Resources for School Nurses :: San Diego Unified School District

Nursing and Wellness > Resources for School Nurses

Resources for School Nurses

Parent Resources:

•	School Health Information
•	School Nurse Profile
•	Facts for Families (source: American Academy of Child & Adolescent Psychiatry)

Health Topics
Health & Medical Reference
Calendars & Schedules
Forms & Forms Notebook
Specialized Physical Health Care Procedures (SPHCS) Manual
Related Organizations

Health Topics

Immunizations

Health & Medical Reference

Calendars & Schedules

Forms & Forms Notebook

(PARD) Project for Attention Related Disorders

HE 1000 — HIPPA-Release of Information – Attention/Behavior: English | Spanish
HE 1001 — Parent Questionnaire: English | Spanish
HE 1002 — Parent Follow-Up Information: English
HE 1003 — School Questionnaire
HE 1004 — School Follow-Up Information
School Medical Referral for Behavior Evaluation

Anaphylaxis

Anaphylaxis Emergency Notebook
HE 490 — Emergency Medication Log
HE 801 — Authorization for use or disclosure of health information to and from schools: English | Spanish
HE 806 — Physician's Recommendations For Medication
SP #5: SPHCS Parent Waiver of Responsibility: English | Spanish
Individualized School Healthcare Plan

Asthma

HE 220 — Asthma Action Plan: English | Spanish
HE 221 — Asthma Letter to Parents (Old Town/Balboa Park Programs): English | Spanish
HE 222 — Case Management Flow Sheet
HE 223 — Dear Doctor - Asthma Affecting Performance
HE 224 — Dear Parent - We've Missed Your Child at School!: English | Spanish

Beginning of School Year Forms

HE 643 — Request for Email Contact Person
HE 644 — Instructions for Substitute Nurse
HE 645 — Health Office Substitute Nurse Information
HE 646 — Ordering Forms
HE 647 — 2008-09 Program Planning Calendar
HE 648 — 2008-09 Nursing Activities Calendar
HE 650 — Frequently Used Resources

Child Abuse

HE 200 — Child Abuse - Annual Inservice Report
HE 201 — Suspected Child Abuse Reporting Instructions
Suspected Child Abuse Form: (PDF | Word )

Child Health and Disability Prevention (CHDP)

HE 900 — Program Procedure
HE 901 — Letter - Important Information for Parents of Kindergarten and First Grade Students:
English | Spanish
CHDP Eligibility Table (April 2008)
Report of Medical Examination for School Entry ("Green" form):
English | Spanish
School Entry Health Checkups (Parent Information)
English | Spanish
CHDP Annual Report
HE 902 — First Grade Exam Notice of Failure to Comply: English | Spanish
School Material Request Form
HE 903 — Notice of Exclusion from School Attendance: English | Spanish

Communicable Disease/Illness/Rash

HE 500 — Communicable Disease Information Log of Notices Sent Home
HE 502 — Parent Letter Regarding Infectious Disease or Infestation
HE 503 — Conjunctivitis Information: English | Spanish
HE 504 — Cytomegalovirus (C.M.V.) Infection
HE 505 — Diarrhea and Vomiting: English | Spanish
HE 506 — Facts About Fifth Disease (Erythema Infectiosum)
HE 507 — Hepatitis Fact Sheet: English | Spanish
HE 509 — Information on Meningococcal Disease for Sharing: English | Spanish
HE 510 — Information Sheet on Infectious Mononucleosis (Mono): English | Spanish
HE 511 — MRSA At School: English | Spanish
HE 512 — Mumps Information Fact Sheet: English | Spanish
HE 513 — Guidelines for Suspected Neurological Impairment
HE 514 — Answering Parents' Questions About Colds, Flu, and When to Keep a Child Home: English | Spanish
HE 515 — Should You Send Them to School? English | Spanish
HE 516 — Pinworms Fact Sheet: English | Spanish
HE 517 — Ringworm Fact Sheet: English | Spanish
HE 518 — Scabies Fact Sheet: English | Spanish

Consent Forms

HE 613 — HIPAA - Authorization for Release of Information: English | Spanish
HE 614 — Caregivers Authorization Affidavit: English | Spanish
HE 615 — Consent for Emergency Medical Treatment: English | Spanish
HE 616 — Motor Skills Assessment Permit: English | Spanish
HE 617 — Transportation Request and Consent: English | Spanish

Dental

Happy Smile - Did You Know?
Happy Smile Evaluation Form
Happy Smile Instructions
Happy Smile Invitation
Happy Smile Permission Slip: English | Spanish
Happy Smile Toothbrush Contract: English | Spanish
Happy Smile Welcome Letter
Weekly Fluoride Instructions
2007-08 Flouride Calendar
Oral Health Assessment (OHA)
- HE 910 - CHDP/OHA Summary of Programs
- HE 911 - Parent Letter:
  English | Spanish
- HE 912 - Oral Health Assessment / Waiver Request Form
  English | Spanish
- HE 913 - Oral Health Assessment Report Form: PDF | Word
- HE 914 Oral Health Assessment/Waiver Request Form Guidelines
- Dental Care Resources: ()
  San Diego County A-Z | Central County | East County | North County | South San Diego
Dental Inspection:
22HO475 English | 22HO475sp Spanish

Diabetes

HE 230 — Blood Glucose Testing - Algorithms for Blood Glucose Results
HE 231 — Information for Parents of Students with Diabetes
HE 232 — Blood Sugar Log: 2008-09
HE 233 — Diabetes Monitoring Log
HE 234 — Diabetes Monitoring Log for Insulin Pump
Diabetes Notebook (full contents)
HE 235 — Parent Consent and Physician Authorization: English | Spanish
HE 613 — HIPAA - Authorization for Release of Information: English | Spanish

First Aid/Health Information

Allergy to Latex
Anaphylaxis Emergency Protocol
Answering Parent Questions About Colds, Flu and When to Keep a Child Home: English | Spanish
Bee Sting Local Reaction Protocol
Bloodborne Disease Prevention: English | Spanish
Communicable Disease Information: English | Spanish
Conjunctivitis Fact Sheet: English | Spanish
Criteria For School Attendance for Health Reasons: English | Spanish
Cytomegalovirus Fact Sheet
Dental Emergency Procedures: English | Spanish
Diarrhea and Vomiting: English | Spanish
Fifth Disease Fact Sheet: English | Spanish
First Aid Protocol
Fractures: Common Symptoms and First Aid
Guidelines for Jog/Walk-A-Thon
Head Injury - Parent Notification: English | Spanish
Heat Cramps Fact Sheet: English | Spanish
Heat Exhaustion Fact Sheet: English | Spanish
Heat Stroke Fact Sheet: English | Spanish
Hepatitis Fact Sheet: English | Spanish
Human Bite Management in Schools
Impetigo Fact Sheet: English | Spanish
Infectious Mononucleosis: English | Spanish
Medical Referral: English
Meningococcal Disease: English | Spanish
Methicillin-Resistant Staphyloccus Aureus (MRSA) at School: English | Spanish
Mumps Fact Sheet: English | Spanish
Neurological Impairment
Parents' Guidelines To Cold and Flu Season: English | Spanish
Pinworms Fact Sheet: English | Spanish
Proper Food Handling Techniques and Practices
Ringworm Fact Sheet: English | Spanish
Scabies Fact Sheet: English | Spanish
Should You Send Them to School? English | Spanish
Staff Guidelines for Prevention of Disease
When To Call 911 for Medical Reasons

HIV

AIDS/HIV Communication Flow Chart - Employee
AIDS/HIV Communication Flow Chart - Student: English | Spanish
AIDS/HIV Consent for Disclosure - Student: English | Spanish
HIV/Hepatitis B - Annual Update to Staff

Hearing Forms

Audiometry Work Sheet
Clinic Appointment Application: English | Spanish
Hearing Test Appointment Application: English | Spanish

Immunization

Consent Form: English | Spanish
Dear Doctor - Immunization Requirements
Exclusion List
Notice of Exclusion from School Attendance: English | Spanish
Notice of Failure to Comply: English | Spanish
Notice of Immunization Due: English | Spanish
Parent Questionnaire: History of Chicken Pox Disease
Post Immunization Instructions For Parents: English | Spanish
Protocol for Chicken Pox Evaluation
Report Of Illness Following Immunization
Tetanus Boosters in School for Contaminated Wounds
Vaccine Adverse Event Reporting System (VAERS)
Vaccines for Children (VFC) Program - Patient Eligibility Screening Record

Medications

HE 613 — Emergency Medication Log
Medication Log: 2008-09
OTC Medication Protocol
OTC Medication Log
Physician's Orders For OTC Medications (For School Nurse Use Only)
HE 806 — Physician's Recommendations For Medication
Preventative Directly Observed Therapy (DOT) Medication Log
Short-Term Medication: English | Spanish
Steps in School Medication Administration
Request for Short-Term Medications: English | Spanish

Miscellaneous

Communicable Disease Information Log of Notices Sent Home
Confidential Nursing Notes
Dear Parent - Child Believed to Be Infected or Infested
Excessive Absence Due to Illness: English | Spanish
Excessive Absence Due to Illness - Second Notification: English | Spanish
Health Office Daily Log - A | B
Nurse Availability: English | Spanish
Nursing Activities Calendar
Nursing Medical Alert to Administrator
Operation School Bell Recommendation Form
Post-Op Instructions For School
Refrigerator/Freezer - Temperature Recording Chart
Universal Precautions

Pediculosis

Communicable Disease Log: Pediculosis
Dear Doctor - Resistant Head Lice
Dear Parent - Notification of Lice in Classroom: English | Spanish
Dear Parent - Your Child Discovered to Have Pediculosis: English | Spanish
Dear Parent -Your Child May Return to Class
Dear Parent -Your Child Still Has Active Lice: English | Spanish
District Policy: English | Spanish
Instructions for Treatment: English | Spanish

Pregnancy Forms

Report Forms

Scoliosis

Dear Parent - Spinal Screening Program Referral/Follow-Up: English | Spanish
Dear Parent - Spinal Screening Program Notice: English | Spanish
Dear Parent - Spinal Screening Results: English | Spanish
Scoliosis Information Sheet: English | Spanish
Scoliosis Screening Report

Special Education

Clinical/Classroom Observation Data Sheet
Developmental History for the Adolescent: English | Spanish
Guidelines of Contract Care for Students with Exceptional Needs
Health and Developmental History for Special Ed Referrals: English | Spanish
Health Assessment Template
Health History Update: English | Spanish
Teacher Evaluation of Student Behavior

Tuberculosis (TB) Skin Test

Attachment to Medication Log for Directly Observed Therapy Chemoprophylaxsis - INH Toxicity Review
Preventative Directly Observed Therapy (DOT) Medication Log
Tuberculin Skin Test Informed Consent: English | Spanish
Tuberculin Skin Test Permission Form: English | Spanish
Tuberculin Skin Testing Schedule 2007-08
Tuberculin Skin Test Sign-in Sheet

Vision Forms

Clinic Appointment Application: English | Spanish
Rest Haven Glasses Fund Application: English & Spanish
Report of Color Perception Test: English | Spanish
#2587 Vision Screening Report: English | Spanish

Specialized Physical Health Care Procedures (SPHCS) Manual

#1: SPHCS Checklist
#2: Individual Treatment Log
#3: Inservice & Monitoring Log
#3a: Procedure for Documentation of Competency in Performing SPHCS
#4: Parent Request for SPHCS: English | Spanish
#5: SPHCS Parent Waiver of Responsibility: English | Spanish
#6: Physician's Authorization for Gastrostomy
#7: Physician's Authorization for SPHCS (Other than Gastrostomy)

Gastrostomy Tube

Seizure Management (DIASTAT & VNS)

Related Organizations