Health Services and Programs Manual
Section 0 - Cover Page, Receipt, and Table of Contents
Section 1 - General Information
- 1 Table of Contents
- 2 Organizational Chart and Mission
- 3 Program Overview
- 4 Director of Health Services
- 5 Nurse Specialist
- 6 Credentialed School Nurse
- 7 Activities Credentialed School Nurse
- 8 Classified Nurse
- 9 Health Services Assistant
- 10 Activities of Health Services Assistant
- 11 Orientation Checklist School Nurse
- 12 Orientation Checklist Health Assistant
- 13 Nurse Buddy Schedule
- 14 Evaluation Profile Crendentialed School Nurse
- 15 Classified Employee Performance Evaluation
- 16 Informal Observation Checklist
Section 2 - Education Codes, District Policies & Health Services Standards
Section 3 - Medications
- 1 Table of Contents
- 2 Administration of Medications to Students in School
- 3 Procedure for Medications in School
- 4 Medication Administration Training for Unlisensed Assistive Personnel
- 5 Procedure for Medication Treatment Error
- 6 Medication Special Procedure Training Documentation
- 7 Med Special Procedure Sign Off
- 8 Medication Required During School Hours English
- 9 Medication Required During School Hours Spanish
- 10 Medication Log Blank and Dates 2020-21
- 11 Inhaler Log of Medication Administered
- 12 Asthma Inhaler-Auto Injector Carried By Student English
- 13 Asthma Inhaler-Auto Injector Carried By Student Spanish
- 14 Asthma Inhaler Waiver Liability English
- 15 Asthma Inhaler Waiver Liability Spanish
- 16 Inhaler Sign Off Sheet
- 17 Inhaler Administration Notification English
- 18 Inhaler Administration Notification Spanish
- 19 Request for Disaster Medication Consent English
- 20 Request for Disaster Medication Consent Spanish
- 21 Medication Required During Disaster English
- 22 Medication Required During Disaster Spanish
- 23 Medication Administration During Field Trip
- 24 Medication Administration Field Trip Checklist
- 25 Field Trip Medication Documentation
- 26 Field Trip Inhaler Instructions
- 27 Medication Renewal Cover Letter English
- 28 Medication Renewal Cover Letter Spanish
- 29 Abbreviations for Medical Terms
- 30 Standing Order for Anaphylaxis SB 1266
- 31 Medication Received Log
Section 4 - Specialized Physical Health Care Procedures
- 1 Table of Contents
- 2 Special Health Care Procedure English
- 3 Special Health Care Procedure Spanish
- 4 Daily Log of Treatment Administered
- 5 Medication or Special Procedure Sign Off
- 6 Asthma - First Aid
- 7 Asthma History Form English
- 8 Asthma History Form Spanish
- 9 Asthma Health Care Plan English
- 10 Asthma Health Care Plan Spanish
- 11 Peak Flow Zone Management
- 12 Diabetes Management in School
- 13 Hyperglycemia Symptoms
- 14 Hypoglycemia Symptoms
- 15 Daily Blood Sugar Monitor Log
- 16 Seizure Disorder Health History English
- 17 Seizure Disorder Health History Spanish
- 18 First Aid for Seizures
- 19 Heart Health History English
- 20 Heart Health History Spanish
- 21 Allergy Action Plan English
- 22 Allergy Action Plan Spanish
- 23 Seizures and Diabetes
- 24 Asthma and Peanut Allergy
- 25 General Allergy and Bee Sting
- 26 Medication Allergy
- 27 Severe Allergy Letter English
- 28 Severe Allergy Letter Spanish
Section 5 - Immunizations
- 1 Table of Contents
- 2 Immunization Overview
- 3 Guide to the Immunization Requirements English-Spanish 2021
- 4 Special Schedule Immunization Requirements Table
- 5 California School Immunizatoin Record
- 6 Student TB Mandate
- 7 Immunization Assessment Kindergarten Annual Report
- 8 Immunization Worksheet
- 9 Note of Inadequate Immunization Letter 1 English
- 10 Note of Inadequate Immunization Letter 1 Spanish
- 11 Exclusion Letter English
- 12 Exclusion Letter Spanish
- 13 Vaccine B4 U Graduate English
- 14 Vaccine B4 U Graduate Spanish
- 15 Immunization Recommendation Letter English
- 16 Immunization Recommendation Letter Spanish
- 17 Immunizations During Summer English
- 18 Immunizations During Summer Spanish
- 19 Common Immunization Abbreviation
- 20 Tdap Letter 1 English
- 21 Tdap Letter 1 Spanish
- 22 Exclusion Letter Tdap English
- 23 Exclusion Letter Tdap Spanish
- 24 No Shots No School Parent Reminder English
- 25 No Shots No School Parent Reminder Spanish
Section 6 - Communicable Diseases
- 1 Table of Contents
- 2 Policy Regarding Notification to Parents
- 3 Exclusion Outbreak English
- 4 Exclusion Outbreak Spanish
- 5 Note Exposure Chicken Pox English
- 6 Note Exposure Chicken Pox Spanish
- 7 Note Exposure Conjunctivitis English
- 8 Note Exposure Conjunctivitis Spanish
- 9 Pink Eye Information Sheet English
- 10 Pink Eye Information Sheet Spanish
- 11 Note Exposure to Head Lice English
- 12 Note Exposure to Head Lice Spanish
- 13 PUSD Head Lice Policy English and Spanish
- 14 Procedure for School Personnel to follow for Head Lice
- 15 Head Lice Log
- 16 Parent Guide to Head Lice English
- 17 Parent Guide to Head Lice Spanish
- 18 Directions for Parents English
- 19 Directions for Parents Spanish
- 20 Head Lice Q and A
- 21 Procedure for Nit Removal English
- 22 Procedure for Nit Removal Spanish
- 23 Head Lice Exclusion Letter English
- 24 Head Lice Exclusion Letter Spanish
- 25 Notice of Exposure to Scabies English
- 26 Notice of Exposure to Scabies Spanish
- 27 Notice of Exposure to Scarlet Fever English
- 28 Notice of Exposure to Scarlet Fever Spanish
- 29 Notice of Exposure to Strep Throat English
- 30 Notice of Exposure to Strep Throat Spanish
- 31 Notice of Exposure to Ringworm English
- 32 Notice of Exposure to Ringworm Spanish
- 33 Notice of Exposure to Ringworn Scalp English
- 34 Notice of Exposure to Ringworm Scalp Spanish
- 35 Notice of Exposure to HandFootMouth Disease English
- 36 Notice of Exposure to HandFootMouth Disease Spanish
- 37 Notice of Exposure Fifth Disease Eng
- 38 Notice of Exposure Fifth Disease Spn
- 39 Reportable Disease List March 2020
- 40 Communicable Disease Worksheet
- 41 RomiComb Instructions
Section 7 - Screening Programs
- 1 Table of Contents
- 2 Oral Health Assessment Notification English
- 3 Oral Health Assessment Notification Spanish
- 4 Oral Health Assessment Form English
- 5 Oral Health Assessment Form Spanish
- 6 Waiver Oral Health Assessment Requirements
- 7 Assistance League Dental Center Application for Dental Care
- 8 Assistance League Dental Center Schedule of Appointments
- 9 Parent Notification Dental Care Needed
- 10 Dental Appointment Reminder Notice
- 11 Map to Assistance League Dental Center
- 12 Oral Assessment Report
- 13 Instruction for Oral Health Assessment Report
- 14 Hearing and Vision
- 15 Referral for Hearing Evaluation English
- 16 Referral for Hearing Evaluation Spanish
- 17 Audiogram
- 18 Parent Note of Ear Wax
- 19 Students with Hearing Deficit in a Regular Classroom
- 20 Hearing Screening Procedure for the School Nurse
- 21 Worksheet for Annual Hearing Report
- 22 Audiological Exam Process
- 23 Annual Report of Hearing Test
- 24 Referral for Vision Evaluation English
- 25 Referral for Vision Evaluation Spanish
- 26 Teacher Notification for Students with Vision Problems
- 27 Parent Response Form for Vision Referral English
- 28 Parent Response Form for Vision Referral Spanish
- 29 Financial Assistance for Studnts Needing Eye Exams and Glasses
- 30 Cover Letter Vision Application English
- 31 Cover Letter Vision Application Spanish
- 32 Application for Vision Assistance English
- 33 Application for Vision Assistance Spanish
- 34 Parent Notification of Color Vision Deficiency English
- 35 Parent Notification of Color Vision Deficiency Spanish
- 36 Types of Vision Screening Utilized
- 37 Signs and Symptoms Indicating Visual Disturbances
- 38 Common Vision Problems
- 39 Vision Referral Worksheet
- 40 Annual Report of Vision Testng
- 41 Vision and Hearing Parent Notification of Possible Problems English
- 42 Vision and Hearing Parent Notification of Possible Problems Spanish
- 43 Scoliosis Screening Procedure
- 44 Parent Permission for Scoliosis Screening English
- 45 Parent Permission for Scoliosis Screening Spanish
- 46 Scoliosis Worksheet
- 47 Referral for Medical Evaluation English
- 48 Referral for Medical Evaluation Spanish
- 49 Parent Notification of Screening English
- 50 Parent Notificaiton of Screening Spanish
- 51 Parent Notification of Potential Diabetes English
- 52 Parent Notification of Potential Diabetes Spanish
- 53 Scoliosis Screening for Girls Worksheet
- 54 Scoliosis Screening for Boys Worksheet
- 55 Scoliosis Screening Report
- 56 Type 2 Diabetes Information English
- 57 Type 2 Diabetes Information Spanish
- 58 Vision and Hearing Worksheet
- 59 Vision and Hearing Monthly Tally K-8
- 60 Vision and Hearing Monthly Tally 9-12
Section 8 - CHDP
- 1 Table of Contents
- 2 School District Responsibility
- 3 CHDP Income Eligibility Table
- 4 Periodic Appointment Schedule
- 5 CHDP Certification for School Entry English
- 6 CHDP Certification for School Entry Spanish
- 7 Waiver of Health Examination for School Entry English
- 8 Waiver of Health Examination for School Entry Spanish
- 9 CHDP Worksheet
- 10 Parent Notification of First Grade Physical Requirements English
- 11 Parent Notification of First Grade Physical Requirements Spanish
- 12 CHDP Parent Reminder
- 13 Physical Exam Follow Up Notification English
- 14 Physical Exam Follow Up Notification Spanish
- 15 Physical Examination Exclusion Notice English
- 16 Physical Examination Exclusion Notice Spanish
- 18 CHDP Annual School Report
Section 9 - Child Abuse Reporting
Section 10 - Assessment Plans
- 1 Table of Contents
- 2 SST Referrals and 504
- 3 SST Nursing Referral
- 4 SST Log
- 5 School Nurse 504 Data Sheet
- 6 504 Eligibilty Considerations
- 7 Definition of Disability
- 8 School Attendance Program and Definitions
- 9 Protocol for Administering Vanderbilt
- 10 Vanderbilt Teacher Letter
- 11 Vanderbilt Parent Letter English
- 12 Vanderbilt Parent Letter Spanish
- 13 Individual Health Services Plan IHSP
- 14 Individual Health Services Plan IHSP ADHD
- 15 School Mental Health Referrals
Section 11 - Special Education
- 1 Table of Contents
- 2 Special Education Health Assessment
- 3 Special Education Procedures for the School Nurse
- 4 DIS-IEP Preparation Log
- 5 Acronyms Used in PUSD
- 6 Assessment Report Short Form
- 7 Health and Development History Forms English
- 8 Health and Development History Forms Spanish
- 9 Eye Report for Children with Visual Problems
- 10 IEP Team Member Excusal Forms English and Spanish
Section 12 - Health Education (optional)
Section 13 - LEA Medi-Cal Billing Info.
- 1 Table of Contents
- 2 Local Educational Agency LEA Medi-Cal Billing Information Manual
- 3 SEIS Daily Log Catheterization
- 4 SEIS Daily Log Diabetes
- 5 SEIS Daily Log GTube
- 6 SEIS Daily Log Oxygen
- 7 SEIS Daily Log Medication
- 8 SEIS Daily Log Seizures
- 9 SEIS Daily Log Tracheostomy
- 10 LEA Medi-Cal Training Power Point 2017
- 11 Service Tracker Mini Manual 2017
- 12 Nursing and Trained Health Care Treatments
Section 15 - Health Office Procedures/Forms
- 1 Table of Contents
- 2 Health Office Activities of Each Month
- 3 End of Year Checklist
- 4 Notice of Head Injury English
- 5 Notice of Head Injury Spanish
- 6 Confidential Health Concerns List
- 7 Procedure for Distribution
- 8 Health Concerns General Recommendations
- 9 Health Office Memo Confidential Student Information
- 10 Student Field Trips and Medications
- 11 Student Health Folders
- 12 Daily Log Procedures
- 13 Daily Log
- 14 Health Information Form English
- 15 Health Information Form Spanish
- 16 Health Office Pass
- 17 Parent Notification of Visit to Health Office English and Spanish
- 18 Note to Parent English and Spanish
- 19 CCS Referral Procedure
- 20 CCS Referral Letter
- 21 Information about CCS English
- 22 Information about CCS Spanish
- 23 Application to Determine Eligibilty English
- 24 Applicaiton to Determine Eligibilty Spanish
- 25 Instructions for Completing Applicaitons English
- 26 Instructions for Completing Applications Spanish
- 27 Referral for Health Care English
- 28 Referral for Health Care Spanish
- 29 Authorization for Release of Medical Records English
- 30 Authorization for Release of Medical Records Spanish
- 31 Findings and Recommendations
- 32 When to Keep Your Child Home English
- 33 When to Keep Your Child Home Spanish
- 34 Health Office Memorandum Before Readmission
- 35 First Aid Follow-Up Parent Instructions English
- 36 First Aid Follow-Up Parent Instructions Spanish
- 37 Crutch Appliance at School Procedure English
- 38 Crutch Appliance at School Procedure Spanish
- 39 PE Excuse Form
Section 16 - Resource Directory
- 1 Table of Contents
- 2 Clinics
- 3 Family Practice
- 4 Pediatrics
- 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
- 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