Health Services and Programs Manual
Section 0 Cover Page, Receipt, Table of Contents
Section 1 General Information
- 1 Table of Contents.docx
- 2 Mission & Vision Statement.docx
- 3 Program Overview.docx
- 4 Director of Health Services.docx
- 5 Nurse Specialist.docx
- 6 Credentialed School Nurse.docx
- 7 Activities Credentialed School Nurse.docx
- 8 Licensed Vocational Nurse.docx
- 9 Health Services Assistant.docx
- 10 Activities of Health Services Assistant.docx
- 11 Orientation Checklist School Nurse.docx
- 12 Orientation Checklist Health Assistant.docx
- 13 FILLABLE Nurse Buddy Schedule
- 14 FILLABLE Informal Observation Checklist
Section 2 Ed Code Policies and Standards
Section 3 Medications
- 1 Table of Contents.docx
- 2 Administration of Medications to Students in School.docx
- 3 Procedure for Medications in School.docx
- 4 FILLABLE Medication Administration Training for Unlisensed Assistive P...
- 5 Procedure for Medication Treatment Error.docx
- 6 FILLABLE Medication Special Procedure Training Documentation
- 7 FILLABLE Med Special Procedure Sign Off
- 8 FILLABLE Medication Required During School Hours English
- 9 FILLABLE Medication Required During School Hours Spanish
- 10 FILLABLE Medication Log - SEIS form
- 11 FILLABLE Inhaler-Nebulizer Administration Log form
- 12 FILLABLE Asthma Inhaler-Auto Injector-Emerg Meds Carried By Student English
- 13 FILLABLE Asthma Inhaler-Auto Injector-Emerg Meds Carried By Student Spanish
- 14 FILLABLE Asthma Inhaler Waiver Liability English
- 15 FILLABLE Asthma Inhaler Waiver Liability Spanish
- 16 FILLABLE Inhaler Sign Off Sheet
- 17 FILLABLE Inhaler Administration Notification English
- 18 FILLABLE Inhaler Administration Notification Spanish
- 19 FILLABLE Request for Disaster Medication Consent English
- 20 FILLABLE Request for Disaster Medication Consent Spanish
- 21 FILLABLE Medication Required During Disaster English
- 22 FILLABLE Medication Required During Disaster Spanish
- 23 Medication Administration During Field Trip.docx
- 24 FILLABLE Medication Administration Field Trip Checklist
- 25 FILLABLE Field Trip Medication Documentation
- 26 Field Trip Inhaler Instructions.docx
- 27 FILLABLE Medication Renewal Cover Letter English
- 28 FILLABLE Medication Renewal Cover Letter Spanish
- 29 Abbreviations for Medical Terms.docx
- 30 FILLABLE Standing Order for Anaphylaxis SB 1266
- 31 FILLABLE Medication Received Log
- 32 FILLABLE Medication Returned Log
Section 4 Specialized Physical Health Care Procedures
- 1 Table of Contents.docx
- 2 FILLABLE Special Health Care Procedure English
- 3 FILLABLE Special Health Care Procedure Spanish
- 4 FILLABLE Daily Log Add_l Documentation FORM
- 5 FILLABLE Medication or Special Procedure Sign Off
- 6 First Aid for Asthma
- 7 FILLABLE Asthma History Form English
- 8 FILLABLE Asthma History Form Spanish
- 9 FILLABLE Asthma Health Care Plan English
- 10 FILLABLE Asthma Health Care Plan Spanish
- 11 Peak Flow Zone Management.docx
- 12 FILLABLE Physican Order for Diabetes Management in School
- 13 Hyperglycemia Symptoms
- 14 Hypoglycemia Symptoms
- 15 FILLABLE Daily Diabetes Management Log
- 16 FILLABLE Seizure Disorder Health History English
- 17 FILLABLE Seizure Disorder Health History Spanish (1)
- 18 First Aid for Seizures
- 19 FILLABLE Heart Health History English
- 20 FILLABLE Heart Health History Spanish
- 21 FILLABLE Allergy Action Plan English
- 22 FILLABLE Allergy Action Plan Spanish
- 23 FILLABLE Seizures & Diabetes Memo
- 24 FILLABLE Asthma and Peanut Allergy
- 25 FILLABLE General Allergy and Bee Sting (1)
- 26 FILLABLE Medication Allergy
- 27 FILLABLE Severe Allergy Letter English
- 28 FILLABLE Severe Allergy Letter Spanish
- 29 Pomona USD-Preparticipation-Physical-Evaluation-Form
Section 5 Immunizations
- 1 Table of Contents.docx (2)
- 2 Immunization Overview.docx
- 3 Guide to the Immunization Requirements Eng
- 3 Guide to the Immunization Requirements Span
- 4 Special Schedule Immunization Requirements Table
- 5 FILLABLE California School Immunization Record
- 6 FILLABLE Immunization Assessment Kinder Annual Report
- 7 FILLABLE Immunization Assessment 7th Grade Annual Report
- 8 FILLABLE Immunization Worksheet
- 9 FILLABLE Note of Inadequate Immunization English
- 10 FILLABLE Note of Inadequate Immunization Spanish
- 11 FILLABLE Exclusion Letter English
- 12 FILLABLE Exclusion Letter Spanish
- 13 Vaccinate Before you Graduate
- 14 Vaccinate Before you Graduate Spanish
- 15 Common Immunization Abbreviation.docx
- 16 FILLABLE Tdap - 7th Grade English
- 17 FILLABLE Tdap - 7th Grade Spanish
- 18 FILLABLE Exclusion Letter Tdap English
- 19 FILLABLE Exclusion Letter Tdap Spanish
- 20 HPV Information ENG
- 21 HPV Information SPAN
Section 6 Communicable Diseases
- 1 Table of Contents.docx (2)
- 2 Policy Regarding Notification to Parents.docx
- 3 FILLABLE Exclusion Outbreak English
- 4 FILLABLE Exclusion Outbreak Spanish
- 5 FILLABLE Note Exposure Chicken Pox English
- 6 FILLABLE Note Exposure Chicken Pox Spanish
- 7 FILLABLE Note Exposure Conjunctivitis English
- 8 FILLABLE Note Exposure Conjunctivitis Spanish
- 9 Pink Eye Information Sheet English.docx
- 10 Pink Eye Information Sheet Spanish.docx
- 11 FILLABLE Note Exposure to Head Lice English
- 12 FILLABLE Note Exposure to Head Lice Spanish
- 13 PUSD Head Lice Policy English and Spanish.docx
- 14 Procedure for School Personnel to follow for Head Lice.docx
- 15 FILLABLE Head Lice Log
- 16 Parent Guide to Head Lice English
- 17 Parent Guide to Head Lice Spanish
- 18 Directions for Parents English.docx
- 19 Directions for Parents Spanish.docx
- 20 Head Lice Q and A ENG
- 20 Head Lice Q and A SPAN
- 21 FILLABLE Procedure for Nit Removal English
- 22 FILLABLE Procedure for Nit Removal Spanish
- 23 FILLABLE Head Lice Exclusion Letter English
- 24 FILLABLE Head Lice Exclusion Letter Spanish
- 25 FILLABLE Notice of Exposure to Scabies English
- 26 FILLABLE Notice of Exposure to Scabies Spanish
- 27 FILLABLE Notice of Exposure to Scarlet Fever English
- 28 FILLABLE Notice of Exposure to Scarlet Fever Spanish
- 29 FILLABLE Notice of Exposure to Strep Throat English
- 30 FILLABLE Notice of Exposure to Strep Throat Spanish
- 31 FILLABLE Notice of Exposure to Ringworm English
- 32 FILLABLE Notice of Exposure to Ringworm Spanish
- 33 FILLABLE Notice of Exposure to Ringworn Scalp English
- 34 FILLABLE Notice of Exposure to Ringworm Scalp Spanish
- 35 FILLABLE Notice of Exposure to HandFootMouth Disease English
- 36 FILLABLE Notice of Exposure to HandFootMouth Disease Spanish
- 37 FILLABLE Notice of Exposure Fifth Disease Eng
- 38 FILLABLE Notice of Exposure Fifth Disease Spn
- 39 ReportableDiseaseList2024
- 40 Respiratory Outbreak Report Form, Worksheet
- 41 Lice Guard RobiComb User Manual
Section 7 Screening Programs
- 1 Table of Contents.docx (2)
- 2 FILLABLE Oral Health Assessment Notification English
- 3 FILLABLE Oral Health Assessment Notification Spanish
- 4 FILLABLE Oral Health Assessment Form
- 5 Oral Health Assessment form spanish.docx
- 6 FILLABLE Oral Health Assessment Waiver Form
- 7 Spanish Oral Health Assessment Waiver.docx
- 8 Oral Assessment Report 23-24
- 9 Hearing and Vision.docx
- 10 FILLABLE Referral for Hearing Evaluation English
- 11 FILLABLE Referral for Hearing Evaluation Spanish
- 12 FILLABLE Audiogram
- 13 FILLABLE Parent Note of Ear Wax
- 14 Students with Hearing Deficit in a Regular Classroom.docx
- 15 Hearing Screening Procedure for the School Nurse.docx
- 16 FILLABLE Worksheet for Annual Hearing Report
- 17 Audiological Exam Process.docx
- 18 FILLABLE Annual Report of Hearing Testing School District Report
- 19 FILLABLE Referral for Vision Evaluation English
- 20 FILLABLE Referral for Vision Evaluation Spanish
- 21 FILLABLE Teacher Notification for Students with Vision Problems
- 22 FILLABLE Parent Response Form for Vision Referral English
- 23 FILLABLE Parent Response Form for Vision Referral Spanish
- 24 Financial Assistance for Students Needing Eye Exams and Glasses.docx
- 25 FILLABLE Cover Letter Vision Application English
- 26 FILLABLE Cover Letter Vision Application Spanish
- 27 FILLABLE Application for Vision Assistance English
- 28 FILLABLE Application for Vision Assistance Spanish
- 29 FILLABLE Parent Notification of Color Vision Deficiency English
- 30 FILLABLE Parent Notification of Color Vision Deficiency Spanish
- 31 Types of Vision Screening Utilized.docx
- 32 Signs and Symptoms Indicating Visual Disturbances
- 33 Common Vision Problems
- 34 FILLABLE Vision Referral Worksheet
- 35 Vision and Hearing Parent Notification of Possible Problems English.docx
- 36 Vision and Hearing Parent Notification of Possible Problems Spanish.docx
- 37 FILLABLE Parent Notification of Potential Diabetes English
- 38 FILLABLE Parent Notification of Potential Diabetes Spanish
- 39 Type 2 Diabetes Information English
- 40 Type 2 Diabetes Information Spanish
- 41 FILLABLE Vision and Hearing Worksheet
- 42 FILLABLE Vision and Hearing Monthly Tally K-8
- 43 FILLABLE Vision and Hearing Monthly Tally 9-12
Section 8 Child Health and Prevention Program CHDP
- 1 Table of Contents.docx (3)
- 2 School District Responsibility.docx
- 3 CHDP Income Eligibility Table
- 4 Periodic Appointment Schedule
- 5 FILLABLE CHDP Certification for School Entry English
- 6 FILLABLE CHDP Certification for School Entry Spanish
- 7 FILLABLE Waiver of Health Examination for School Entry English
- 8 FILLABLE Waiver of Health Examination for School Entry Spanish
- 9 FILLABLE CHDP Worksheet
- 10 FILLABLE Parent Notification of First Grade Physical Requirements English
- 11 FILLABLE Parent Notification of First Grade Physical Requirements Spanish
- 12 FILLABLE Physical Exam Follow Up Notification English
- 13 FILLABLE Physical Exam Follow Up Notification Spanish
- 14 Requirements for Kindergarten Parent Letter English.docx
- 16 FILLABLE CHDP Annual School Report
- 15 Requirements for Kindergarten Parent Letter Spanish.docx
Section 10 Assessment Plans
- 1 Table of Contents.docx
- 2 SST Referrals and 504.docx
- 3 FILLABLE SST Nursing Referral
- 4 FILLABLE SST Log
- 5 FILLABLE School Nurse 504 Data Sheet
- 6 504 Eligibilty Considerations.docx
- 7 Definition of Disability.docx
- 8 School Attendance Program and Definitions.docx
- 9 Protocol for Administering Vanderbilt.docx
- 10 FILLABLE Vanderbilt Teacher Letter
- 11 FILLABLE Vanderbilt Parent Letter English
- 12 FILLABLE Vanderbilt Parent Letter Spanish
- 13 Vanderbilt Parent Assessment Scale Form
- 14 Vanderbilt Teacher Assessment Scale Form
- 15 Vanderbilt Sample Scoring Form
- 16 Vanderbilt Scoring Instructions
- 17 FILLABLE Individual Health Services Plan IHSP
- 18 Individual Health Services Plan IHSP ADHD.docx
- 19 24-25 Mental Health Referral
Section 11 Special Education
- 1 Table of Contents.docx
- 2 Special Education Health Assessment.docx
- 3 Special Education Procedures for the School Nurse.docx
- 4 FILLABLE DIS-IEP Preparation Log
- 5 Acronyms Used in PUSD
- 6 FILLABLE Assessment Report Short Form
- 7 FILLABLE Health and Development History Forms English
- 8 FILLABLE Health and Development History Forms Spanish
- 9 FILLABLE Eye Report for Children with Visual Problems
Section 12 LEA-Medical Billing Information
- 1 Table of Contents.docx
- 2 Local Educational Agency Medi-Cal Billing Information Manual
- 3 FILLABLE Catheterization Documentation Template
- 4 FILLABLE Diabetes documentation Template
- 5 FILLABLE G-Tube Documentation Template
- 6 FILLABLE Oxygen Documentation Template
- 7 FILLABLE Medication Administration Form
- 8 FILLABLE Seizure Documentation Form
- 9 FILLABLE Trach Documentation Form
- 10 FILLABLE Activites of Daily Living documentation Template
- 11 Additional Documentation Form
- 12 Fillable Health Assessment Log
- 13 FILLABLE Mandated hearing screening documentation (Updated)
- 14 FILLABLE Mandated vision screening documentation
- 15 FILLABLE Nebulizer-Inhaler form
- 16 FILLABLE Oral Nasal Suction Form
- 17 FILLABLE Ostomy Documentation Form
- 18 Service Tracker Provider Training
- 19 Service Tracker Mini Manual 2017
- 20 Nursing and Trained Health Care Treatments
Section 14 Health Office Procedures and Forms
- 1 Table of Contents.docx
- 2 Health Office Activities of Each Month.docx
- 3 End of Year Checklist.docx
- 4 FILLABLE Notice of Head Injury English
- 5 FILLABLE Notice of Head Injury Spanish
- 6 Confidential Health Concerns List.docx
- 7 Procedure for Distribution.docx
- 8 Health Concerns General Recommendations.docx
- 9 FILLABLE Health Office Memo Confidential Student Information
- 10 Student Field Trips and Medications.docx
- 11 Student Health Folders.docx
- 12 Daily Log Procedures.docx
- 13 FILLABLE Daily Log
- 14 FILLABLE Health Information Form English
- 15 FILLABLE Health Information Form Spanish
- 16 Health Office Pass
- 17 FILLABLE Parent Notification of Visit to Health Office English and Spanish
- 18 FILLABLE Note to Parent English and Spanish
- 19 CCS Referral Procedure.docx
- 20 FILLABLE CCS Referral Letter
- 21 FILLABLE Information About CCS English
- 22 Information About CCS Spanish
- 23 FILLABLE Referral for Health Care English
- 24 FILLABLE Referral for Health Care Spanish
- 25 FILLABLE Authorization for Release of Medical Records English
- 26 FILLABLE Authorization for Release of Medical Records Spanish
- 27 FILLABLE Findings and Recommendations
- 28 When to Keep Your Child Home English.docx
- 29 When to Keep Your Child Home Spanish.docx
- 30 FILLABLE Health Office Memorandum Before Readmission
- 31 FILLABLE First Aid Follow-Up Parent Instructions English
- 32 FILLABLE First Aid Follow-Up Parent Instructions Spanish
- 33 Crutch Appliance at School Procedure English.docx
- 34 Crutch Appliance at School Procedure Spanish.docx
- 35 FILLABLE PE Excuse Form
- 36 ConcussionInformationSheet.docx
Section 15 Resource Directory
- 1 Table of Contents.docx
- 2 Clinics
- 3 Family Practice
- 4 Pediatrics
- 5 Asthma and Allergies
- 6 Cardiology
- 7 Ear Nose Throat
- 8 Orthopedics
- 9 Urology
- 10 Family Planning
- 11 Hospitals
- 12 Health Insurance
- 13 Dental Clinics
- 14 Dentists
- 15 Optometry Opthalmology
- 16 Legal Assistance
- 17 Mental Health
- 18 Food Clothing Shelter
- 19 Victim Assistance
- 20 Drug Alcohol Programs
- 21 Hotlines
- 22 Helpful Numbers
- 23 Sports Physicals
- 24 Urgent Care
- 25 Veterans and Family Svcs
- 26 Pomona Comm Referral Svcs