Alabama State Department of Education A labama School Health Services Resource/Guidelines Manual

1. Taskforce One Year Later Alabama State Department of Education Alabama School Health Services Resource/Guidelines Manual

2. Caitlin Cauthen • Charlene Young • Diana Collins • Jan Peterson • Janis C. Ward • Lesa Cotton • Margaret Guthrie • Sharon Dickerson • Sherry McWhorter • Theresa Thompson RESOURCE GUIDELINES TASK FORCE

3. Barbara Robertson • Brenda Caudle • Diana Collins • Janis C. Ward • Lesa Cotton • Margaret Guthrie • Sherry McWhorter • Wanda Hannon Subcommittee TASK FORCE

4. Committee Members and Local Education Agencies The State Board of Education members and the State Department of Education appreciate the time and effort expended by our committee members. We also appreciate the local superintendents who allowed these members time to participate in this project.

5. The material presented may be the first step in the development of local guidelines and procedures. • It is not intended as a substitute for local board policies and procedures, nor advice of counsel. Resource Guidelines

6. This manual is designed to serve as a guide • To ensure its usefulness, we solicited the assistance of selected school nurses from the local board of education level and our own department Resource Manual

7. This manual represents the committee’s attempt and recommendation to organize information from various sources • Resource Guide : Index • Tool to facilitate structure Word Documents

8. Section 1 • Alabama State Department of Education • Alabama Board of Nursing • Alabama Course of Study • Laws and References • Act No 2014-405 HB0156 Enacted Anaphylaxis Preparedness • Act No 2014-274 SB0075 Enacted Meningococcal (Jessica Elkins Act) • Act No 2014-437 SB0057 Enacted Safe at Schools • Rescind Attorney General Opinion 2006-127 Table of Contents

9. Section 2 • School Health Overview • AED/ CPR • Assessment (Form) Health Assessment Record HAR Memo and Act No 2009-280 • Communicable Flu Lice Reportable Diseases • Documentation Records of Disposition Table of Contents

10. 6. Emergency Action Plans Anaphylaxis – Act No 2014-437 Anaphylaxis Preparedness , EpiPen Diabetes – Act No 2014-437 Alabama Safe at Schools Act (Move to SAMPLES IN SECTION 3) Seizures - Diastat 7. First Aid (Form) First Aid 8. Immunization Immunization Memo, Law and schedule Act No 2014-274 SB 0075 Jessica Elkins Act (Meningococcal info to parents) 9. Medications 10. Procedures VNS 11. Screenings Scoliosis (Form) Vision and Hearing Section 2 (continued)

11. Section 3 • Index • Web Resources • Opinions / Memorandums / Local Education Agency Samples (Statewide and/or Local Education Samples) Table of Contents

12. Resource Guidelines Task Force and Subcommittee Taskforce One Year Later

13. Medication Curriculum Forms • Prescriber Parent Authorization Medication • Prescriber Parent Authorization Procedures: • Catheterization • G-tube • Tracheostomy Care • Vagus Nerve Stimulator (VNS) • Unusual Occurrence Report Taskforce One Year Later

14. STUDENT INFORMATION Student’s Name:________________________ School: _______________Date of Birth:_____/_____/______ Age: _____ Grade: ____ Teacher: __ No known drug allergies---if drug allergies list: ______________ WEIGHT: _____POUNDS REVISION: □CHECK BOX ADDED TO DRUG ALLERGY INFORMATION IN ATTEMPT TO ENSURE THIS INFORMATION IS PROVIDED BY PARENT.

15. PRESCRIBER AUTHORIZATION (To be completed by licensed healthcare provider) REVISIONS:

16. PARENT AUTHORIZATION Prescription Medication must be registered with School Nurse or trained Medication Assistants. Prescription medication must be properly labeled with student’s name, prescriber’s name, name of medication, dosage, time intervals, route of administration and the date of drug’s expiration when appropriate.Over the Counter Medication must be registered with the School Nurse or Trained Medication Assistant, OTC’s in the original, unopened and sealed container. Local Education Agency Policy for OTC medication to be followed:Parent’s/Guardian’s Signature: ___________________________Date: ___/___/___ Phone: ( ) _______-_______ REVISIONS: • Separate instructions provided for packaging and delivery of Rx & OTC meds • Retained language related to authorization for school nurse to administer medication and/or to delegate task to trained unlicensed personnel in accordance with ABN administrative code practice guidelines.

17. SELF-ADMINISTRATION AUTHORIZATION • (To be completed ONLY if student is authorized to complete self-care by licensed healthcare provider.) I authorize and recommend self-medication by my child for the above medication. I also affirm that he/she has been instructed in the proper self-administration of the prescribed medication by his/her attending physician. I shall indemnify and hold harmless the school, the agents of the school, and the local board of education against any claims that may arise relating to my child’s self-administration of prescribed medication(s). Revisions: • Parenthetical instruction added: (To be completed ONLY if student is authorized to complete self care by licensed healthcare provider).

18. SELF-ADMINISTRATION AUTHORIZATION • (To be completed ONLY if student is authorized to complete self-care by licensed healthcare provider.) I authorize and recommend self-medication by my child for the above medication. I also affirm that he/she has been instructed in the proper self-administration of the prescribed medication by his/her attending physician. I shall indemnify and hold harmless the school, the agents of the school, and the local board of education against any claims that may arise relating to my child’s self-administration of prescribed medication(s). Revisions: • Parenthetical instruction added: (To be completed ONLY if student is authorized to complete self care by licensed healthcare provider).

19. SCHOOL PROCEDURE PRESCRIBER/PARENT AUTHORIZATION FORMS CLEAN INTERMITTENT CATHETERIZATION GASTROSTOMY TUBE CARETRACHEOSTOMY CAREVAGUS NERVE STIMULATOR • UTILIZE THE SAME FORMAT AS THE MEDICATION AUTHORIZATION FORM • LANGUAGE VARIES IN THE PARENT AUTHORIZATION SECTION AND THE SELF-ADMINISTRATION SECTION, TO REMAIN CONSISTENT WITH ABN ADMINISTRATIVE CODE PRACTICE GUIDELINES

20. Health Assessment Record