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5141.3 Student Health Services

Adoption Date: 01/11/1979, Revised: 03/17/2016, 03/17/2000, 04/20/2006, 05/16/2006, 06/14/2012, 10/18/2012, 11/21/2013, 11/21/2019, 11/19/2020, 11/18/2021, 3/23/2023
5000 - Students

5141.3 Student Health Services

The Board of Education recognizes the importance of student health services in both the prevention of and education about student health concerns.  The Board believes that good student health is vital to successful learning.  

In accordance with law, the District will provide vision, hearing, scoliosis and other required screening.  Problems will be referred to the parent/guardian who shall be encouraged to seek appropriate care from their family physician.  

The District shall also provide emergency care for students in accidental or unexpected medical situations.  Parents/guardians will be notified of any emergency medical situation as soon as is practicable.

Each student’s cumulative school record shall include a permanent student health record, which should follow the student from grade to grade and school to school along with their academic record.  This medical record folder shall be maintained by the school nurse.    

In order to safeguard the school community from the spread of certain communicable diseases and in recognition that prevention is a means of combating the spread of disease, the Board requires all students to be fully immunized against certain diseases in accordance with State statutes and rules of the New York State Department of Health.  
Upon registration, all new students are required to present a record of required immunizations from a licensed physician, physician assistant or nurse practitioner as set forth in Section 2164 of the Public Health Law.  No child will be admitted to school or allowed to attend school without certification of the child’s immunizations.  

Notwithstanding the above, students may be admitted to school or continue attendance without proof of the required immunizations if:
    a)    A physician licensed to practice medicine in New York State certifies in writing, on the form required by the New York State Department of Health, that administering a vaccine or vaccines to a specific student will be detrimental to that student’s health, indicating the specific medical contraindication to a specific immunization(s), the length of time the immunization(s) is/are contraindicated and a specific date for review of the determination.  Medical exemptions must be reissued annually to remain valid.  The Building Principal may require supporting documents for medical exemptions.
    b)    A parent submits acceptable documentation that the student is in process of receiving immunizations in accordance with the ACIP catch-up schedule or obtaining blood tests to establish immunity;
    c)    For varicella only, a physician, physician assistant or nurse practitioner certifies in writing that the student has had the disease in question.
    d)    A physician, physician assistant or nurse practitioner provides written results of an antibody test for the disease in question which shows immunity.  This option may only be used for measles, mumps, rubella, varicella, and hepatitis B.   
    e)    For poliomyelitis, by showing a positive blood test for the disease antibodies for all three types (limited to tests performed prior to 9/1/19).

The Board believes that immunization is the primary responsibility of the parent/guardian.  The School District will refer those students who cannot afford such immunizations to the Westchester or Putnam County Health Department.  Except as provided above or as ordered by the New York State Department of Health, no student who does not have the required immunizations shall be admitted to the School District or allowed to continue in school for more than 14 calendar days from the first day of student instruction in the school year (30 calendar days for a student from out-of-state or out of the country).
In the event that a parent/guardian is unable to provide an immunization record, the School Nurse or other authorized District official, will access the New York State Immunization Information System (NYSIIS) to determine if the child has met the immunization requirements.  If the system indicates that the child has received the required immunizations, the information will be entered as part of the student’s record, the source and date noted, and the documentation requirement will have been met.
When a student transfers out of the District, the parent/guardian will be provided with an immunization transfer record showing the student’s current immunization status which will be signed by the School Nurse or District’s Chief Medical Officer.  A transcript or photocopy of the immunization portion of the cumulative health record will be provided to the new educational institution upon request.

Notwithstanding the above, students in temporary housing (homeless students) shall be admitted to school even if they do not have the required immunization records, but may be temporarily excluded if they show actual symptoms of a communicable disease that poses a significant risk of transmission to others.  The McKinney-Vento liaison shall assist homeless students in accessing health services.

When a child is excluded from school for lack of immunizations, the Building Principal must notify the parent/guardian of their responsibility to have the child immunized, and the public resources available for doing so.  The Principal must also notify the county health department of the child’s name and address and the immunization(s) the child lacks, and cooperate with the county health department to provide a time and place for the required immunization(s) to be administered. 

Communicable Diseases
As part of the District’s responsibility to provide students with a safe and healthy school environment it may be necessary to exclude students with contagious and infectious diseases, as defined in the Public Health Law, from attendance in school.  Students will be excluded during periods of contagion for time periods as indicated by the District’s Chief Medical Officer.
The District will maintain a list of students who have been exempted from immunization for medical reasons, or who are in the process of receiving immunizations, and will exclude such students from school when ordered by the Commissioner of Health, in the event of an outbreak in school of the vaccine-preventable disease.  The District will provide additional protections to students who are otherwise medically vulnerable.  Students who are excluded or additionally protected under this paragraph will be provided with alternate instruction or remote learning opportunities to continue their education during the exclusion period.  

It is the responsibility of the Superintendent of Schools or designee, working with District health personnel, to contact the New York State Department of Health and the Westchester or Putnam County Board of Health immediately upon notification of an outbreak of a communicable disease, as required by the Department of Health.

Students Residing Outside of United States
All children who have resided outside of the United States for more than two (2) months prior to entering or returning to the District, must submit medical documentation of current tuberculosis screening through either a PPD skin test or an Interferon Gold blood test in order to ascertain exposure to or active tuberculosis disease.

Return to School after Illness/Surgery or Injury
Prior to a child’s return to school after a communicable, contagious or infectious illness, other prolonged illness, injury or surgery, or condition that poses a risk to the health, safety or welfare of the student or others, a note from the child’s health care provider is required to advise that (1) the child is cleared to return to school; (2) whether or not there are any restrictions on the child’s return to school (e.g., participation in physical activities or after-school activities); and (3) whether or not the child is required to use crutches or other equipment and for how long. Upon receipt of a writing clearing a child to return to school, the District may, in an appropriate case, require that the child’s health care provider advise, in writing, whether or not the child is a danger to him/herself or others

Student Medical Examinations
In accordance with Section 903 of the Education Law, each student must have a physical examination within 12 months prior to the commencement of the school year in which the examination is required and present a health certificate describing the student’s condition including an assessment of the student’s Body Mass Index (BMI) and a determination of weight status category based upon BMI-for-age percentiles, signed by a duly licensed physician, physician assistant or nurse practitioner in the state of New York, upon entrance to school and upon entering pre-kindergarten or kindergarten, and the first, third, fifth, seventh, ninth and eleventh grades.  If the required health certificate is not furnished at these times, the principal shall notify the student’s parent/guardian, in writing, that the District’s Chief Medical Officer would perform the physical examination.
A student may be excluded from the medical examination requirements because the child’s parent/guardian holds a genuine and sincere religious belief which is contrary to medical examinations.  The request for exemption must be in writing, notarized, and submitted to the Principal or designee.
An examination of any child may be required at any time by the School District, in its discretion, to promote the educational interests of the child.  
All students participating in interscholastic sports must have a physical examination, which may be reviewed by the District’s Chief Medical Officer.

Dental Health Certificates
The School District shall request that a dental health certificate be submitted for each student within 30 days after their entrance into school and within 30 days after entrance into the first, third, fifth, seventh, and ninth grades.  The dental health certificate shall be signed by a licensed dentist and shall describe the health condition of the student when the examination was conducted, which must be within 12 months prior to the beginning of the school year in which the examination is requested.  The dental health certificate, if submitted, shall be filed in the student’s cumulative health record.

The School District shall submit a notice of request for dental health certificates at the same time that the notice of health examination requirements are distributed to parents/guardians, including a statement that a list of dentists to which students who need comprehensive dental examinations may be referred for treatment on a free or reduced cost basis, is available upon request at the student’s school

Administering Medication to Students
The District shall not be responsible for the diagnosis or treatment of student illness.  The administration of prescribed medication to a student during school hours is permitted only when the medication is necessary to allow the student to attend school or when failure to administer the medication would adversely affect the student’s health or when it is done pursuant to law requiring accommodation of a student’s special medical needs (e.g., Section 504 of the Rehabilitation Act of 1973).  “Medication” will include all medicines prescribed by a physician, physician assistant or nurse practitioner, over-the-counter medications/remedies, cough drops and herbal remedies.

Before any medication may be administered to or by any student during school hours, the following is required:
    a)    The child’s parent/guardian must bring the medication to school in the original labeled container, which must include the student’s name, name of medication, dosage, frequency, and prescribing medical provider.
    b)    There must be a written signed request of the parent/guardian, which shall give permission for such administration by the School Nurse, teacher or other staff member, and shall relieve the District, its officers, employees and agents, of liability for administration of medication; and 
    c)    There must be the original written order of the prescribing physician, physician assistant or nurse practitioner (hereinafter “physician”) which includes the student’s name; the date; the name of the medication; the purpose of the medication; the dosage; frequency; the time at which or special circumstances under which the medication is to be administered; the period for which the medication is prescribed; and a list of possible side effects of the medication.

In order for a student to carry and use a rescue inhaler, an epinephrine auto-injector (e.g., epi-pen), insulin or glucagon and associated diabetes testing supplies, written permission must be provided both by the parent/guardian and the prescribing authorized medical provider in accordance with law and regulations, as follows:
a)    An authorized medical provider must provide written permission that includes (1) an attestation that the student’s diagnosis requires the medication; (2) the student has demonstrated that they can self-administer the prescribed medication effectively; (3) the name of the medication, the dose, and the times when it is to be taken; (4) the circumstances which may warrant use; and (4) the length of time during which the student may use it.
b)    Written permission from the child’s parent/guardian.
If a student is authorized to carry and use medication, as described above, the parent/guardian is permitted to give extra medication and supplies that the District will maintain in accordance with the written directions of the authorized medical provider.  The extra medication and supplies shall be readily available to the student.

All permission slips shall be kept on file in the office of the School Nurse.  All medication orders must be reviewed annually by the School Nurse or whenever there is a change in dosage.
Students are permitted to carry and apply parent provided sunscreen without a prescription from a medical provider, as long as the sunscreen is FDA approved, the sunscreen is not treating a medical condition and the parents have provided the District with written permission for their child to use sunscreen.

The procedures to be followed for the administration of medication are dependent upon the status of the student as “nurse dependent”, “supervised” or “independent”.  A “nurse dependent” student requires the assistance of a licensed health professional to administer medication; a “supervised student” may self-administer medication under the supervision of licensed health professional or trained unlicensed school personnel; an “independent student” with the appropriate provider orders and attestation and written parent/guardian consent, may carry and self-administer their medication to prevent negative health consequences.  

    a)    All medications shall be administered by the School Nurse or other staff member, as appropriate unless the child is a supervised student or an independent student;
b)    Medications shall be securely stored in the School Nurse’s Office, unless the student is an independent student, and kept in their original labeled container, which specifies the type of medication, the dosage to be given and the times of administration;
    c)    The School Nurse shall maintain a record of the name of the student to whom medication may be administered, the prescribing physician, the dosage and timing of medication and a notation of each instance of administration; and
    d)    It is the responsibility of the parent(s)/guardian to bring all medications to school and to pick up all medications at the end of the school year or the end of the period of medication, whichever is earlier.  If not picked up within five days of the period of medication, the medication shall be discarded.
    e)    It is the responsibility of the parent(s)/guardian to ensure that medicines are refilled on a timely basis and that the District is notified of any change in dosage.  A new written order of the prescribing physician, physician assistant or nurse practitioner must be presented for any dosage change.
In accordance with Section 919 of the Education Law, the District shall make a nebulizer available on-site in school buildings where nursing services are provided.  Students with a patient-specific order, who require inhaled medications, shall have access to the nebulizer provided that the student has their own labeled spacer or their own labeled tubing and facemask or mouthpiece to be used with the nebulizer.  

No student, other than an independent student, may have any other type of medication, prescription or over-the-counter, on his/her person in school under any circumstances,
A request to permit a student to be a supervised student shall be considered on an individual basis and a decision made based upon an assessment of the student’s cognitive and/or emotional development.  A student may be considered a supervised student only they are consistently able to do all of the following:
    a)    Administer the medication to themselves via the correct route;
    b)    Identify the correct medication (e.g., color, shape);
    c)    Identify the purpose of the medication;
    d)    Identify the correct dosage is handed to them if they cannot pour their own medication for dexterity issues;
    e)    Identify the time the medication is needed during the school day;
    f)    Know the parameters or condition(s) under which the medication is to be taken, and will refuse to take the medication if the parameters or condition(s) are not met;
    g)    Describe what will happen if medication is not taken; 
    h)    Refuse to take medication if the student has any concerns about its appropriateness.
    i)    School administration and parents will be notified of any unauthorized use of medication by the student.    
Other considerations for the School Nurse to consider in determining whether or not a student is a supervised student is the student’s particular diagnosis and the type of medication prescribed.
Each student who is permitted to self-carry and self-administer medication should have an emergency care plan developed by the School Nurse or Medical Director on file with the District.  The student should be instructed how to obtain help from school personnel as needed.  

Field Trips and After-School Activities
Taking medication on field trips and at after-school activities is permitted if a student is a supervised student or an independent student administering their own medication.  On field trips or after-school activities, teachers or other school staff may carry the medication so that the supervised student can take it at the proper time.
If a student is going on a field trip but is not a supervised student or an independent student (i.e., fully aware and capable of understanding the need and assuming responsibility for taking medicine), then the District may:
a)        Permit the parent/guardian to attend the activity and administer the medication;
b)    Permit the parent to personally request another adult who is not employed by the District to voluntarily administer the medication on the field trip or at the activity and inform the District in writing of such request;
c)    Allow the student’s health care provider to be consulted and, if they permit, order the medication time to be adjusted or the dose eliminated;
d)    If no other alternative can be found, a School Nurse or licensed person, or a person trained in administering the medication in an appropriate case, must administer the medication.

The Superintendent of Schools in collaboration and consultation with the Chief Medical Director and the School Nurse will develop regulations to implement this policy.

Cross-Ref:  Policy 5141.6  (Life Threatening Allergies and Other Allergies)
           Policy 5141.7 (Concussion Management)
           Policy 5143 (Head Lice)
Ref:    Public Health Law Section 2164
    Education Law Sections 912 and 914
    10 NYCRR Part 66-1
SED Memo dated July 31, 2012 (Updated Information Regarding the Use of Sunscreen)
SED Guidance dated June 2012, (Guidelines for Concussion Management in the School Setting)
SED Memo dated March 2012 (Clarification on Insulin Pumps)
SED Memo dated August 23, 2011 (New Policy for Stocking Albuterol Metered Dose Inhalers (MDIs)
SED Guidance dated August 2010 (Clarification on Medication Storage in Schools)
SED Guidance dated September 10, 2009 (Administration of Medications to Students During School-Sponsored Events by Parent/Guardian Designee)
Making the Difference:  Caring for Students with Life-Threatening Allergies, New York State Department of Health, New York State Education Department, New York Statewide School Health Service Center, June 2008
SED Memo dated March 2004 (Training of Unlicensed Individuals in the Injection of Glucagon in Emergency Situations)
SED Guidance dated June 2002 (Use of Epinephrine Auto-Injector Devices in the School Setting)
SED Memo dated April 2002 (Guidelines for Administration of Medication in Schools)
SED Memo dated February 27, 2001 (New Provisions of Law Concerning the Administration of Immunizations and Anaphylactic Agents by Registered Professional Nurses Utilizing Non-Patient Specific Orders and Protocols) and SED Memo dated October 3, 2001 (Clarification about Administering Immunizations and Anaphylactic Agents by Registered Professional Nurses using Non-Patient Specific Orders and Protocols)
SED EMSC School Executive’s Bulletin dated January 2001 (Blood Glucose Monitoring)