 

 PHYSICIAN’S INSTRUCTIONS: PATIENT’S NAME                                                                           DATE OF BIRTH                                                                                                         

 

DATE OF REQUEST                                         MEDICATION TO BE CONTINUED AS PRESCRIBED UNTIL                                                                                

 

CONDITION(S) FOR WHICH THE DRUG IS TO BE GIVEN :
                                                                                                                                                                                                                                             

 

MEDICATION:                                                                                                                                                                                                                                             

(Complete any applicable sections on reverse side)

 

DOSAGE, ROUTE, & TIME SCHEDULE OF ADMINISTRATION
                                                                                                                                                                                                                                                                             

 

POSSIBLE SIDE EFFECTS                                                                                                                                                                                                                                          

 

The above medication cannot be scheduled for other than during school hours and may be administered by medically untrained school personnel.

 

For medication that is to be administered on an as-needed basis, indicate the specific symptoms that would necessitate administration of the medication, allowable frequency for administration, and indications for referral for medical evaluation.

 

__________________________________________________________________________________________________________________________________________

 

 

Physician’s Name (please print) ________________________________  Physician’s Signature __________________________________ Date _________________Phone Number___________________

 

FAX Number _____________________   Physician’s Address _______________________________________________________________________________________________________________

 

Additional consent to carry/self administer medication, consent for non employee to administer medication, and consent to administer emergency antiseizure medication on reverse side.

 

 

CONSENT TO CARRY/SELF ADMINISTER EMERGENCY MEDICATION

 

If a parent/guardian requests that his/her child be allowed to carry and self-administer prescription auto-injectable epinephrine or prescription inhaled asthma medication, the parent/guardian and physician complete the following statement: (Education Code 49423, 49423.1)

 

The student,                                                                                 has been instructed in the proper use of his/her inhaler or auto-injectable epinephrine. The child’s well-being is in jeopardy unless this medication is carried on his/her person. We request that he/she be permitted to carry the medication.. He/she understands the purpose, appropriate method, and frequency of use of this medication. Also, for the safety of other students, he/she will be responsible for keeping the medication in his/her possession at all times on campus.

 

I permit my child to carry the medication listed on the reverse side as ordered by his/her physician. I release the district and school personnel from civil liability if the student suffers an adverse reaction as a result of self-administering the medication. I understand that sharing medication with other students will result in disciplinary action.

Parent/Guardian Signature:                                                                                                                           Date:                                                   Physician’s Signature:                                                                                        Date:                                                                                                                           

 

 

Physician’s Signature:                                                                                           Date:                                                                                                                             



CONSENT FOR A NON EMPLOYEE OF THE DISTRICT TO ADMINISTER MEDICATION

 

Please allow the following person to sign in to the school office to administer the medication described on the reverse side of this form to my child. This person has agreed to accept this designation.

 

Name:                                                                                     Daytime Phone:                                               

Any limitations on this individual's authority ______________________________________________________________________________________________________________

 

Parent/Guardian Signature:                                                                                        Date:                           


AUTHORIZATION FOR A DISTRICT EMPLOYEE TO ADMINISTER EMERGENCY ANTISEIZURE MEDICATION TO A STUDENT (Education Code 49414.7)

 

Student’s name:                                                                     Date of Birth:                                                    

Regarding the administration of the emergency antiseizure medication described on the reverse side of this form:

 

Provide detailed seizure symptoms, including frequency, type, or length of seizures that identify when the administration of the medication becomes necessary.

 

 

 

 

 

Provide protocol for observing the student after a seizure, including, but not limited to, whether he/she should rest in the school office or return to his/her class, the length of time for direct observation, and a requirement to contact the school nurse and the student's parent/guardian to continue the observation plan

 

 

 

 

 

Physician’s Signature:                                                                                           Date:                                                                                                                             

 

COLFAX ELEMENTARY SCHOOL DISTRICT

24825 Ben Taylor Road, Colfax, CA 95713 (530) 346-2202 FAX (530) 346-2205

 

Parent/Guardian: Please read entire instructions and form before completing.

 

Medical treatment is the responsibility of the parent and the family physician. Medications are rarely given at school. The only exceptions involve special or serious problems where it is deemed absolutely necessary to give the medication.

 

A school nurse often serves more than one school and is not be available every day to administer medications. Thus, the principal or secretary might be the person who administers it. They cannot be expected to assume the responsibility unless it is absolutely necessary. Consequently, the parent is urged, with the help of the family physician, to work out a schedule of giving medication outside school hours.

 

The definition of “medication” may include not only a substance dispensed in the United States by prescription, but also a substance that does not require a prescription, such as over-the-counter remedies, nutritional supplements, and herbal remedies. (5 CCR 601)

 

With the parent/guardian's consent, the school nurse or other designated employee may communicate with the student's physician regarding the medication and its effects and may counsel school personnel regarding the possible effects of the medication on the student's physical, intellectual, and social behavior, as well as possible behavioral signs and symptoms of adverse side effects, omission, or overdose.

 

 

Parent/Guardian Responsibilities

 

The responsibilities of the parent/guardian of any student who may need medication during the school day shall include, but are not limited to:

 

  1. Each year, providing required parent/guardian and authorized health care provider written statements by completing the ADMINISTRATION OF MEDICATION BY SCHOOL PERSONNEL form In addition, the parent/guardian shall provide a new authorized health care provider's statement if the medication, dosage, frequency of administration, or reason for administration changes. (Education Code 49414.5, 49414.7, 49423, 49423.1; 5 CCR 600)

 

  1. If the student is on a continuing medication regimen for a nonepisodic condition, informing the school nurse or other designated certificated employee of the medication being taken, the current dosage, and the name of the supervising physician. (Education Code 49480)

 

  1. If the student suffers from epilepsy, notifying the principal or designee whenever the student has had an emergency antiseizure medication administered to him/her within four hours before a school day. (Education Code 7)

 

  1. Providing medications in properly labeled, original containers along with the authorized health care provider's instructions. For prescribed or ordered medication, the container also shall bear the name and telephone number of the pharmacy, the student's identification, and the name and phone number of the authorized health care

 

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