STUDENT HEALTH SERVICES
Each school building may develop a customized student health services program based on its unique needs and resources. Scientific advances, laws, and school improvement necessitate supports to students with health needs to receive their education program.

Supports to improve student achievement include:

1. Qualified health personnel;
2. Superintendent, school nurse, and school health team working collaboratively;
3. Family and community involvement; and
4. Optimal student health services program with commitment to its continuing improvement.

Components provided within a coordinated school health program include:

1. Health services;
2. Nutrition;
3. Healthy, safe environment;
4. Staff wellness;
5. Health education;
6. Physical education and activity;
7. Counseling, psychological, and social services; and
8. Family and community involvement.

Student health services are provided to identify health needs; facilitate access to health care; provide for health needs related to educational achievement; promote health, well-being, and safety; and plan and develop the health services program.

STUDENT HEALTH SERVICES ESSENTIAL FUNCTIONS

1. Identify student health needs:
   
   1. Provide individual initial and annual health assessments;
   2. Provide needed health screenings;
   3. Maintain and update confidential health records; and
   4. Communicate (written, oral, electronic) health needs as consistent with confidentiality laws.
       
2. Facilitate student access to physical and mental health services:
   
   1. Link students to community resources and monitor follow through;
   2. Promote increased access and referral to primary health care financial resources such as Medicaid, HAWK-I, social security, and community health clinics; and
   3. Encourage appropriate use of health care.
       
3. Provide for student health needs related to educational achievement:
   
   1. Manage chronic and acute illnesses;
   2. Provide special health procedures and medication including delegation, training, and supervision of qualified, designated school personnel;
   3. Develop, implement, evaluate, and revise Individual Health Plans (IHP) for all students with special health needs according to mandates in the Individuals with Disabilities Education Act (IDEA), Rehabilitation Act (Section 504), and Americans with Disabilities Act (ADA);
   4. Provide urgent and emergency care for individual and group illness and injury;
   5. Prevent and control communicable diseases and monitor immunizations;
   6. Promote optimal mental health;
   7. Promote a safe school facility and a safe school environment; and
   8. Participate in and attend team meetings as a team member and health consultant.
       
4. Promote student health, wellbeing, and safety to foster healthy living:
   
   1. Provide developmentally appropriate health education and health counseling for individuals and groups;
   2. Encourage injury and disease prevention practices;
   3. Promote personal and public health practices; and
   4. Provide health promotion and injury and disease prevention education.
       
5. Plan and develop the student health services program collaboratively with the superintendent, school nurse, and school health team:
   
   1. Gather and interpret data to evaluate needs and performance;
   2. Establish health advisory council and school health team;
   3. Develop health procedures and guidelines;
   4. Collaborate with staff, families, and community;
   5. Maintain and update confidential student health records;
   6. Coordinate program with all school health components;
   7. Coordinate with school improvement;
   8. Evaluate and revise the health services program to meet changing needs;
   9. Organize scheduling and direct health services staff;
   10. Develop student health services annual status report;
   11. Coordinate information and program delivery within the school and between school and major constituents;
   12. Provide health services by qualified health professionals to effectively deliver services, including multiple levels of school health expertise such as registered nurses, physicians, and advanced registered nurse practitioners; and
   13. Provide for professional development for school health services staff.

EXPANDED HEALTH SERVICES
These additional health services address learning barriers and the lack of access to health care. Examples include school-based services in the schools, school-linked services connected to the schools, primary care, mental health, substance abuse, and dental health.

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Adopted: 8/23
Related Policy: 504
IASB Reference: 607.02; 607.02-R(1)

Attention Parents and Guardians

All students entering the Linn-Mar Community School District are required by state law to meet at least the minimum immunization requirements before they are allowed to attend school. A record of these immunizations must be on file at the student’s attendance center.

No student will be allowed to attend school without the minimum
immunizations required by state law.

Minimum immunizations required to enroll in school are one dose of the following for elementary or secondary (K-12) students that are four years of age or older:

If your student was born on or after September 15, 2003:

1. Diphtheria/Pertussis/Tetanus (DPT): Five doses with at least one dose of DPT received on or after four years of age;
2. Polio: Four doses with at least one dose received on or after four years of age;
3. Measles/Rubella: Two doses with the first dose received on or after 12 months of age and the second dose received no less than 28 days after the first dose or applicant demonstrates a positive antibody test for measles and rubella from a US laboratory;
4. Hepatitis B: Three doses if the applicant was born on or after July 1, 1994; and
5. Varicella (Chickenpox): Two doses received on or after 12 months of age unless the applicant has a reliable history of natural disease.

If your student was born after September 15, 2000; but before September 15, 2003:

1. Diphtheria/Pertussis/Tetanus (DPT): Four doses with at least one dose of DPT received on or after four years of age;
2. Polio: Three doses with at least one dose received on or after four years of age;
3. Measles/Rubella: Two doses with the first dose received on or after 12 months of age and the second dose received no less than 28 days after the first dose or applicant demonstrates a positive antibody test for measles and rubella from a US laboratory;
4. Hepatitis B: Three doses if the applicant was born on or after July 1, 1994; and
5. Varicella (Chickenpox): One dose received on or after 12 months of age unless the applicant has a reliable history of natural disease.

If your student was born on or before September 15, 2000:

1. Diphtheria/Pertussis/Tetanus (DPT): Three doses with at least one dose of DPT received on or after four years of age;
2. Polio: Four doses with at least one dose received on or after four years of age;
3. Measles/Rubella: Two doses with the first dose received on or after 12 months of age and the second dose received no less than 28 days after the first dose or applicant demonstrates a positive antibody test for measles and rubella from a US laboratory;
4. Hepatitis B: Three doses if the applicant was born on or after July 1, 1994; and
5. Varicella (Chickenpox): Two doses received on or after 12 months of age unless the applicant has a reliable history of natural disease.

If your student was born on or after September 15, 2000:

1. Tetanus/Diphtheria/Acellular Pertussis: One-time dose containing vaccine (Tdap) for applicants in grades 7 and above regardless of the interval service the last tetanus/diphtheria containing vaccine.

Also Required – Meningococcal Vaccine:

1. One dose received on or after 10 years of age for students entering 7^th grade and above if born on or after September 15, 2004;
2. Two doses received for students entering 12^th grade if born on or after September 15, 1999; and
3. One dose if received when the student is 16 years of age or older.

Provisional/Conditional Enrollment: If a student has begun immunizations but has not yet received all the required immunizations they may be able to attend school on a provisional or conditional basis. To qualify for provisional enrollment a student must have received at least one dose of each of the required immunizations. If a student falls into this category they must submit an Iowa Department of Health & Human Services Provisional Certificate of Enrollment to the school. This certificate expires in 60 days so the student must be completely immunized during this time or they will not be permitted to attend school until the immunizations have been received. When a student has received all of the required immunizations, they must submit a completed Certificate of Immunization to the school.

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EXCLUSION OF STUDENTS
A student with a communicable disease will be allowed to attend school provided their presence does not create a substantial risk of illness or transmission to other students or employees. If, in the judgment of the building administrator [or designee], there is any risk of the student transmitting the disease to others the building administrator [or designee] will immediately exclude the student from school and may require the student be examined by a physician. The building administrator [or designee] may also require a written statement of health from a physician in order for the affected student to return to school.

ALTERNATIVE PROGRAM
If it is determined that the student will not be permitted to attend classes and/or participate in school activities, arrangements will be made to provide an alternative education program.

RETURN TO SCHOOL
Criteria will be established to determine whether a student with a communicable, contagious, and/or infectious disease including common childhood diseases will be permitted to attend classes. All cases will be reviewed on an individual basis.

CONFIDENTIALITY OF INFORMATION
Records of a student who has a communicable, contagious, and/or infectious disease other than a common childhood disease will be kept confidential and the name of the individual will not be revealed publicly.

APPEAL PROCESS
The student and/or parent/guardian may appeal decisions regarding exclusion from school. This appeal is to be submitted in writing to the superintendent [or designee]. The superintendent [or designee] will respond to the appeal within three school days. If the appeal is denied by the superintendent [or designee] the student and/or parent/guardian may continue the appeal with the Linn-Mar Board of Directors at their next regularly scheduled meeting.

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Adopted: 6/88
Reviewed: 4/11; 4/12; 7/13; 10/14; 11/17; 12/20; 10/23
Revised: 9/02
Related Policy: 504.02; 504.02-E1-E4

CLICK HERE TO DOWNLOAD THE COMMUNICABLE DISEASES CHART

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Concise descriptions and recommendations for exclusion of cases from school.
Source: Iowa Department of Health & Human Services

Disease *Immunization Available	Usual Interval Between Exposure and First Symptoms	Main Symptoms	Minimum Exclusion from School
*Chickenpox	10-21 Days [Average 14-16 Days]	Mild symptoms and fever, pocks are blistery, and scabs develop for most on covered parts of the body	Seven days from onset of rash until all blisters have crusted
Conjunctivitis [Pink Eye]	24-72 Hours	Tearing, redness, puffy lids, and discharge	Until treatment begins or physician approves return
COVID-19 {SARS-CoV-2}	2-14 Days	Fever or chills, cough, shortness of breath or difficulty breathing, fatigue, muscle or body aches, headache, new loss of taste or smell, sore throat, congestion or runny nose, nausea or vomiting, diarrhea	Five days after symptoms start and 24 hours with no fever and improved symptoms
Erythema Infectiosum [5th Disease]	4-20 Days	Usual age is 5-14 years, unusual in adults, brief prodrome or low grade fever followed by erythema (slapped appearance on cheeks), lace-like rash on extremities lasting a few days to three weeks, and rash seems to recur	After diagnosis; no exclusion from school
*German Measles [Rubella]	14-21 Days	Usually mild, enlarged glands in neck and behind ears, and brief rash	Seven days from onset of rash; keep away from pregnant women
*Haemophilus Meningitis	2-4 Days	Fever, vomiting, lethargy, and stiff neck and back	Until physician approves return
*Hepatitis A	Varies from 15-50 Days [Average 28-30 Days]	Abdominal pain, nausea, fever, and skin/eyes may or may not turn yellow	Fourteen days from onset of clinical disease and at least seven days from onset of jaundice
Impetigo	4-10 Days	Inflamed sores with pus	Twenty-four hours after antibiotic therapy has started or until physician approves return; avoid contact with drainage from lesions and cover lesions when attending school
*Measles	10 Days to Fever 14 Days to Rash	Begins with fever, conjunctivitis, runny nose, cough, and then blotchy red rash	Four days from onset of rash
Meningococcal Meningitis	2-10 Days [Commonly 3-4 Days]	Headache, nausea, stiff neck, and fever	Until physician approves return
*Mumps	12-25 Days [Average 16-18 Days]	Fever, swelling, and tenderness of glands at angle of jaw	Five days after onset or until symptoms have resolved
Pediculosis [Head/Body Lice]	7 Days for Eggs to Hatch	Lice and nits (eggs) in hair	No need to send home upon diagnosis and return to school after initial treatment; no-nit policy is recommended
Ringworm	4-10 Days	Scaly red patch; usually ring shaped	No exclusion from school; exclude from gymnasiums, pools, and contact sports
Scabies	2-6 Weeks for Initial Exposure 1-4 Days After Re-Exposure	Tiny burrows in skin caused by mites	Until 24 hours after treatment
Scarlet Fever Scarlantina Strep Throat	1-3 Days	Sudden onset, vomiting, fever, later a fine rash (not on face), and rash usually only with first infections	Twenty-four hours after antibiotics started and no fever
*Whooping Cough [Pertussis]	6-20 Days [Average 9-10 Days]	Head cold, slight fever, cough, and characteristic whoop after two weeks	Five days after start of antibiotic treatment

ACTION STEPS

1. Encourage staff or families with students who may have a communicable disease to alert the school;
2. Contact the school nurse if student/staff absentee rate is greater than 10% due to illness;
3. Report rate to building principal and superintendent [or designee];
4. Report rate to Linn County Public Health (319-892-6000);
5. If school cancellation is recommended by Linn County Public Health, consult with building principal and superintendent [or designee];
6. If cancellation should occur, superintendent [or designee] will assist in getting information to the families and public; and
7. Recommended guidelines about common communicable illnesses are available to families and staff from Linn-Mar Health Services. The school nurses will consult with administration regarding distribution of these guidelines.

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Adopted: 11/07
Reviewed: 4/11; 4/12; 7/13; 10/14; 11/17; 12/20; 10/23
Revised: 9/09
Related Policy: 504.02; 504.02-R; 504.02-E(1); 504.02-E(3)-E(4)

CLICK HERE TO DOWNLOAD THE DISEASES REPORTABLE TO IOWA DEPARTMENT OF HEALTH & HUMAN SERVICES

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Disease Reporting Hotline (1-800-362-2736)

Report information requested on disease reporting form which may be obtained by calling 1-888-398-9696.

EMERGECY REPORTABLE DISEASES OR CONDITIONS: REPORT BY PHONE IMMEDIATELY!

Botulism	# Measles	Rabies (Human)
Cholera	> Meningococcal Invasive Disease	Vancomycin-Resistant Staph Aereus
Diphtheria	Plaque	Yellow Fever
> Haemophilus Influenza Type B Invasive Disease	# Polio

Also, outbreaks of any kind, unusual syndromes, and uncommon diseases should be reported immediately by phone. These could be infectious, environmental, or occupational in origin and include food-borne outbreaks and illness secondary to chemical exposure (e.g. pesticides, anhydrous ammonia).

AGENTS OF TERRORISM
Diseases or syndromes of any kind caused by a biological, chemical, or radiological agent or toxin when the provider reasonably believes or suspects that the agent or toxin may be the result of a deliberate act such as terrorism. Examples of these agents or toxins include but are not limited to anthrax, mustard gas, sarin gas, ricin, tularemia, and smallpox.

DISEASES REPORTABLE BY MAIL OR PHONE

Common-Reportable Diseases	Rare-Reportable Diseases
Campylobacteriosis	Anthrax
Cryptosporidiosis	# Brucellosis
COVID-19 [SARS-CoV-2]	Cyclospora
> Encephalitis, Arboviral	# Hansen's Disease (Leprosy)
# Escherichia Coli O157:H7 (And Related Diseases HUS & TTP)	Hantavirus Syndromes
Giardiasis	Listeria Monocytogenes Invasive Disease
# Hepatitis A, B, C, D, and E	# Malaria
> Legionellosis	Mumps
# Lyme Disease	Psittacosis
# Pertussis	# Rocky Mountain Spotted Fever
Rabies (Animal)	# Rubella (Including Congenital)
# Salmonellosis (Including Typhoid Fever)	# Tetanus
# Shigellosis	> Toxic Shock Syndrome
# Tuberculosis	# Trichinosis

DISEASES REPORTABLE ONLY BY SENDING ISOLATES TO STATE HYGIENIC LAB (319) 335-4500

Enterococcus Invasive Disease	Methicillin-Resistant Staphylococcus Aereus Invasive Disease
Group A Streptococcus Invasive Disease	Streptococcus Pneumonia Invasive Disease

# Diseases that require follow-up by local health agency
> Diseases that require follow up by hospital infection control practitioner
Isolates in bold type should be sent to State Hygienic Laboratory
Report on a quarterly basis to UHL: Total number of Invasive Staphylococcus Aereus isolates

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CLICK HERE TO DOWNLOAD THE DISEASE REPORTING CARD

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Disease reporting is required by Iowa Administrative Code [641]-1 (139A).
To report call (800) 362-2736 or fax (515) 281-5698 or Iowa Disease Surveillance Systems (IDSS).

DISEASE AND REPORTING INFORMATION

Disease/Event:	Species/Type/Group:
Specimen Source:	Date Collected:
Onset Date:	Date Reported to IDPH:
Epi Link?  Yes   No   Unknown	Isolate to UHL?  Yes   No   Unknown
Reporter's Name:	Phone:
Reporting Facility's Name:

PATIENT INFORMATION

Name (Last, First, Middle):	Date of Birth:
Address:	Age:
City/State/Zip/County:	Gender:   M   F   Unknown
Marital Status:  Single  Married   Divorced   Widowed   Unknown	Pregnant: Yes   No   Unknown
Race: White    Black/African American    American Indian/Alaska Native      Asian    Hawaiian/Pacific Islander     Other       Unknown
Ethnicity:    Hispanic/Latino      Not Hispanic/Latino  Unknown
If minor, parent/guardian name(s):	Home Phone:
Work Phone:	Other Phone:

Long-Term Care Facility Resident:   Yes   No   Unknown	Facility Name:
Is the Case Employed:   Yes   No   Unknown	Employer Name:
City:	State:
In this case does the case:     Handle Food     Work in a healthcare setting        Work in a lab setting
Is the case enrolled in school or attending a childcare facility:     Yes   No   Unknown
School/Childcare Name:	City:                                      State:

Hospitalized for this disease:    Yes   No	Where:
Admission Date:	Was death due to this disease:   Yes   No

HEALTHCARE PROVIDER AND LABORATORY INFORMATION

Name and Title of Healthcare Provider:	Name of Laboratory:
Facility or Clinic:	Laboratory Phone:
City and State:	City and State:
Phone:	Does the case have clinical symptoms:   Yes   No Is the case lab confirmed:                           Yes  No
Comments:

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Adopted: 9/98
Reviewed 7/13; 10/14; 11/17; 12/20; 10/23
Revised: 11/07
Related Policy: 504.02; 504.02-R; 504.02-E(1)-E(3)

The following information provides a basis for the management of a medical emergency. All schools throughout the Linn-Mar Community School District have emergency response teams that will respond to an emergency and follow guidelines per American Red Cross training.

ASSESS THE SITUATION

• For safety of the individual (protect from further injury)
• For safety of the responder (personal protective equipment, universal precautions as applicable to situation)

ASSESS SEVERITY OF INJURY/ILLNESS OF INDIVIDUAL

• Airway
• Breathing
• Circulation
• Obtain history of incident from individual witness if possible

ACTIVATE BUILDING EMERGENCY RESPONSE TEAM

• Call 911 for emergency medical assistance
• Provide appropriate life support or first aid

NOTIFY

• Family/emergency contact
• School nurse
• Building administration

No injured or ill student should be sent home or to a medical facility without the knowledge and permission of the parent/guardian or other responsible person. If emergency situation is life-threatening, call 911, even if the parent/guardian cannot be reached.

Document incident using Complete Variance Report.

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Adopted: 10/14
Reviewed: 11/17; 12/20; 10/23
Related Policy: 504.03

CLICK HERE TO DOWNLOAD THE PARENT/GUARDIAN AUTHORIZATION AND RELEASE FORM FOR THE ADMINISTRATION OF MEDICATION OR SPECIAL HEALTH SERVICESTO STUDENTS

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Student’s Name (Last, first, middle): ___________________________________________________________

Birthday: _________________________ School: ______________________ Date: _____________________

School medications and special health services are administered following these guidelines:

1. Parent/guardian has provided a signed, dated authorization to administer prescription medication and/or provide special health services listed. Electronic signatures meet the requirement of written signatures.
2. The prescribed medication is in the original, labeled container as dispensed.
3. The prescription medication label contains the student’s name, name of the medication, the medication dosage, time(s) to administer, route to administer, and date.
4. Authorization is renewed annually and as soon as practical when the parent/guardian notifies the school that changes are necessary.

Prescribed Medication: ______________________________________ Dosage: ________________________

Route: _______________________________________________ Time at School: _____________________

Special health services and instructions, if indicated: _________________________________________________

_____________________________________________________________________________________
Discontinue/Re-Evaluate/Follow-Up Date for prescribed medication or special health services listed.

 

Prescriber’s Signature: _____________________________________________ Date: _____________

Prescriber’s Credentials (when indicated for health service delivery): _______________________________

Parent/Guardian Signature: ___________________________________________ Date: __________________

Parent/Guardian Address: ________________________________________ Phone: ____________________

Additional Information: ___________________________________________________________________

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Reviewed: 7/13; 12/20
Revised: 10/14; 4/16; 10/17; 6/20; 8/21; 8/23
Related Policy: 504.31; 504.31-E2; 504.32
IASB Reference: 504.07-E(2)

CLICK HERE TO DOWNLOAD THE AUTHORIZATION-ASTHMA, AIRWAY CONSTRICTING, OR
RESPIRATORY DISTRESS MEDICATION SELF-ADMINISTRATION CONSENT FORM

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Student Name (Last, First, Middle):
Birthday:
School:
Date:

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In accordance with applicable laws, students with asthma, airway constricting diseases, respiratory distress, or students at risk of anaphylaxis who use epinephrine auto-injectors may self-administer their medication upon the written approval of the student’s parent/guardian and prescribing licensed health care professional regardless of competency. The following must occur for a student to self-administer asthma medication, bronchodilator canisters or spacers, other airway constricting disease medication, or to self-administer an epinephrine auto-injector:

1. Parent/guardian provides a signed/dated copy of the authorization for student medication self-administration;
2. Parent/guardian provides a written statement from the student’s licensed health care professional (A person licensed under Chapter 148 to practice medicine and surgery or osteopathic medicine and surgery, an advanced registered nurse practitioner licensed under Chapter 152 or 152E and registered with the Board of Nursing, or a physician’s assistant licensed to practice under the supervision of a physician as authorized in Chapters 147 and 148C) containing the following:
   1. Name and purpose of the medication;
   2. Prescribed dosage; and
   3. Times or special circumstances under which the prescribed medication is to be administered.
3. The medication is in the original, labeled container as dispensed or the manufacturer’s labeled container containing the student’s name, name of the medication, directions for use, and date; and
4. Authorization shall be renewed annually. In addition, if any changes occur in the medication, dosage or time of administration, the parent/guardian is to notify school officials immediately. The authorization shall be reviewed as soon as practical.

Provided the above requirements are fulfilled, the school shall permit the self-administration of the prescribed medication by a student while in school, at school-sponsored activities, under the supervision of school personnel, and before or after normal school activities, such as while in before-school or after-school care on school-operated property. If the student abuses the self-administration policy, the ability to self-administer may be withdrawn by the school or discipline may be imposed, after notification is provided to the student’s parent/guardian.

Pursuant to state law, the school district and its employees are to incur no liability, except for gross negligence, as a result of injury arising from self-administration of medication or use of an epinephrine auto-injector by the student. The parent/guardian of the student shall sign a statement acknowledging that the school district is to incur no liability, except for gross negligence, as a result of self-administration of medication or an epinephrine auto-injector by the student as provided by law.

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PRESCRIBER INFORMATION
Medication:
Dosage:
Route:
Time:
Purpose for Medication and Administration/Instructions:
Special Circumstances:
Discontinue/Re-Evaluate/Follow-Up Date:
Prescriber's Signature:
Date:
Prescriber's Address:
Emergency Phone:

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1. I request the above-named student possess and self-administer asthma medication, bronchodilator canisters or spacers, or other airway constricting disease medication(s) and/or an epinephrine auto-injector at school and in school activities according to the authorization and instructions;
2. I understand the school district and its employees acting reasonably and in good faith shall incur no liability for any improper use of medication or an epinephrine auto-injector or for supervising, monitoring, or interfering with a student’s self-administration of medication or use of an epinephrine auto-injector. I acknowledge that the school district is to incur no liability, except for gross negligence, as a result of self-administration of medication or use of an epinephrine auto-injector by the student;
3. I agree to coordinate and work with school personnel and notify them when questions arise or relevant conditions change;
4. I agree to provide safe delivery of medication and equipment to and from school and to pick up remaining medication and equipment;
5. I agree the information shared with school personnel in accordance with the Family Educational Rights and Privacy Act (FERPA) and any other applicable laws;
6. I agree to provide the school with back-up medication approved on this form; and
7. I agree that the student will maintain their own self-administration records.

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Parent/Guardian Signature:
Date:
Address:
Home Phone:
Cell Phone:
Work Phone:
Self-Administration Authorization Additional Information:

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Adopted: 4/16
Reviewed: 11/17; 12/20
Revised: 3/23; 8/23
Related Policy: 504.31; 504.31-E1; 504.32
IASB Reference: 507.02-E(1)

CLICK HERE TO DOWNLOAD THE PARENT/GUARDIAN AUTHORIZATION AND RELEASE FORM FOR INDEPENDENT SELF CARRY AND ADMINISTRATION OF PRESCRIBED MEDICATION OR INDEPENDENT DELIVERY OF HEALTH SERVICES BY THE STUDENT

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Student's Name (Last, First, Middle):
Birthday:
Building:
Date:

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I request the above-named student: (Parent/guardian initial below all that apply)

CLICK HERE TO DOWNLOAD PARENT/GUARDIAN AUTHORIZATION AND RELEASE FORM FOR ADMINISTRATION OF VOLUNTARY SCHOOL STOCK OF OVER-THE-COUNTER MEDICATION TO STUDENTS

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Student's Name (Last, Middle, First):
Birthday:
Building:
Date:

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• Acetaminophen administered per manufacturer label
• Ibuprofen administered per manufacturer label

Voluntary school stock of nonprescription, over-the-counter medications are administered following these guidelines;

1. Parent/guardian has provided a signed, dated annual authorization to administer of the nonprescription, over-the-counter medication(s) listed according to the manufacturer instructions. Electronic signature meets the requirement of written signature.
2. The nonprescription, over-the-counter medication is in the original, labeled container and dispensed per the manufacturing label.
3. All other nonprescription, over-the-counter medication not listed will require a written parent/guardian authorization and supply for the over-the-counter medication.
4. Supplements are not nonprescription, over-the-counter medications approved by the Federal Drug Administration (FDA) and are NOT applicable.
5. Nonprescription, over-the-counter medications approved by the FDA that require emergency medical service (EMS) notification after administration are NOT applicable.
6. Persons administering nonprescription, over-the-counter medication include licensed health personnel working under the auspices of the school and individuals, whom licensed health personnel have delegated the administration of medication with valid certification who have successfully completed a medication administration course approved by the department and annual medication administration procedural skills check.
   
   • Districts stocking the administration of a voluntary stock of nonprescription, over-the counter medications, collaborate with licensed health personnel to develop and adopt a protocol shared with the parent/guardian to define at a minimum:
     • When to contact the parent/guardian when a nonprescription medication, over-the-counter medication is administered;
     • Documentation of the administration of the nonprescription, over-the-counter medication and parent/guardian contact;
     • A limit to the administration of a school’s stock nonprescription, over-the-counter medications that would require a prescriber signature for further administration of a school’s nonprescription, over-the-counter medications for the remaining school year; and
     • The development of an Individual Health Plan (IHP) for ongoing medication administration or health service delivery at school.

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I request the above-named student receive the voluntary stock nonprescription, over-the-counter medications supplied by the school in accordance with the district guidelines and protocol.

Parent/Guardian Signature:
Date:
Address:
Phone:

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Adopted: 8/23
Related Policy: 504.31; 504.31-E1-E3
IASB Reference: 507.02-E(4)

CLICK HERE TO DOWNLOAD THE PARENTAL AUTHORIZATION FORM FOR ADMINISTRATION
OF VOLUNTARY SCHOOL SUPPLY OF STOCK MEDICATION FOR LIFE-THREATENING INCIDENTS

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Student Name:
Student Birthdate:
Building:  
Date: 

The district seeks to provide a safe environment for students, staff, and visitors who are at risk of potentially life-threatening incidents. The district supplies the following prescription medications for life-threatening incidents that are listed below. Generic brands may be substituted. (Select all that apply)

            _____ Epinephrine Auto-Injectors

            _____ Bronchodilator

            _____ Bronchodilator Canisters and Spacers

            _____ Opioid Antagonist

Pursuant to state law, the district or its employees are to incur no liability for any injury arising from the provision, administration, failure to administer, or assistance in the administration of the selected prescription medications supplied by the district for life-threatening incidents provided they have acted reasonably and in good faith.

The parent/guardian shall sign consent for the student to receive the voluntary school supply of stock medications listed for life-threatening incidents and a statement acknowledging that the district is to incur no liability as a result of administration of a prescription medication for life-threatening incidents provided the school district to have acted reasonably and in good faith. Electronic signatures meet the requirement of written signatures.

• I request the above-named student be administered the voluntary stock supply of prescription medication(s), in the name of the school district, by a school nurse or personnel trained and authorized to administer to a student who, acting reasonably and in good faith, perceives the student may be experiencing symptoms associated with a life-threatening incident following the administration instructions listed as identified in the required annual awareness training associated with the stock medication(s) above and after completion of the medication administration course requirements.
• I understand the school district and its employees acting reasonably and in good faith shall incur no liability as a result of administration of the prescription medication(s) for life-threatening incidents provided the school district to have acted reasonably and in good faith.

Parent/Guardian Signature:   (Agreed to above statements)
Date: 
                                                  

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Adopted: 10/23
Related Policy: 504.32
IASB Reference: 804.5-E(1)

Some students who require special education need special health services in order to participate in the educational program. These students will receive special health services in accordance with their Individualized Health Plan (IHP).

A. Definitions

Assignment and Delegation: Occurs when licensed health personnel, in collaboration with the education team, determine the special health services to be provided and the qualifications of individuals performing the health services. Primary consideration is given to the recommendation of the licensed health personnel. Each designation considers the student’s special health service. The rationale in accordance with licensed practice for the designation is documented. If the designation decision of the team differs from the licensed health professional, team members may file a dissenting opinion in the student’s education record.

Co-Administration: The eligible student’s participation in the planning, management, and implementation of the student’s special health service and demonstration of proficiency to licensed health personnel.

Educational Program: Includes all school curricular programs and activities both on and off school grounds.

Education Team: May include the eligible student, the student’s parent, administrator, teacher, licensed health personnel, others involved in the student’s educational program, or as described in the Individuals with Disabilities Education Act or Section 504 of the Rehabilitation Act of 1973.

Health Assessment: Health data collection, observation, analysis, and interpretation relating to the eligible student’s educational program.

Health Instruction: Education by licensed health personnel to prepare qualified, designated personnel to deliver and perform special health services contained in the eligible student’s health plan. Documentation of education and periodic updates are on file at school.

Individual Health Plan: The confidential, written, preplanned, and ongoing special health service in the educational program. It includes assessment, nursing diagnosis, outcomes, planning, interventions, evaluation, student goals (if applicable), and a plan for emergencies. The plan is updated as needed and at least annually. Licensed health personnel develop this written plan with collaboration from the parent or guardian, the individual’s health care provider, or education team.

Licensed Health Personnel: Includes licensed registered nurses, licensed physicians, and other licensed health personnel legally authorized to provide special health services and medications under the auspices of the district.

Prescriber: Licensed health personnel legally authorized to prescribe special health services and medications.

Qualified Designated Personnel: Persons instructed, supervised, and competent in implementing the eligible student’s health plan.

Special Health Services: Includes, but is not limited to, services for eligible students whose health status (stable or unstable) requires:

1. Interpretation or intervention;
2. Administration of health procedures and healthcare; or
3. Use of a health device to compensate for the reduction or loss of a body function.

Supervision: The assessment, delegation, evaluation, and documentation of special health services by licensed health personnel. Levels of supervision include situations in which licensed health personnel are:

1. Physically present;
2. Available at the same site; or
3. Available on call.

B. Licensed health personnel will provide special health services under the auspices of the district. The duties of the licensed health personnel include:

1. Participate as a member of the education team;
2. Provide the health assessment;
3. Plan, implement, and evaluate the written Individual Health Plan (IHP);
4. Plan, implement, and evaluate the special emergency health services;
5. Serve as a liaison and encourage participation and communication with health service agencies and individuals providing health care;
6. Provide health consultation, counseling, and instruction with the eligible student, the student’s parent, and the staff in cooperation and conjunction with the prescriber;
7. Maintain a record of special health services. The documentation includes the eligible student’s name, special health services, prescriber or person authorizing, date and time, signature and title of person providing the special health services, and any unusual circumstances in the provision of such services;
8. Report unusual circumstances to the parent, school administration, and prescriber;
9. Assign and delegate to, instruct, provide technical assistance, and supervise qualified designated personnel; and
10. Update knowledge and skills to meet special health service needs.

C. Prior to the provision of special health services the following will be on file:

1. Written statement by prescriber detailing the specific method and schedule of the special health services, when indicated;
2. Written statement by the student’s parent requesting the provision of the special health services;
3. Written report of the preplanning staffing or meeting of the education team; and
4. Written Individual Health Plan (IHP) available in the health record or integrated into the Individualized Education Program (IEP) or Individualized Family Service Plan (IFSP).

D. Licensed health personnel, in collaboration with the education team, will determine the special health services to be provided and the qualifications of individuals performing the special health services. The documented rationale will include the following:

1. Analysis and interpretation of the special health service needs, health status stability, complexity of the service, predictability of the service outcome, and risk of improperly performed service;
2. Determination that the special health services, tasks, procedures, or function is part of the designated person’s job description;
3. Determination of the assignment and delegation based on the student’s needs and qualifications of school personnel performing the health services;
4. Review of the designated person’s competency; and
5. Determination of initial and ongoing level of supervision, monitoring, and evaluation required to ensure quality services.

E. Licensed health personnel will supervise the special health services, define the level and frequency of supervision, and document the supervision.

F. Licensed health personnel will instruct qualified, designated personnel to deliver and perform special health services contained in the eligible Individual Health Plan (IHP). Documentation of instruction, written consent of personnel as required in Iowa Code 280.23, and periodic updates are on file at school.

G. Parents will provide the usual equipment, supplies, and necessary maintenance for such, unless the district is required to provide the equipment, supplies, and maintenance under the Individuals with Disabilities Education Act (IDEA) or Section 504 of the Rehabilitation Act of 1973. The equipment is stored in a secured area. The personnel responsible for the equipment are designated in the Individual Health Plan (IHP). The IHP will designate the role of the school, parents, and others in the provision, supply, storage, and maintenance of necessary equipment.

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Adopted: 2/96
Reviewed: 4/11; 4/12; 7/13; 10/14; 11/17; 12/20
Revised: 8/02; 10/23; 8/24
Related Policy: 504.11
IASB Reference: 507.08-R(1)

To implement the wellness policy (Refer to Policy 504.12), the following district-specific goals have been established:

GOAL 1: NUTRITION EDUCATION AND PROMOTION
Schools will provide nutrition education and engage in nutrition promotion that help students develop lifelong healthy eating behaviors. The goals for addressing nutrition education and nutrition promotion include the following:

1. Provide students with the knowledge and skills necessary to promote and protect their health;
2. Ensure nutrition education and promotion are not only part of health education classes, but also integrated into other classroom instruction through subjects such as math, science, language arts, social studies, and elective subjects;
3. Include enjoyable, developmentally appropriate, culturally relevant, and participatory activities such as cooking demonstrations or lessons and taste-testing;
4. Promote fruits, vegetables, whole-grain products, low-fat and fat-free dairy products, and healthy foods;
5. Emphasize caloric balance between food intake and energy expenditure (promotes physical activity/exercise);
6. Link with school meal programs, cafeteria nutrition promotion activities, other school foods, and nutrition-related community services; and
7. Implement evidence-based healthy food promotion techniques through the school meal programs using Smarter Lunchroom techniques.

GOAL 2: PHYSICAL ACTIVITY
Schools will provide students and staff with age and grade appropriate opportunities to engage in physical activity that meet federal and state guidelines, including the Iowa Healthy Kids Act. The goals for addressing physical activity include the following:

1. Develop a comprehensive, school-based physical activity program (CSPAP), that includes the following components:
   • Physical education, recess;
   • Classroom-based physical activity;
   • Walk to school; and
   • Out of school time activities;
2. Promote the benefits of a physically active lifestyle and help students develop skills to engage in lifelong healthy habits;
3. Engage students in moderate to vigorous activity during at least 50% of physical education class time;
4. Encourage classroom teachers to provide short physical activity breaks (3-5 minutes), as appropriate;
5. Offer classroom health education that complements physical education by reinforcing the knowledge and self-management skills needed to maintain a physically active lifestyle;
6. Ensure physical activity is not used for or withheld as a punishment;
7. Afford elementary students with recess according to the following:
   • At least 20 minutes a day;
   • Outdoors as weather and time permits; and
   • Encourages moderate to vigorous physical activity; and
8. Scheduled to avoid extended periods of inactivity.

GOAL 3: OTHER SCHOOL-BASED ACTIVITES THE PROMOTE STUDENT WELLNESS
Schools will support student, staff, and parent/guardian efforts to maintain a healthy lifestyle, as appropriate. The goals for addressing other school-based activities that promote student wellness include the following:

1. Provide parents/guardians a list of foods and beverages that meet nutrition standards for classroom snacks and celebrations;
2. Provide school staff a list of alternative ways to reward students. Foods and beverages will not be used as rewards or withheld for punishment;
3. Develop a plan to promote staff health and wellness;
4. Share information about the nutritional content of meals with parents/guardians and students;
5. Support the consumption of breakfast at school by implementing alternative breakfast options to the extent possible;
6. Permit students to bring and carry water bottles filled with water throughout the day;
7. Make drinking water available where school meals are served during mealtimes;
8. Encourage fundraising efforts held outside school hours to sell only non-food items, promote physical activity, or include foods and beverages that meet or exceed the Smart Snacks nutrition standards;
9. Strive to provide students with at least 10 minutes to eat after sitting down for breakfast and 20 minutes after sitting down for lunch;
10. Discourage students from sharing foods or beverages during meal or snack times, given concerns about allergies and dietary needs; and
11. Apply for USDA’s Healthier US School Challenge: Smarter Lunchroom Award, a certification initiative that recognizes schools for nutrition and physical activity excellence.

PUBLIC INVOLVEMENT
There is a process for permitting parents/guardians, students, representatives of the school food authority, teachers of physical education, school health professionals, the school board, administrators, and the public to participate in the development, implementation, and periodic review and update of the policy.

1. The district has a local Wellness Committee to advise the district on the development, implementation, and improvement of the school wellness policy (Refer to Policy 504.12);
2. The superintendent [or designee] invites suggestions or comments concerning the development, implementation, and improvement of the school wellness policy. As such, interested persons are encouraged to contact the superintendent [or designee].

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Adopted: 10/23
Related Policy: 504.12
IASB Reference: 507.90-R(1)

CLICK HERE TO DOWNLOAD THE FORM

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Dear Parent/Guardian,

This letter is to inform you that your student (Insert student's name as listed on school registration form) has made a request of a licensed employee to: (Check all that apply)

_____Make an accommodation that is intended to affirm the student's gender identity as follows:

_____________________________________________________________________________________

_____Use a name, pronoun, or gender identity that is different from the name, pronoun, and/or gender identity listed on
              the student's school registration forms.  The name, pronoun, or gender identity requested is: ________________

 

CLICK HERE TO DOWNLOAD REQUEST TO UPDATE STUDENT IDENTITY

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Student's name on current school registration forms: ___________________________________

Date: _______________________________

Please update my student's names, pronouns, and/or gender identities on my student's school registration paperwork to include all of the following:

Names: ___________________________________________________________________

Pronouns: _________________________________________________________________

Gender Identities: ____________________________________________________________

 

Parent/Guardian Signature: ____________________________________________________

Date: ________________________________

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Adopted: 8/23
Related Policy: 504.14; 504.14-E1
Legal Reference (Code of Iowa): SF496
IASB Reference: 503.07-E(2)