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School Nurse Procedure Manual The School District of Philadelphia

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					SCHOOL DISTRICT OF PHILADELPHIA
       SCHOOL HEALTH SERVICES




         School Nurse
       Procedure Manual




                           September   1,   2002
“Although the primary function
of schools is to educate our
young people, when health and
social problems impede
students’ ability to learn,
schools must assist the
students and their families in
securing the services they need
to succeed by linking students
with health and social
services.”*




*Children Achieving Action Design
  School Reform Commission


  James E. Nevels, Chairman

    Sandra Dungee Glenn

  James P. Gallagher, Ph.D.

       Michael Masch

      Daniel J. Whelan


****************************


        Paul J. Vallas
   Chief Executive Officer

         Flora Turner
      Executive Director
Office of Specialized Services
                          SCHOOL DISTRICT OF PHILADELPHIA
                         SCHOOL NURSE PROCEDURE MANUAL

                            Table of Contents                 (Sep. 02)

MANDATED PROGRAMS___________________________________________ 3
   REQUIREMENTS AND PURPOSE (SEPT. 01)___________________________________________________4
   GROWTH SCREENING       (SEP. 02) ___________________________________________________________5
   HEARING SCREENING (SEP. 02) ____________________________________________________________8
   PHYSICAL EXAMINATIONS FOR STUDENTS (SEPT. 02)________________________________________13
   DENTAL EXAMINATIONS FOR STUDENTS (SEPT. 02)________________________________________ 20
   SCOLIOSIS (SEP. 02)______________________________________________________________________23
   VISION SCREENING - MYOPIA (SEP. 02) _____________________________________________________31
   VISION SCREENING - HYPEROPIA (SEP. 02)__________________________________________________33
GENERAL PROCEDURES__________________________________________ 3 6
   ACCIDENTS/ ILLNESS (SEP. 02)____________________________________________________________37
   CATEGORIES OF EMERGENCIES (DEC. 98) _________________________________________________39
   RELEASE FROM SCHOOL FOR ACCIDENT / ILLNESS (SEP. 01) _________________________________42
   RETENTION OF STUDENT IN SCHOOL (ACCIDENT / ILLNESS) (DEC. 98) ________________________44
   SERIOUS HEAD AND NECK INJURY (DEC. 98) ________________________________________________45
   MINOR HEAD AND NECK INJURY (SEP. 01)__________________________________________________46
CHILD ABUSE / NEGLECT ________________________________________ 4 9
   CHILD ABUSE (BOARD POLICY) (DEC. 98)____________________________________________________50
   INVESTIGATION OF ALLEGED MISCONDUCT WITH CHILDREN BY EMPLOYEES (DEC. 98) _______52
   CHILD PROTECTIVE SERVICES (DEC. 98) ___________________________________________________57
   RESPONSIBILITIES OF PRINCIPAL (DEC. 98)_________________________________________________59
   RESPONSIBILITIES OF THE SCHOOL NURSE (DEC. 98) _______________________________________60
   PROCEDURE FOR REPORTING (SEP. 01) ____________________________________________________61
   NOTIFICATION OF PARENTS (DEC. 98) _____________________________________________________63
   COOPERATION WITH LAW ENFORCEMENT (DEC. 98) ________________________________________64
   EARLY CHILDHOOD PROGRAMS (DEC. 98) _________________________________________________65
   RESPONSIBILITIES OF SCHOOL COUNSELORS (DEC. 98) ______________________________________66
   DOMESTIC VIOLENCE-SPOUSAL & DATE ABUSE (SEP. 01) ____________________________________67
COMMUNICABLE DISEASE CONDITIONS ___________________________ 6 9
   AIDS/HIV INFECTION (DEC. 98)____________________________________________________________70
   INTERAGENCY PROTOCOL, SD & DEPARTMENT OF HEALTH (SEP. 02) ________________________72
   IMMUNIZATION (SEP.02) ________________________________________________________________74
   PEDICULOSIS CAPITIS (SEP. 01) ___________________________________________________________78
   SEXUALLY TRANSMITTED DISEASES (DEC. 98) _____________________________________________83
MEDICATION ADMINISTRATION __________________________________ 8 5
   ACETAMINOPHEN STANDING ORDERS (SEP. 02) ___________________________________________86
   IBUPROFEN - STANDING ORDER (SEP. 02) __________________________________________________89
   ADMINISTRATION OF LONG TERM MEDICATION - SCHOOL BOARD POLICY (DEC. 98) __________92
   USE OF MEDICATION/MEDICAL EQUIPMENT SCHOOL BOARD POLICY (DEC. 98)_______________93
   PRESCRIBED MEDICATION (SEP. 02) _______________________________________________________94
NON-COMPUTERIZED HEALTH ROOM_____________________________ 1 0 7
   RECORD OF ILLNESS AND/OR INJURY (M98) (DEC. 98)_______________________________________108
   SCREENING WORKSHEETS (DEC. 98)______________________________________________________117
   TEMPORARY PROBLEM LIST (DEC. 98)____________________________________________________123




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                        SCHOOL NURSE PROCEDURE MANUAL

RESOURCES ____________________________________________________ 1 2 4
   PUBLIC SCHOOL HEALTH FUND: PURPOSE AND ELIGIBILITY STANDARDS (SEP. 02)____________126
   PUBLIC SCHOOL HEALTH FUND: DENTAL SERVICES (SEP. 01) _______________________________128
   PUBLIC SCHOOL HEALTH FUND: ORTHODONTIA (SEP. 02) __________________________________129
STUDENTS WITH SPECIAL NEEDS________________________________ 1 3 2
   LEGAL BASIS / PURPOSE (DEC. 98) _______________________________________________________133
   DO NOT RESUSCITATE ORDERS - SCHOOL BOARD POLICY (DEC. 98) __________________________135
   SERVICES OF SPECIAL EDUCATION CONSULTANT (SEP. 01) ________________________________136
   PROTECTED HANDICAPPED STUDENTS: HEARING PREPARATION (SEP. 01) ___________________138
   REFERRAL TO STUDENT SUPPORT TEAM (SST) (DEC. 98) _____________________________________140
   PROTECTED HANDICAPPED STUDENTS (SEP. 02) __________________________________________141
   SPECIAL CASE FILE (SEP. 02) ____________________________________________________________145
   EXTENDED SCHOOL YEAR (ESY) (SEP. 02)___________________________________________________150
   PREGNANT STUDENTS (SEP. 02)__________________________________________________________151
   TRANSPORTATION REQUESTS FOR MEDICAL REASONS (SEP 01)______________________________152
   TRANSPORTATION REQUESTS, AUTHORIZATION LETTER (DEC. 98)___________________________155
   HOMEBOUND INSTRUCTIONAL PROGRAMS (SEP. 02)_______________________________________156
   SUICIDE PREVENTION/INTERVENTION GUIDELINES (SEP. 02)_________________________________161
   VISUALLY IMPAIRED (DEC. 98)___________________________________________________________166
MISCELLANEOUS_________________________________________________169
   ACCESS BILLING PROCEDURE (SEP. 02 )__________________________________________________ 170
   CALENDAR OF ACTIVITIES (SEP. 02)______________________________________________________172
   INFECTION CONTROL PRECAUTIONS: CONTACT WITH BODILY FLUIDS (APR. 02)______________175




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      MANDATED PROGRAMS




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SUBJECT:                                                          NUMBER 100
MANDATED PROGRAMS

CLASSIFICATION:

REQUIREMENTS AND PURPOSE (SEP. 01)

REQUIREMENTS

1. Section 1402 (a) of the School Code requires:
          a. Physical examinations upon entry and in grades 6 and 11
          b. Annual vision screening
          c. Annual growth screening
          d. Audiometric screening in grades K, 1, 2, 3, 7, 11 as well as annual testing for children
              who have failed previously
          e. Scoliosis Screening in grades 6 and 7
2. Section 1403 (a) requires:
          a. Dental examinations upon entry and in grades 3 and 7

3. Section 1402 (f) allows the School District of Philadelphia to modify the School Health Program with
   the approval of the Pennsylvania Secretary of Health. The School District of Philadelphia require
          a. Growth screening every other year
          b. Audiometric screening in 6th rather than 7th grade, in 9th rather than 11th
          c. In some schools, School Nurse Practitioners may provide a modified program which is
              adapted to meet the needs of the school/community.
          d. Tuberculin Testing in schools and grades selected in collaboration with the City of
              Philadelphia Department of Public Health.
          e. Physical examinations in 9th rather than 11th grade.

DEFINITION AND PURPOSE

1. Screening is a method of testing large numbers of persons, quickly against a standard pass/fail criteria.
   It is possible for an individual to fail a screening test and be found normal upon completion of a
   comprehensive examination. It is also possible for an individual who has a problem to pass a
   screening test.

2. The purpose of height, weight, vision and hearing screening tests is:
          a. To identify students who may have acquired or been born with problems
          b. To provide an opportunity for health education and health counseling for the student
          c. To bring about care or remediation of identified problems
          d. To teach students and parents to be informed health care consumers
          e. To comply with School Code Section 1402




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SUBJECT: MANDATED PROGRAMS                                       NUMBER 104
CLASSIFICATION :

GROWTH SCREENING             (SEP. O2)

I. Purpose
    A. To assess physical growth.
    B. To assess nutritional status.
    C. To identify students with possible growth or nutritional problems.
    D. To standardize growth assessment and results.
    E. To standardize case management of the at risk student.

II. Frequency
     A. Bi-annually
     B. Growth above the 90th percentile or below the 10th percentile should be assessed annually

III. Procedure
     A. Measure and weigh student without shoes and with indoor clothing.
     B. Measure with wall chart or stadiometer.
     C. Student should stand against wall with arms at sides and heels back against wall.
     D. Student should face forward with chin in neutral position.

IV. Calculation of height to weight percentiles.
   A. For students in whom a problem is identified, initiate a graph growth record.
   B. Abnormal or questionable findings should be rechecked for accuracy and rechecked in three
       months.
   C. Complete documentation.
       1. Document results in screen H5 in Main Menu #2, Health Inquiry and Maintenance. Where HIS
          is unavailable, use MEH-3.

V. Interpretation of Measurements
   A. Measurements between the 25th and 75th percentiles are likely to represent normal growth.
   B. Measurements between the 10th and 25th, and the 75th and 90th percentiles may or may not be
       normal. Previous and subsequent measurements and genetic factors need to be considered.
   C. Measurements above the 90th and below the 10th percentiles should be checked for accuracy and
       referral for further evaluation should be considered.
   D. Measurements above the 95th or below the 5th percentiles are of priority concern and warrant
       referral and follow-up.
   E. Measurements indicating a percentile shift of 25 percentile or more should be rechecked. Carefully
       evaluate for cause and refer appropriately.
   F. When there is considerable difference in height and weight percentiles, careful assessment of the
       student is warranted.




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SUBJECT: MANDATED PROGRAMS                                          NUMBER 106

CLASSIFICATION:

HEARING SCREENING                  (SEP. 02)


HEARING SCREENING PROGRAM

I.        Purpose
       A. To identify students with hearing loss
       B. To refer failures for further evaluation

II.       Frequency
       A. Sweep Check Test @25 dB
          1. All students in grades K, 1, 2, 3, 6, 9, and ungraded age-equivalent.
          2. All newly admitted students who have not been screened by the sending school.
          3. On referral.
       B. Pure Tone Threshold Test
          1. Students who have failed the Sweep-Check Test
          2. All students, regardless of grade, whose previous hearing test has shown a loss.

III.        Equipment required
       A.   Pure Tone Audiometer
       B.   Testing Table
       C.   Chairs
       D.   Benzalkonium Chloride 1:5000

IV.       Preparation
       A. Assure that the audiometer is in good working condition by:
          1. Checking all wires, knobs, and ear phones.
          2. Being certain a threshold done on self is consistent with pre-established data.
       B. Assure a setting as free of noise-producing activity as possible. (Do not schedule other health
          room activities which might impact on the hearing screening)
       C. Place a chair for the student to be screened in a direction facing away from the screener.

V.        Hearing Screening Procedures
       A. Sweep Check Test
          1. Explain the screening procedure to student. Allow student to practice “raising their hand” to
             the sound of the tone. Seat the student to be screened in the chair near the testing table.
          2. Instruct the student to remove all objects which might interfere with proper fit of the
             headband, i.e., eyeglasses, earrings, hair ornaments. Briefly review the procedure with the
             student.
          3. Face the student and place the earphones directly over the external ear canal with the red
             earphone over the right ear.
          4. Be certain the student being screened cannot watch the tester.




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                    5.   Screen the RIGHT ear first as below:
              Decibel Level                Frequency                      Hears The Tone
              55                           1000                           once
              40                           1000                           once
              25                           1000                           2 out of 3
              25                           2000                           2 out of 3
              25                           4000                           2 out of 3
              25                           1000                           once
              25                           500                            2 out of 3
              25                           250                            2 out of 3


                    6.   Screen the LEFT ear.

              Decibel Level                 Frequency                     Hears The Tone
              25                            1000                          2 out of 3
              25                            2000                          2 out of 3
              25                            4000                          2 out of 3
              25                            1000                          once
              25                            500                           2 out of 3
              25                            250                           2 out of 3
              50                            1000                          Return machine to red ear.


         Note: Always screen the right ear first.

                    7.   Record the test results on the HIS, Main Menu #2, Health Inquiry and
                         Maintenance, screen H4. Where HIS is unavailable, use the MEH-3.
                         a.     Pass is the ability to hear all or all except one frequency at 25 decibels.
                         b.     Fail is:
                                1).      Failure to hear two (2) or more frequencies at 25 decibels.
                                2).      Failure to hear the same frequency in both ears.
                    8.   A student who fails requires further assessment by the school nurse.
                         a.     A student who fails should receive a second Sweep Test within one (1)
                                month.
                         b.     Failure of the second sweep test will result in a Threshold Test that same
                                day.




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    B. Pure-Tone Threshold Hearing Test Procedure
       1. Begin the testing in the right ear. Begin testing at 50 dB, 1000 Hz. If the child hears this tone
          set the decibel dial to 40 and repeat this procedure, decreasing the decibel dial by 10 dB steps
          until the child no longer indicates that he hears. Then increase the decibel dial by 5 dB steps
          until he hears the tone again. This is the threshold for that frequency.
       2. Repeat the same procedure until the following frequencies have been tested in the right ear:
          250, 500, 1000, 2000, 4000, and 8000 Hz. Use this same procedure in the left ear.
       3. Record the lowest decibel level that the student is able to hear on the Student School Health
          Record/ Health Information System.
       4. Failure constitutes any one of the following:
          a. Failure to hear 30 dB or more for two or more frequencies.
          b. Failure to hear 35 dB or more for one (1) frequency.
       5. A referral for a complete ear examination for otologic assessment and audiometric tests should
          be initiated (M117 - Hearing Test Report to Parents and Physician) and documented on the
          Student Health Record/Health Information System.




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SUBJECT: MANDATED PROGRAMS                                            NUMBER 103

      CLASSIFICATION:

PHYSICAL EXAMINATIONS FOR STUDENTS (SEP. 02)


I.        “Although the primary function of schools is to educate our young
       people, when health and social problems impede students’ ability to learn,
       schools must assist the students and their families in securing the services
       they need to succeed by linking students with health and social services.”*
II.       Section 1402 (a) of the School Code requires:
       A. All students must be examined upon entry to school, in sixth grade, and again in eleventh grade or
          age equivalent.
       B. In accordance with Section 1402 (f) of the School Code, the School District of
          Philadelphia requires physical examinations upon entry to school, in sixth grade, and again in
          ninth grade or age equivalent.
       C. Students in any grade, who have never been examined, or who have no record of an examination
          shall be part of the mandated physical examination program.

III.      The purpose of the Physical Examination Program is as follows:
       A. to insure that students are ready to learn.
       B. to identify important health problems which may prevent the student from maximizing his/her
          learning experiences.
       C. to provide an opportunity for health education and health counseling for the student and parent.
       D. to bring about care or remediation of identified health problems.
       E. to teach students and parents to be informed health care consumers.
       F. to increase access to and utilization of primary care providers by families.
       G. to comply with School Code Section 1402.

IV.       School Nursing Practice Roles and Standards state:
       A. The school nurse collaborates with other school professionals, parents, and caregivers to meet the
          health, developmental, and educational needs of clients. (Number 6)
       B. The school nurse collaborates with members of the community in the delivery of health and social
          services, and utilizes knowledge of community health systems and resources to function as a
          school-community liaison. (Number 7)

V.        Rules and Regulations of the Commonwealth of Pennsylvania Department of
       A. Health Chapter 3, Article 322, School Health, Section 1 A state:
       B. “Medical examinations shall be done carefully and in such detail as to command medical respect
          and to provide an educational experience for the child and his parents. Examinations will be
          scheduled so that on an average no more than four children will be examined in an hour. Results
          of vision, hearing, and growth screening tests will be available to the physician at the time of the
          examination.”


          * Children Achieving Action Design




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VI.      Confidentiality:
      A. The Physical Examination Report is confidential and shall be retained by the school nurse.

VII. Process:
   A. All parents and caregivers should be referred to their primary care provider to obtain physical
      examinations for their children.
   B. Form MEH-2 Student Medical History and Form MEH-1, Private Physicians Report must be
      given to parents to take to their provider.
   C. Encourage the parent to have the examination done within a reasonable amount of time.
   D. Instruct the parent or student to return the completed MEH-2 and MEH-1 to the School Nurse.
   E. A Physical Examination Report completed by a primary care provider, other than an MEH-1 is
      acceptable for purposes of meeting this mandate provided it contains all of the required
      information. One example of an acceptable form is the EPSDT Physical Form.

VIII. School Physician Service:
   A. School Physician Service is available for physical examinations of students in accordance with the
      following criteria:
      1. The student has no other means of obtaining a physical examination, e.g., has no health
          insurance.
      2. The student is in a mandated grade (or age equivalent) or never had a physical.
      3. The health history and parent consent are on file.

      B. School nurses may also request school physician service for these reasons:
         1. Consultation with Nurse Practitioner.
         2. Consultation with School Nurses, School Nurse Practitioners, and/or School Support Teams
            regarding, for example, case management of unresolved health problems or to assist the team
            with decisions regarding homebound instruction etc.
         3. Support for Health Education and Health Promotion Activities, e.g., staff development,
            assemblies, health fairs, and other programs.

IX.      Requesting School Physician Service:
      A. Written requests for school physician service shall be submitted to:

                         The School District of Philadelphia
                         School Health Services
                         JFK Center, Room 500
                         734 Schuylkill Ave., Phila. PA 19146).

         1. The request must include School name; Location number; Academic Area; type of service
            requested; Day of the week requested; Name and phone number of the School Nurse.
         2. Requests will be honored on a first come, first serve basis.
         3. Schedules will be mailed ONLY to nurses and schools which are listed on the schedule.
         4. If you wish to contact a School Physician you may obtain information by contacting 215-875-
            3490.

X.       Medical Examination in School:
     A. The parent MUST be notified of the date, time and place of the physical examination, and be
         encouraged to be present.
     B. Schedule students at 15 minute intervals.
     C. Notify appropriate school personnel that students will be examined.
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      D. The physical examination should be done in a space where there is running water and privacy for
         the student to disrobe. No other students should be in the room. There should be acoustical
         privacy to permit the physician, nurse, student and/or parent to talk confidentially.
      E. The school nurse shall remain with the physician throughout the entire physical examination.
      F. The results of the examination shall be explained to the parent and student, including discussion of
         any health problems which require further evaluation.
      G. The following equipment shall be available to the school physician:

         examining paper                table or desk and chair        waste basket

         alcohol sponges                tongue depressors              thermometer

         signed consent and             physical exam form             M-34, Report of
         history                            (MEH 1)                    Visit to the Health Room

XI.      Problem Management:
      A. Problem Management is the responsibility of the Family and the Primary Care Provider. The
         School Nurse and, where appropriate, the School Support Team will monitor progress toward
         further evaluation and treatment or management of health conditions.
      B. Maintain communication with the parent/student to facilitate treatment of health problems identified
         by the primary care provider.
      C. Facilitate linkages to all resources which will make it possible for the parent to follow-through.
      D. When necessary, and with parent or guardian consent, contact the HMO hotline for assistance.
      E. Document all contacts on Screen H-7, using the appropriate note code. (If there is no computer,
         use Nurses Notes in the Student Health Record). Type your name at the end of the notes.

XII. Documentation by school nurses:
   A. All pertinent information should be documented using the appropriate screens (e.g. physical exam
      screen H2, hearing screen H4, vision screen H3, growth screen H5) and relevant codes in the
      HIS.
   B. It is not necessary to transcribe results which are recorded electronically on to an MEH-3 (Student
      Health Record).

XIII. Hard Copy MEH-3 Student Health Record:
   A. School Nurses who do not have a computer shall use the Student Health Record and Screening
      Worksheets to record the results of Private Physical Examinations.




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REQUEST FOR SCHOOL PHYSICIAN SERVICE

To:
School District of Philadelphia
School Health Services
JFK Center, Room 500
734 Schuylkill Ave.
Philadelphia, PA 19146


School:______________________________________Location number:_________

Academic Area:_____________________________________

Type of service requested:
       _______ Physical examinations for students.

         _______ Consultation with Nurse Practitioner.

         _______ Consultation with School Nurses, School Nurse Practitioners, and/or School Support
         Teams regarding, for example, case management of unresolved health problems or to assist the
         team with decisions regarding homebound instruction etc.

         _______ Support for Health Education and Health Promotion Activities, e.g., staff development,
         assemblies, health fairs, and other programs.

         _______ Other-(Please be specific)

         ________________________________________________________________________

         ________________________________________________________________________

Day of the week requested:_______________________________

Name of School Nurse: _____________________ Signature:____________________________

Phone number:___________________________

Date of request:___________________________




•   Requests will be honored on a first come, first serve basis.

•   Schedules will be mailed ONLY to nurses and schools which are listed on the schedule.

•   If you wish to contact a School Physician you may obtain information by contacting 215-875-3490.

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SUBJECT: MANDATED SERVICES                                            NUMBER 107
CLASSIFICATION:

DENTAL EXAMINATIONS (SEP. 02)


I.        “Children whose dental needs are not met experience pain that often keeps them out of school.
       Schools must assist students and their families in accessing dental care.”

II.       Section 1403(a) of the School Code requires:
       A. All students must have a dental examination upon entry to school, in third grade and seventh grade
          or age equivalent.
       B. In accordance with Section 1403 of the School Code the School District of Philadelphia requires
          dental examinations upon entry to school, third grade and seventh grade or age equivalent.
       C. Students in any grade, who have never been examined, or who have no record of an examination
          shall be part of the mandated dental examination program.
       D. The School Code urges administrators to have as many children privately examined as possible to
          provide for continuity in the dental care of the child. Children examined privately will be counted
          in the mandated program.

III.        The purpose of the Dental Examination is to:
       A.   Insure students obtain regular dental care to help prevent school absence.
       B.   Provide an opportunity for regular dental education and counseling.
       C.   Bring about care or remediation of identified dental problems.
       D.   Comply with the School Code Section 1403.

IV.       Confidentiality:
       A. The Dental Examination Report is confidential and shall be retained by the Certified School Nurse.
          The results will be documented in the dental examination screen of the Health Information
          System, or in non-computerized Health Rooms, in the student’s MEH-3 (Health Record).

V.      Process
VI.     All parents/guardians should be referred to their dentist to obtain dental examinations for their
    children.
VII. The Form “Report of Dental Examination” (MEH-155) must be given to parent guardian to take to
    their dentist.
VIII. Encourage the parent/guardian to have the dental examination done within a reasonable amount of
    time.
IX.     Instruct the parent/guardian or student to return the completed Dental Examination form to the
    School Nurse.
X.      A dental report completed o n other than the “Report of Dental Examination”, is acceptable in
    meeting this mandate.

XI.       Referral
       A. The Certified School Nurse will assist families in obtaining dental care as needed. The School
          Nurse will utilize the attached list for the referral process.




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XII. Problem Management
   Problem Management is the responsibility of the family and the dentist. The Certified School Nurse
   will monitor progress, as needed, by:
   A. Maintaining communication with the family.
   B. Facilitating linkages to appropriate resources.
   C. Documenting all contacts and problem resolution, as appropriate, to the HIS, screen H10 (or
       MEH-3, in non-computerized health rooms).




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SUBJECT: MANDATED PROGRAMS                                        NUMBER 105

CLASSIFICATION:

SCOLIOSIS           (SEP. 02)

I.       Purpose
         A.     To assess spinal abnormalities.
         B.     To screen the most at risk student populations.
         C.     To identify students with possible spinal abnormalities.
         D.     To implement early intervention in spinal abnormalities.
         E.     To standardize the case management of the student identified as having potential
                for scoliosis and/or other spinal problems.
II.      Frequency
         A.     Yearly for all 6th and 7th grade students.
         B.     Yearly for all age appropriate students in ungraded classes (11 and 12 years of age).
         C.     The student already under care for spinal abnormalities by a private health care provider
                does not need to be screened in the school screening. The parent/guardian will be asked to
                submit a written report of this care.
         D. Students whose parents object in writing to scoliosis screening will be excused from
                the screening. The parent/guardian will be asked to seek a screening with a private health
                care provider and submit a written report.
         E.     Students who have scoliosis screening done by a private health care provider in response
                to the mandated physical examination for 6th grade and age-appropriate will be excused
                from the school based screening program.
III.     Procedure
         A.     Preliminary Activities
                1.      Select a date and time for scoliosis screening, with consideration of student
                        schedule and in collaboration with teachers and any other school staff considered
                        appropriate.
                2.      Provide an instructional program, including information about scoliosis and other
                        spinal abnormalities as well as the details of the screening procedure for students
                        and staff, and as requested by parents/guardians.
                3.      Issue Parent Information Letter with selected date to parents/guardians of students
                        scheduled for screening.
         B.     Screening Concerns
                1.      Initial screening will be done by the Certified School Nurse.
                2.      The screening area will be located where the students will have complete privacy.
                3.      At the time screening is in progress, this area will not be used for any other
                        purpose.
                4.      The area selected will be warm and well-lit.
                5.      Boys and girls will be screened separately.
                6.      Students will be screened with shoes off and with outer clothing off to the waist.
                7.      Girls will be allowed to keep on their bras and have the option, as stated in the
                        parent letter, to wear a bathing suit top, or halter under their clothing.
         C.     Screening technique
                1.      Facing the screener, the student will stand in the erect position with feet together
                        and arms hanging relaxed at sides. The screener will observe for the following:
                        a)       Level shoulders
                        b)       Equal distances between the arms and the body.
                        c)       Breasts of equal size
                        d)       Nipples equal in height on chest.
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                    2.  With the student in the erect position, the screener should move to the student’s
                        back and run the index finger on each hand under the scapula and towards the
                        middle of the back observing for equal height of scapula. This technique should
                        be employed at the waist to observe for equal level of the pelvis.
                3.      Facing the screener, the student will bend over slowly with palms of hands
                        together and arms hanging relaxed from shoulder, head hanging down. The
                        screener will observe the student in this position from both sides and the back,
                        observing for any fullness (rib hump) in the right/ left thoracic area or in the
                        right/left lumbar area.
             D. Positive findings at initial screening
                1.      Any student who is found to have any positive signs of spinal abnormality will be
                        rescreened by the Certified School Nurse and a second screener, who may be
                        another Certified School Nurse or a School Physician.
                2.      Any student who is scheduled to be rescreened will receive a Report of Visit to
                        Health Services card (M34) with the appointment for rescreening and a brief
                        explanation of the purpose of rescreening. In addition an effort to contact the
                        parent/guardian by phone should be made to alleviate any anxiety the rescreening
                        may cause.
             E. Positive findings at second screening
                1.      Students with positive findings following rescreening must be referred to their
                        private health care provider.
                2.      A positive finding for RIB HUMP in any location in the forward bending position
                        is the major criteria for scoliosis referral. Other observations made by the screener
                        are merely supportive of the rib hump finding.
                3.      The Certified School Nurse will speak to any student with positive findings to
                        allay fears and encourage cooperation.
                4.      Every effort must be made to notify, by phone, parents/guardians of students with
                        positive findings and encourage further medical evaluation.
                5.      The “Parent-Physician Letter” form with the findings of both screeners will be
                        completed and signed by both screeners and sent to parent/guardian.
                6.      The Certified School Nurse will assist parents/guardians needing guidance in
                        making arrangements for further evaluation.
                7.      The Certified School Nurse will contact parents/guardians who do not return
                        evidence of further medical evaluation within four weeks of the initial referral. The
                        following methods are suggested;
                        a)       Telephone call or personal interview.
                        b)       Repeat referral letter. Send home by U.S. mail.
                        c)       M34 form sent with student or U.S. mail.
                8.      Upon receipt of the completed private health care providers’ report the appropriate
                        documentation will be made.
                9.      It is appropriate for the Certified School Nurse to contact the private health care
                        provider if the form is incomplete or additional information is needed regarding
                        this student.
             F. Documentation
                1.      Record all results in the HIS, Main Menu #2, Health Inquiry and Maintenance,
                        screen H11 (where HIS is unavailable, use MEH-3).




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                                  Fig. 1

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                                  Fig. 2


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                                  Fig. 3



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              THE SCHOOL DISTRICT OF PHILADELPHIA
                                    BOARD OF EDUCATION
                               21ST STREET S. OF THE PARKWAY
                             PHILADELPHIA, PENNSYLVANIA 19103



                                                                            SCHOOL HEALTH SERVICES
                                                                                        (215) 875-3490




Dear Parent/Guardian:

         School law requires that a screening for scoliosis be performed on all children in grades 6 and 7.

       The purpose of the screening program is to detect possible curvature of the spine in children. If
the condition is detected early and appropriately treated, progressive spinal deformity may be prevented.

        The school nurse/school nurse practitioner will check your child’s back by observing it while your
child is standing and bending forward. To assure a view of the spine, we request that students expose
their backs during the screening. It is recommended that boys wear a shirt that can be easily removed.
Girls should wear a bathing suit top or halter under a blouse or sweater. The date of screening is
                               .

       You will be contacted if there is any reason to have your child examined by a pediatrician, family
physician, or orthopedist.

        If your child is currently under active treatment for a spinal problem, or if you have any objection
to having your child participate in the screening program, please inform your school nurse in writing. A
report from your physician is requested.




                                                       ___________________
         School Nurse/ SNP                                     Principal



H511.400 (5/82)




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School District                                                             Intermediate Unit




NAME OF CHILD                                                      SEX                DATE

ADDRESS                                                                               GRADE

SCHOOL




                    Dear Parent/Guardian:

                            In a recent screening program your child displayed possible scoliosis, or curvature of the spine.
                    Further evaluation is recommended to determine if treatment is necessary. The effect of scoliosis depends
                    on its severity, how early it is detected, and how promptly it is treated. Please have your child examined
                    by your family physician or check with the school nurse for other sources of treatment.


                            Please have the examining physician complete the form on the back of this letter and return it to
                    the school nurse.




School Nurse                                                    Physical Therapy Consultant,
                                                                Pennsylvania Department of Health
                                                                or Qualified Rescreener
Telephone Number




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SUBJECT: MANDATED PROGRAMS                                           NUMBER 101

CLASSIFICATION:

VISION SCREENING - MYOPIA                   (SEP. 02)

I.       Apparatus
      A. Snellen or Good-Lite Chart
         1. Letter chart
         2. An illiterate “E” chart or a picture chart may be used as needed for pre-literate or special
            education students.
      B. Adequate Lighting
         1. Light should shine without glare on chart.
         2. Room illumination should be constant without light shining into student’s eyes.
      C. Room space
         1. The student should sit or stand twenty feet from the chart. Distance should be accurately
            measured and clearly marked.
         2. In smaller rooms it may be necessary to use a 10 foot distance. In those instances, a 10 foot
            chart should be used.
      D. Occluder

II.      Procedure
      A. Place occluder before the student’s eye with both eyes open.
         1. If a student wears corrective lenses, test child with lenses in place.
         2. Test each eye separately. Always begin with the right eye.
         3. Student should identify characters by pointing when using E chart or naming letters if letters
             are used. Be alert in noting those young children still unsure of letter names. Verify the results
             of testing by using the E chart.
         4. Begin with the top line on the chart. Proceed downward to the child’s limit.
         5. Stop test when evidence of eyestrain appears. Record last line read. Evidence of eyestrain may
             include:
             a. Thrusting head forward
             b. Tilting head
             c. Watering eyes
             d. Frowning or scowling
         6. All students in first and second grades who Pass the Myopia screening are to be screened with
             the plus lens (+2.25). Follow Hyperopia Screening Procedure (Below).

      B. Recording Measurements
         1. Visual acuity is represented as a fraction. The numerator indicates the distance from the chart
            at which the test was conducted. The denominator means the smallest line of letters that a
            student can read from the testing distance. -1 or -2 after the fraction indicates number of
            mistakes by the student while reading that line.
         2. In cases where the student is unable to read the uppermost letter on the chart, he should walk
            forward until he can see the top line or symbol. The distance between student and chart
            becomes the numerator and vision is recorded as such: i.e.: 10/100, 5/200, 2/100.
         3. If the student does not recognize the top letter from a distance of less than one foot from chart,
            vision is recorded as 0/0 and the results documented in the nurse’s notes.




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III.      Criteria for referral
       A. Kindergarten through Gr. 3: vision that is no less than 20/40-3 in one or both eyes.
       B. Grade 4 and up: vision that is no less than 20/30-3 in one or both eyes.
       C. In any grade, when the difference between both eyes is two lines or more, the student has failed.
          This is true even if the visual acuity for each eye is within the passing range. For example, a
          student who reads 20/20 in the right eye,, and 20/30 in the left eye has failed the vision screening.
IV.         Referral
       A.   Screen initial failures a second time before sending Vision Screening Referral.
       B.   Initiate a Vision Screening Referral for all students who fail screening.
       C.   Explain use of referral form to student and/or parent/guardian.
       D.   When referral or follow-up indicate need, Public School Health Fund vision appointments can be
            made for public school students.

V.        Complete documentation on the student’s record.
       A. The HIS, screen H3 in Main Menu #2, Health Inquiry and Maintenance, is to be used unless it is
          not available in the school.
       B. In the event that the HIS is not available, document on the MEH 3, Student Health Record, and on
          the Vision Screening Worksheet or Program Control Sheet.

VI.       When a child’s corrected vision is 20/70 or less in the better eye the student is considered visually
       impaired. Follow procedure for Students with Special Needs/Visually Impaired.

VII.        Rescreen student with new glasses to verify a correction as reported. Document this screening.




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SUBJECT: MANDATED PROGRAMS                                            NUMBER 102
      CLASSIFICATION:

VISION SCREENING - HYPEROPIA                      (SEP. 02)

I.     All students in first and second grades who do not already wear corrective lenses, and who have
passed the standard vision screening are to be screened with the plus lens (+2.25).

II.    Instruct the student to remain at the same testing distance from the Snellen chart as for standard
screening.

II.       Instruct the student to keep both eyes open.

III.      Place the plus lens in front of eyes.

IV.       Instruct the student to read the 20/20 line on the Snellen chart.

V.        Criteria for Pass/Fail (All Students)

       A. Passing Criteria: Passing is the INABILITY of the student to read the 20/20 line on the Snellen
          Chart with the use of the Plus Lens, i.e.: if the student cannot read the 20/20 line with the Plus
          Lens, she/he has passed the screening.

       B. Failure Criteria: Failure is the ABILITY to read the 20/20 line on the Snellen Chart with the use
          of the Plus Lens: i.e.: if the student can read the 20/20 line with the Plus Lens, he/she has failed
          the screening.

VI.       Referral

       A. All students who fail the Plus Lens screening, with or without corrective lenses, should be
          referred using standard procedure.

          1. Initiate Vision Screening Referral.

          2. Indicate “vision referral issued” on the student health record.

              a. The HIS, screen H3 in Main Menu #2, Health Inquiry and Maintenance, is to be used
                 unless it is not available in the school.

              b. In the event that the HIS is not available, document on the Student Health Record (MEH
                 3) and on the Vision Screening Worksheet or Program Control Sheet.

       B. Keep returned Vision Referral on file for one year.

VII. Since the vision screening program is a State mandated program, the consent of the parent is not a
   prerequisite.




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                          SAMPLE SIDE 1 OF 2
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                            SAMPLE SIDE 2 OF 2

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      GENERAL PROCEDURES




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SUBJECT: GENERAL PROCEDURES                                         NUMBER 511
CLASSIFICATION:

ACCIDENTS/ ILLNESS               (DEC. 98)

                                       ACCIDENTS / ILLNESS
       Emergency care for students who become sick or who are injured at school or at school sponsored
functions away from school, is the responsibility of school personnel and an integral part of health
services provided for school.
       Fundamental to any accident and/or illness treatment plan is acceptance by school personnel of
responsibility for:
       >        providing immediate care
       >        notification of student’s parent/guardian
       >        arranging for disposition and/or transportation to home or hospital
       >        guiding parent/guardian, when necessary, to sources of care

RESPONSIBILITIES
  A. The principal is to develop a plan for the care of ill or injured persons within the school.

         1. To provide for the maximum safety of all students in cases of fire or other disasters, the
            principal must plan for the care and welfare of every ill or injured student and for every
            student with chronic or recurrent medical disorders.
         2. The Physical Health Office is available for consultation in the development of the plan.
         3. The principal is to develop a cooperative relationship with the district police captain to ensure a
            workable procedure in emergency situations.
         4. The principal, or designee, upon notification of an ill or injured person, must act promptly to
            provide immediate care.
         5. The principal must have on file an employee information card containing the name, address,
            and telephone number of each employee’s physician and the person to notify in case of
            emergency.
         6. All students are to participate in all school safety drills.

    B. The principal is to post in the school office and health suite a list of persons to be called upon to
       render first-aid.
       1. A school employee is to render necessary first-aid in extreme emergencies; reference is to be
          made to the official wall chart “FIRST-AID AND EMERGENCY CARE,” Form MEH
          50, which must be posted in the school office, the health suite, and every classroom.
       2. First-aid by non-medical personnel is to be guided by the care listed on the chart.
       3. As a minimum, one staff member, in addition to the Certified School Nurse should be trained
          to render first-aid.
    C. TO PROVIDE PROMPT EMERGENCY CARE FOR LIFE THREATENING
       CIRCUMSTANCES CALL 911 TO ACTIVATE EMERGENCY MEDICAL
       SERVICES (EMS).

    D. The principal or designee is to promptly notify the parent, guardian or person designated in case
       of the emergency, by phone, messenger, or police; if the parent, guardian or person designated in
       case of emergencies cannot be reached, the principal is to act in place of the parent to secure
       adequate medical attention.



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    E. Responsibility for further medical attention in the case of students rests with the parent/guardian
       or person designated for emergencies; adults are responsible for their own further care.
    F. The principal is to inform the Academic Area Leader regarding details of all the serious cases
       before the end of the school day.

    G. The Incident Control Desk is to be notified by the principal and a serious incident report is to be
       filed.

    H. All activities must be documented.
       1. If the school nurse is in the building, the HIS, Main Menu #8, Health Room Log, must be
           used (where not available, use the MEH-3 or M-100).
       2. If the school nurse was not in the building when a serious incident occurred, the school nurse
           should summarize pertinent details as to the event and any follow-up, in the student's health
           record on the HIS, screen H7, or in Main Menu #9, Health Log for a Student, upon the
           nurse's return. Written and verbal sources of information and providers of service to the
           student should be clearly identified. The note should indicate that it is a summary of events
           occurring on another day (provide actual date of service).




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SUBJECT: GENERAL PROCEDURES                                       NUMBER       511.1
CLASSIFICATION:

CATEGORIES OF EMERGENCIES                 (DEC. 98)

Students, teachers, other School District of Philadelphia employees, and visitors may have medical
emergencies at school or off school premises, but on school business (e.g., on the school bus, field trips,
etc.). All personnel should be familiar with the School District of Philadelphia First Aid Chart AND
should know how to access the Emergency Medical System (EMS) by calling 911.

While most emergency situations encountered in schools are not life threatening, the possibility exists that
they may be. It is appropriate to develop plans for immediate treatment and mobilization of emergency
services. EACH SCHOOL SHOULD HAVE AN EMERGENCY PLAN IN PLACE. The Certified
School Nurse should be involved in the development of the plan.

The Following triage plan was developed for schools by the Connecticut American Academy of Pediatrics
School Health Committee. It is adapted and included here as a guide in the development of the School
Emergency Plan.

Emergencies are divided into categories, depending upon the amount of time which is allowed to elapse
before intervention is necessary to save lives or prevent death. School Emergency Plans should take
these categories into consideration.

I.      CATEGORY I Emergencies are Emergent or Life Threatening.
     A. In these situations:
        1. The first person on the scene should Call 911 immediately for transport to the nearest
            emergency room. No time should be wasted making contacts with the school nurse, families,
            or physicians until 911 has been called.
        2. Send for assistance and remain with victim.
        3. Administer any authorized medication at once, e.g. epi - pens or glucagon.
        4. Administer first-aid to the level of competence.
        5. Initiate CPR; if CPR certified staff is available.
        6. Once EMS takes over, notify parents/guardians.
        7. Notify principal or person in charge.
        8. Document all activities.
        9. File Incident Report.

     B. Examples of CATEGORY I Emergencies are:
        1. Acute airway obstruction
        2. Cardiac arrest ( no heartbeat)
        3. Respiratory arrest (not breathing)
        4. Drowning or near drowning
        5. Massive bleeding, internal or external
        6. Poisoning internal or external
        7. Anaphylaxis
        8. Neck or back injury (possible spinal cord injury)
        9. Chemical burns of the eye
        10. Heat stroke
        11. Penetrating (stab) or crushing chest wounds
        12. Severe acute asthma attack


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II.       CATEGORY II Emergencies are urgent.
       A. In these situations:
          1. Arrange for immediate transportation to the nearest hospital.
          2. Administer any authorized medication at once, e.g. asthma medication.
          3. Administer first-aid to the level of competence.
          4. Notify principal or person in charge.
          5. Document all activities.
          6. File Incident Report.

       B. Examples of CATEGORY II Emergencies are:
          1. Internal bleeding
          2. Angina or chest pain
          3. Unconscious states
          4. Heat cramps
          5. Major burns
          6. Drug overdose and reaction
          7. Head injury with loss of consciousness
          8. Penetration eye injuries
          9. Seizure in a person who is not known to have seizures
          10. Bee stings with rash but no breathing difficulties

III.       CATEGORY III Emergencies: Medical consultation is desirable within an hour, although delays
       will not seriously affect the outcome.
       A. In these situations staff can render care:
           1. In accordance with the School District First Aid Chart.
           2. Parents/guardians should be contacted to arrange further care by their primary care provider.
           3. All actions should be documented.

       B. Examples of CATEGORY III Emergencies are:
          1. Lacerations (cuts) that require sutures
          2. Animal and human bites
          3. Burns with blisters
          4. Tooth loss or fracture as a result of fracture
          5. Bone fractures and dislocations
          6. Acute emotional state
          7. Moderate reactions to medications
          8. Fever above 103 degrees
          9. Asthma/wheezing (Yellow Zone Peak Flow, if available)
          10. Non-penetrating eye injury

IV.       CATEGORY IV

       A. Emergencies: In these instances some students will have care plans which were developed by the
          school nurse. Otherwise:
          1. Staff can render care according to the School District First Aid Chart.
          2. Notify principal or person in charge.
          3. Document all activities.




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     B. Examples of CATEGORY IV Emergencies are:
        1. Seizure in a person known to have a seizure disorder
        2. Insulin reaction in diabetic
        3. Abdominal pain
        4. Fever 100 degree to 103 degree
        5. Sprains
        6. Strains
V.      CATEGORY V
     A. Emergencies
        1. Emergencies can be handled by referring to the School District First Aid Chart.
        2. All activities should be documented.

     B. Examples of CATEGORY V Emergencies are:
        1. Abrasions, minor cuts, and scratches
        2. Minor burns
        3. Nosebleeds
        4. Minor illnesses and complaints (no fever, no vomiting)




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SUBJECT: GENERAL PROCEDURES                                         NUMBER        511.2
CLASSIFICATION:

RELEASE FROM SCHOOL FOR ACCIDENT / ILLNESS
(SEP. 01)


I.       RELEASE FROM SCHOOL FOR ACCIDENT / ILLNESS

        The professional judgment of the School District of Philadelphia Certified School Nurses, and the
“FIRST-AID AND EMERGENCY CARE CHART” (MEH 50) are to assist the principal in the
care of the ill or injured person. No ill or injured student is to be permitted to go home or to the hospital
without being accompanied by a member of the school staff in the absence of a parent or guardian. No
student is to be left at home unless there is a responsible adult to receive him/her.

     A. EARLY DISMISSAL OF ILL OR INJURED STUDENTS TO HOME
        1. It is advisable to send an ill or injured student home provided:
           a. The illness or injury warrants dismissal in the opinion of the Certified School Nurse or the
                individual designated by the principal.
           b. A responsible adult is at home to receive the student.
        2. When a student needs home care, every effort is to be made to have the parent/guardian (or if
           unable to do so, the person designated as emergency contact) come to school to pick up the
           student; if a taxi is required, the parent/guardian is to request the taxi, as they are responsible
           for the fare.
        3. If no responsible adult can come to the school for the student and if, in the opinion of the
           principal, the illness or injury is sufficiently serious to warrant an escort, such service is to be
           provided.
           a. A student who is ill or injured may not be sent home without an escort.
           b. The escort may be school staff or the principal; students are not to be used for this
                purpose.
           c. The escort is to report to the principal the disposition of the case, and a record is to be
                made.
           d. In cases of serious injury a serious incident report should be completed.
           e. Under Pennsylvania law, the School District assumes no responsibility for the
                transportation of students or employees in private automobiles; insurance coverage is
                provided only by the escort’s own automobile insurance.

     B. STUDENTS SENT TO THE HOSPITAL
        1. It is advisable to send an ill or injured student to a hospital emergency room as soon as
           possible in any case in which:
           a. The parent/guardian and other responsible persons concerned with the incident agree that
                the illness or injury is not compatible with home care.
           b. The parent /guardian of a student whose condition apparently demands prompt medical
                care cannot be located within a reasonable time.
           c. Extreme emergencies may demand immediate action without preliminary attempts to locate
                responsible adults; however, these adults are to be notified as promptly as possible
                thereafter.
        2. Transportation to the Hospital
           a. The Emergency Medical System (EMS) should be activated by calling 911.

              b. A member of the school staff must accompany the student in the emergency vehicle, and is

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                 to remain at the hospital with the student until the parent/guardian or parent designated
                 emergency contact arrives at the hospital. The principal or designee should make sure that
                 transportation from the hospital is provided to the staff member.
              c. In case of a serious illness or injury occurring when the Certified School Nurse is not
                 available, he/she should be notified.
              d. The Incident Control Desk is to be notified and a serious incident report completed.




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SUBJECT: GENERAL PROCEDURES                                           NUMBER        511.3
CLASSIFICATION:


RETENTION OF STUDENT IN SCHOOL (ACCIDENT /
ILLNESS)   (DEC. 98)


II.       RETENTION OF STUDENT IN SCHOOL
      A. If an ill or injured student is to remain in school until the end of the school day, but is unable to
         return to class, the student is to be placed under the supervision of an adult designated by the
         principal.

      B. The nature of the illness or injury is to guide the principal in the selection of the person to
         supervise the ill student.

      C. At dismissal time, the principal will make a decision concerning the necessity of providing escort
         service for the student.




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SUBJECT: GENERAL PROCEDURES                                    NUMBER      511.4
CLASSIFICATION:

SERIOUS HEAD AND NECK INJURY                (DEC. 98)


                     SERIOUS HEAD, NECK OR SPINE INJURY
I. The School Nurse/Practitioner shall:
   A. Refer a student with a serious head, neck or spine injury to a hospital immediately: Phone 911
      Fire Rescue for emergency transportation.
   B. Position the student:
      1. For head or neck injury keep student flat and immobilize the affected part.
      2. If fracture of the neck is suspected, place rolled up clothing, blankets, etc. around the
          student’s head, sides of neck and shoulders to prevent movement.
      3. If fracture of the spine is suspected keep student in the position in which found to avoid
          further damage to the spinal cord resulting in paralysis.
   C. Control hemorrhage immediately with application of a sterile dressing (without cleansing). (Avoid
      using excessive pressure due to possible skull fracture).
   D. Ensure an open airway.
   E. Offer calm reassurance.
   F. Notify school principal or designee and teacher.
   G. Notify parent of nature of injury and name of hospital to which student has been taken.
   H. Send M-34 Report of Visit to Health Services, with a thorough and accurate account of accident
      and observations along with student to the hospital.
   I. Provide documentation to the principal or designee for use in filing a serious incident report.
   J. Document all relevant data, including reports from the treating agency.
   K. Monitor and document the progress of recovery.




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SUBJECT: GENERAL PROCEDURES                                        NUMBER       511.5
CLASSIFICATION:

MINOR HEAD AND NECK INJURY                   (SEP. 01)


                MINOR HEAD, NECK OR SPINE INJURY TREATMENT
I.      The School Nurse/Practitioner shall:
     A. Control any bleeding immediately.
     B. Detain in health room (under adult supervision) for at least 15 minutes for observation.
        1. If signs of serious injury develop keep the person in the health room for further observation
            and follow procedure for serious head injury.
        2. If at the end of at least 15 minutes no signs of serious injury are observed, student may return
            to classroom with a note to:
            a. Instruct student and teacher that student is to report back to the nurse for a brief follow-up
                one hour after he returns to the classroom (or sooner if needed)
            b. Instruct teacher to observe student and contact the nurse if signs of serious injury develop
                after return to the classroom. If this occurs, procedures for serious injury should be
                followed.
     C. Every reasonable effort must be made to contact the parent by telephone,
     D. Inform parent of head injury by completing the Head Injury Letter to Parent, MEH-51 and making
        certain that it is taken home by the student.
     E. In the event that school is dismissed prior to the 15 minutes of observation, inform parents to
        transport student home and to continue observation.
     F. Monitor the progress of the student’s recovery.
     G. Record all data.




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                            SAMPLE SIDE 1 OF 2

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                            SAMPLE SIDE 2 OF 2
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CHILD ABUSE / NEGLECT




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SUBJECT: CHILD ABUSE / NEGLECT                                     NUMBER: 806
CLASSIFICATION:

CHILD ABUSE (BOARD POLICY) (DEC. 98)




806. CHILD ABUSE

Date Adopted: April 27, 1981
Date Revised: April 25, 1988

1. Purpose

The Board of Public Education recognizes that successful school achievement
depends both on the quality of instruction and the physical and emotional
well-being of the learner.

This policy reflects concern regarding child abuse and accepts the role of
the School District in:

         Providing all possible assistance to students who suffer abuse

         Requiring the reporting of suspected child abuse in accordance with the law

         Cooperating with appropriate community agencies

         Mandating staff development to fulfill the purpose of this policy

         Evaluating school environment continually for the purpose of timely
         identification and reporting of suspected child abuse.

2. Definition

Child Abuse shall be defined in accordance with the provisions of the Child
Protective Services Law, the regulations of the Pennsylvania Department of
Welfare, and the decisions of the Courts of this Commonwealth. This
definition shall be implemented in the directives of the School Operations
Manual.

3. Delegation of Responsibility

The Superintendent shall set forth the legal definition of child abuse and
provide regulations for compliance with the statutory requirements that
instances of child abuse be reported. Such regulations shall:

         inform all staff members having contact with students of their
         responsibility to report all cases of abuse, abandonment, cruelty or neglect
         resulting in physical or mental injury by other than accidental means
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         designate the school principal as the staff member who shall report
         suspected instances of child abuse to the appropriate county welfare agency

         require prompt attention to injuries which result from abuse as to protect
         the health of the child

         provide for the release to the appropriate county child welfare agency the
         name and age of the child as well as the name and address of the parent(s)
         or guardian(s) and information regarding the nature and extent of the
         child's injuries, abuse or maltreatment and such information which, in the
         opinion of the Superintendent, has a bearing on the suspected child abuse.

References:

School Code: SS 1319 Act 124 of 1975
11 P.S. SS 2203
55 PA Code 3490.4
School Operations Manual 504




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SUBJECT: CHILD ABUSE / NEGLECT                                         NUMBER       111.5
CLASSIFICATION:

GUIDELINES FOR REPORT AND
INVESTIGATION OF ALLEGED SEXUAL AND
SERIOUS PHYSICAL MISCONDUCT WITH
CHILDREN BY EMPLOYEES    (DEC. 98)


PA Law (Act 151 of 1994) requires that all allegations by students "of serious bodily injury, sexual
abuse, or sexual exploitation," by school employees or the employees of independent contractors working
in the schools or with students, be reported to the authorities set forth below. As previously provided for
in the PA Child Protective Services Act (see #111.6 through #111.13), good faith reports by school
employees are subject to civil immunity, and the failure to report is subject to criminal sanctions.


I. DEFINITIONS
         A. Sexual Abuse or Exploitation
                    The rape, molestation, incest, prostitution or other form of sexual exploitation of children,
                    including the employment, use, persuasion, inducement, enticement or coercion of any
                    child to engage in or assist any other person to engage in any sexually explicit conduct, or
                    any simulation of any sexually explicit conduct, for the purpose of producing any visual
                    depiction of any sexually explicit conduct.
         B. Serious Bodily Injury
                    Bodily injury which creates a substantial risk of death or which causes serious permanent
                    disfigurement or protracted loss or impairment of function of any bodily member or organ.
NOTE:               In addition to the technical definition contained in the statue the District
                    Attorney’s Office has provided the School District with the following
                    supplemental definitions:
              1. Substantial Risk of Death - Injury or neglect requiring admission to an Intensive care Unit
                 or which in the opinion of the health care provider’s judgment poses a substantial risk of
                 death; any physical injury caused by a deadly weapon; suspected intentional poisoning;
                 abandonment which consists of prolonged or repeated lack of supervision that endangers a
                 child’s life or development; starvation; internal bleeding or trauma; or head injury/brain
                 damage
              2. 2.Serious Permanent Disfigurement - Genital disfigurement; amputation; ear or eye
                 disfigurements; branding/burns; loss of permanent teeth; or cuts or scrapes that will cause
                 noticeable scars.
              3. Protracted Loss or Impairment of the Function of a Body Member or Organ - Damage to
                 sight; hearing or esophagus; internal injuries, including kidney or liver damage; cuts that
                 sever nerves or ligaments; broken bones; starvation; or sexually transmitted diseases.




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II.        REPORTING REQUIREMENTS
          A.      Any school employee receiving a report from a student, or who by virtue of their training
          or experience, reasonably suspects that a student coming before him/her is a victim of sexual
          abuse or sexual exploitation, or serious bodily injury by a school employee must notify the
          building or program administrator. If the accused employee is the administrator, the employee
          shall make the reports set forth in Section B (below) him/herself (See Section IV on
          Confidentiality).
          The principal or other administrator in charge must make the following calls in the order shown:
                    1. Police Department - 911
                    2. The Philadelphia District Attorney's Office – 215-686-8096, 8014, 8080
                    3. Parent or emergency contact
                    4. Incident Control Desk – 215-875-3613 - 3615
                    5. Administrator to whom the school directly reports
                    6. Office of General Counsel – 215-299-7676
                           The report shall include:
                           a) the name, age, address and school of the student(s);
                           b) name and address of the student's parent or guardian;
                           c) name and address of the person making the report;
                           d) name, work and home address of the employee who is the subject of the report;
                           e) the nature of the alleged offense;
                           f) any specific comments or observations directly related to the alleged incident or
                           the parties involved.
                    The content or existence of an allegation or report may not be disseminated to any other
                    person or agency without the approval of the Office of General Counsel. (Note: formal
                    investigations will be carried out jointly by the police and Department of Human Services,
                    and cooperation with that investigation is required).
III.      INTERNAL DISCIPLINARY INVESTIGATIONS
       A. Following compliance with the reporting requirements set forth in Section II above, the principal
          or administrator in charge must conduct an investigation of all allegations to determine whether a
          clear accusation of intentional misconduct has been made. The investigation shall include
          interviews with the victim, all possible witnesses and, where appropriate, the accused. The victim
          should be the first person interviewed. The initiation of the internal investigation should not be
          delayed to await completion of the police or District Attorney’s investigations, which may take up
          to 60 days. Under no circumstances should the principal’s investigation jeopardize the
          preservation of physical evidence. For instance, if a complainant alleges a contemporaneous

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         incident and the possibility exists that a medical examination could prove or disprove the existence
         of body secretions, bruises or abrasions, a report should not be delayed overnight or for any
         lessor period of time which could affect the outcome of such tests.
    B. The Initial Report of Serious Incident Follow-up Reports and any memoranda must be marked
       confidential. (See Section 111.1 of the School Operations Manual for additional procedures).
       File an Initial Report of Serious Incident the same day that any accusations come to the attention of
       the principal or person in charge of the School District facility. The report must contain:
                        1.      Complainant’s name, age, address and relationship to the victim if the
                                complainant is not the victim.
                        2.      Name, age, sex, and job title of the accused employee.
                        3.      Name, address, age, grade in school and sex of the victim.


    C. An incident Follow-up Report shall be filed after the investigation. This report shall include the
       following information:
                        1. Name, age, address of the complainant
                        2. Name, age, address and grade of victim
                        3. Name and job title of accused employee
                        4. Name, age, address, and job title or age and grade, if applicable, of all
                        witnesses
                        5. Description of place(s) where events allegedly occurred
                        6. Date(s) and time(s) when events allegedly occurred
                        7. Verbatim transcription of child's allegations. The transcription should be made
                        by someone other than the interviewer (e.g., secretary) to ensure accuracy and
                        facilitate questioning. Whenever possible a staff member who is the same sex as
                        the child (e.g., nurse, counselor, vice principal) should be present. In some
                        situations, it may be advisable for this staff member to conduct the questioning,
                        depending upon the age and personal modesty of the child.
                        8. The names, addresses or locations of any witnesses revealed by the
                        investigation or identified by the student or employee.
                        9. Record names and job titles of all employees who participate in the
                        investigation.




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                    D.   Interview of Accused Employee
                         Any interview with an employee must be conducted in accordance with due
                         process requirements, i.e., notice of the charges and an opportunity to be heard in
                         person or in writing. Compliance with proper procedure will ensure that any
                         disciplinary action, e.g., SEH-204, will be upheld upon later review. It is
                         recommended that the principal or person in charge of the investigation refer to the
                         appropriate collective bargaining agreement regarding notice provisions and refer
                         any questions to Labor Relations or the Office of General Counsel prior to the
                         interview with the accused employee.
                    E.   Cooperation with Law Enforcement
                         School District policy requires full cooperation with the police, District Attorney
                         and/or DHS in any investigation. Refer to #109.0 of the School Operations
                         Manual. In some sexual molestation cases, the parents may impede a full
                         independent investigation by School District officials by preventing access to the
                         child. It is still the responsibility of the principal or the person in charge of the
                         investigation to make an assessment of the situation and make a recommendation
                         regarding the status of the employee even if he/she has not had a full opportunity to
                         interview the child. Factors to be considered include, but are not limited to, initial
                         discussion with child, interview with accused employee, interviews with witnesses
                         and police reports.
                    F.   Removal of Employee from School - Suspension
                         1. In some circumstances, it may be necessary to remove the employee from the
                         building pending the School District’s internal investigation. As in the case of
                         suspension, removal of an employee can only be done with the approval of the
                         Academic Area Leader and Chief of Staff’s Office.
                         2. The School District should not postpone its decision regarding removal or
                         suspension of an employee (with or without pay) because of a delay in the
                         completion of the police or DHS investigation. Suspension of an employee must
                         follow appropriate due process. Any questions should be referred to Labor
                         Relations or the Office of General Counsel. In the event an employee is suspended
                         (with or without pay) it is imperative that the Office of Human Resources is
                         notified. Under no circumstances may an employee be suspended without first
                         being given notice of the charges and opportunity to respond to those charges.
                         The parent(s) of the accusing student(s) should be advised that without a criminal
                         conviction their child's testimony will be needed if the case reaches the arbitration
                         level regarding the accused's status as a School District employee. They should
                         understand that the criminal and administrative processes are separate and apart.




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IV.      CONFIDENTIALITY OF INVESTIGATION
         Accusations, the nature of which are the subject of these reporting procedures, can severely
         damage the reputation of the accused. These accusations may also disrupt a school community
         and result in additional trauma to a victim. It is, therefore, imperative that only those people with
         a need to know be involved in the investigation. Anyone involved in the investigation must be
         cautioned that any breach of confidentiality could result in personal liability (civil and monetary)
         for the employee as well as disciplinary action.
V.       NON-REPORTABLE PHYSICAL CONTACT
         While the reporting requirements for physical assault set forth in Section II above only apply to
         instances where serious bodily injury occurs, the internal investigative procedures set forth in
         Section III are also to be applied to allegations of corporal punishment which is specifically
         prohibited by Board Policy #218, Section 2.121. Corporal punishment means any physical
         contact designed to punish a student for any school infraction or to deter a student from future
         violations. Corporal punishment does not include reasonable physical contact or restraint
         necessary to protect the safety and welfare of any member of the school community including the
         offending student, or to terminate any on-going serious disruption of the school or its programs.




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SUBJECT: CHILD ABUSE / NEGLECT                                        NUMBER         111.6/504.0
CLASSIFICATION:

CHILD PROTECTIVE SERVICES                    (DEC. 98)

It is the Policy of the School District of Philadelphia that all of its employees are to be aware of and
comply with the Child Protective Services Law, P.L. 438, Act 124, 1975, as amended by Act 33 (1985)
and Act 151 (1994).


A.       Under the Act, any person who, in good faith, reports suspected child abuse or cooperates with
         an investigation or court proceeding, shall have immunity from civil and criminal liability that
         might otherwise result by reason of those actions. The good faith of all persons required to report
         under the Act is presumed. Where abuse is suspected and the student is 18 years of age or older,
         or where the Child Abuse Hotline rejects a report because the alleged abuse did not occur in the
         family or home unit (e.g. by a boy/girlfriend) please refer to procedure #111.14.
B.       Under the Act, any person who is required to report a case of suspected child abuse and fails to do
         so "shall be guilty of a misdemeanor”.
C.       The privileged communication between any professional person required to report and the patient
         or clients does not apply to situations involving child abuse and does not constitute grounds for
         failure to report suspected child abuse.
D.        Persons Required to Report:
         1. School personnel, because of their sustained contact with pre-school and school-age children,
         are in a position to identify children who may be abused or neglected.
         2. Thus, School District employees are required to report, whenever they have reasonable cause
         to suspect child abuse and/or neglect.
E.       Definitions contained in the Act:

         1. Child Abuse

                    a)   Any recent act or failure to act by a perpetrator which causes non accidental serious
                         physical injury to a child under 18 years of age.

                    b)   An act or failure to act by a perpetrator which causes non accidental serious mental
                         injury to or sexual abuse or sexual exploitation of a child under 18 years of age.

                    c)   Any recent act, failure to act or series of such acts or failures to act by a perpetrator
                         which creates an imminent risk of serious physical injury to or sexual abuse or
                         sexual exploitation of a child under 18 years of age.

                    d)   Serious physical neglect by a perpetrator constituting prolonged or repeated lack of
                         supervision or the failure to provide essentials of life, including adequate medical
                         care, which endangers a child’s life or development or impairs the child’s
                         functioning.


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         2. “Serious Physical Injury” An injury that
                    a)      causes a child severe pain; or

                    b)      significantly impairs a child’s physical functioning, either temporarily or
                            permanently

         3. "Serious Mental Injury"- A psychological condition, as diagnosed by a physician or licensed
            psychologist, including the refusal of appropriate treatment, that:
                    (a) renders a child chronically and severely anxious, agitated, depressed, socially
                    withdrawn, psychotic or in reasonable fear that the child's life or safety is threatened; or
                    (b) seriously interferes with a child's ability to accomplish age-appropriate developmental
                    and social tasks.
         4. "Sexual abuse or exploitation" - The employment, use, persuasion, inducement, enticement or
            coercion of any child to engage in or assist any other person to engage in any sexually explicit
            conduct or any simulation of any sexually explicit conduct, for the purpose of producing any
            visual depiction of any sexually explicit conduct, or the rape, molestation, incest, prostitution
            or other form of sexual exploitation of children.
         5. "Perpetrator" - A person who has committed child abuse and is a parent of a child, a person
            responsible for the welfare of a child, an individual residing in the same home as a child or a
            paramour of a child's parent.
         6. "Person responsible for the child's welfare" - A person who provides permanent or temporary
            care, supervision, mental health diagnosis or treatment, training or control of a child in lieu of
            parental care, supervision and control. The term does not include a person who is employed
            by or provides services or programs in any public or private school, intermediate unit or area
            vocational-technical school.
         7. “Individual residing in the same home as the child” - An individual who is 14 years of age or
            older and who resides in the same house as the child.

         8. “ Recent acts or omissions” - Acts or omissions committed within two years of the date of the
            report to the Department of Public Welfare or country agency.

         9. “School employee” - An individual employed by a public or private school, intermediate unit
            or area vocation-technical school. The term includes an independent contractor and employees.
            The term excludes an individual who has no direct contact with students.




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SUBJECT: CHILD ABUSE / NEGLECT                                    NUMBER         111.7/504.1
CLASSIFICATION:

RESPONSIBILITIES OF PRINCIPAL                  (DEC. 98)


The principal, or person in charge of a School District facility, when informed of a suspected case of child
abuse and/or neglect is to:
A. Complete a report of suspected child abuse and/or neglect; please refer to Section 111.9. Note: The
building administrator has the legal obligation to report allegations received from staff members. Where
there is a serious question concerning whether the report was made in good faith or whether the conduct
is reportable the administrator should, without delay, contact the Office of General Counsel.


B. Refer the pupil to the school or program nurse. If the nurse is not present on the day when the pupil
presents evidence of abuse and/or neglect, the principal or person in charge of the facility is to proceed
with the referral. If the injury is one which should be documented by a trained care-giver the nurse
should be called to the school from her/his other assignment or the nursing supervisor is to be notified
that a nurse is unavailable. If such documentation is not required or where the child is being taken to a
hospital the school nurse is to be notified at her/his next visit.


C. Reports to DHS and/or CHILD LINE should be made immediately upon learning of the suspected
abuse. This is particularly critical where the child indicates a reluctance or refusal to return home as DHS
needs as much time as possible to obtain a court order and to arrange to have the child picked up.


D. A staff member must be assigned to stay with the child until a DHS worker can take over custody. If
the DHS worker does not arrive as promised within a reasonable time after school is dismissed,
arrangements should be made with School Safety or the Philadelphia Police to transport the child to DHS.
If such arrangements are made DHS should be so informed.




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SUBJECT: CHILD ABUSE / NEGLECT                                      NUMBER        111.8/504.2
CLASSIFICATION:

RESPONSIBILITIES OF THE SCHOOL NURSE
(DEC. 98)

A referral of the suspected case of child abuse and/or neglect is to be referred to the school nurse if one is
available.
         A. The pupil is to be examined and interviewed.
         B. The teacher, counselor and principal are to be consulted regarding the injury and/or neglect.
         C. The existence of previous indices of possible abuse and/or neglect are to be checked.
         D. The Pupil Health Record, "is to be completed with facts relevant to the situation." This shall
         include a professional description of the injuries and/or chief complaint, and a note that State Form
         CY-47, "Report of Suspected Child Abuse," has been filed.
         E. The school nurse is to make a referral to the counselor, if the pupil is not known to the
         counselor.
F. Where the suspected abuse involves health issues (physical or mental) any written documentation
including reports to the parent or guardian, requests for examinations, referrals, and the response (or lack
thereof) from the caregiver is to be included with the CY-47 filed in the case.




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SUBJECT: CHILD ABUSE / NEGLECT                                         NUMBER         111.9/504.4
CLASSIFICATION:

PROCEDURE FOR REPORTING                      (SEP. 01)

When informed of a case of suspected child abuse and/or neglect, the principal or person in charge
of a facility is to:
A.       Telephone the Pennsylvania Department of Public Welfare, Bureau of Child Welfare:
         CHILD LINE 1-800-932-0313.
         1. Principal is to identify himself/herself.
         2. Provide as much of the following information as possible:
                    a. the names of the child and adults being reported
                    b. the date, nature, and extent of the alleged child abuse and/or neglect
                    c. the home addresses of persons in the report
                    d. the age(s) and sex of the child(ren) suspected of being abused and/or neglected
                    e. the locality in which the alleged abuse and/or neglect occurred
                    f. any evidence of prior abuse by the alleged perpetrator(s)
                    g. the source of the report
                    h. actions taken (medical test, exam, photographs)
                    i. seek directions whether the school should notify the parent or guardian of the
                    report of abuse, or whether the child care agency wishes a delay in the notification
                    and will take over responsibility for the notification. (See Procedure #111.10)

B.       Telephone the Philadelphia Department of Human Services Child Abuse HOT LINE: 215-
         683-6100. Inform them that the State Child Line has already been called. Provide the
         same information as was given to the state and any additional information requested.
         Failure to place this call will delay DHS's response as there is frequently a 2 to 3 hour
         delay before they are notified by the state agency.
C.       Form CY-47, “Report of Suspected Child Abuse” with an accompanying letter if needed
         are to be sent within 48 hours to:

                            Supervisor
                            Child Abuse Hotline
                            Philadelphia County Children and Youth Agency
                            1515 Arch Street
                            Philadelphia, PA 19102




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D.       No copies of the CY-47 are to be made or maintained in any file. An Incident Report is
         to be prepared documenting the allegations and that steps A, B, and C above were
         followed. The name of the alleged perpetrator is NOT to be included. The Child is only to
         be referred to by his/her I.D. Number.

E.       Still photographs of the child, showing injuries MAY be taken. The photographs are to be
         retained in the school and made available to DHS workers upon request. They are NOT to
         be sent with the CY-47. The fact that photographs were taken is to be noted on the CY-47.

F.       In the event that questions regarding the referrals persist after a report is filed, consult with
         either School Health Services (215-875-3490) or the Office of General Counsel (215-299-
         7676).




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SUBJECT: CHILD ABUSE / NEGLECT                                     NUMBER        111.10/504.5
CLASSIFICATION:

NOTIFICATION OF PARENTS                (DEC. 98)

After the referral of a suspected case of child abuse and/or neglect is made, every effort must be
made to notify the parents of the fact. However, where the parent or guardian is the suspected
abuser, the Department of Human Services (DHS) shall be consulted prior to informing the parent
or guardian of the referral. Where the DHS investigator requests that notice not be made, because
it may compromise the investigation or endanger the child, the principal may allow DHS to assume
responsibility for the above notice.


Premature notice has, in the past, resulted in the suspected abuser removing the child from the
school, prior to the arrival of an investigator, in an effort to hide the child from authorities.




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SUBJECT: CHILD ABUSE / NEGLECT                                    NUMBER        111.11/504.6
CLASSIFICATION:

COOPERATION WITH CHILD AND YOUTH AGENCY
WORKERS AND LAW ENFORCEMENT (DEC. 98)

A. Properly identified caseworkers from the Philadelphia Children Youth Agency (DHS) may
request the assistance and cooperation of school personnel, such as:
         1. Releasing the pupil to the DHS worker upon an order from a judge.
         2. Arranging a private interview of the pupil, with the caseworker and pupil alone, on
         school premises.
         3. Providing information in the pupil pocket to the DHS worker, assigned law
         enforcement agent, or court appointed guardian.


B. Any questions regarding information requests are to be referred to the Office of General
Counsel, (215-299-7676).


C. The permission of parents is not required for the compliance of school personnel with
authorized child abuse investigators.




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SUBJECT: CHILD ABUSE / NEGLECT                                   NUMBER        111.12/504.7
CLASSIFICATION:

EARLY CHILDHOOD PROGRAMS                 (DEC. 98)


A. In ALL Early Childhood Programs: In Get Set, Day Care, Child Care Programs,
Prekindergarten Head Start, and Parent Cooperative Nursery Program, staff members are to report
suspected cases of abuse/neglect to any of the following persons: head teacher, lead or resource
teacher, caseworker, supervisors, social service coordinator, instructional coordinator or nurse.


B. Procedures listed in section 111.9 are to be followed by the person receiving the report.




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SUBJECT: CHILD ABUSE / NEGLECT                                     NUMBER         111.13/504.9
CLASSIFICATION:

RESPONSIBILITIES OF SCHOOL COUNSELORS
(DEC. 98)


I. A referral of a suspected case of child abuse and/or neglect may be referred to the school
counselor
         A. The pupil may be interviewed by the counselor.
         B. The principal, teacher and counselor are to be consulted regarding the injury and/or
         neglect.
         C. The counselor and school nurse are to work in collaboration to complete the referral.
         D. The counselor may provide follow-up counseling service to the pupil and/or the family
         if indicated.
II. Recognizing that feedback to school personnel is desirable to allow for evaluation of, planning
for, sensitivity to, a child's needs, an amendment to the Child's Protective Services Act (effective
date 1/5/88) allows School Personnel who have filed a report of abuse to obtain from DHS:
         A. The final status of the report following the investigation (indicated, founded or
         unfounded); and
         B. Information identifying any services provided, arranged for, or to be provided, by
         DHS to protect the child from further abuse.
III. To obtain this information, the counselor should contact the social worker or the social
worker's supervisor who investigated the report.




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SUBJECT: CHILD ABUSE / NEGLECT                                          NUMBER         111.14/504.9
CLASSIFICATION:

DOMESTIC VIOLENCE-SPOUSAL & DATE ABUSE
(SEP. 01)


A. Students 18 years of age or older or employees may be the victim of physical or sexual abuse at
   the hands of spouses, dates or significant others. While the Child Abuse reporting provisions
   set forth in the preceding policies and procedures do not apply to victims who are 18 years of
   age or older, other legal safeguards and services are available. Where a student is the victim of
   such abuse the procedures set forth in the following paragraphs must be followed. These
   procedures may also be followed for staff members and other members of the school
   community. Where a child under the age of 18 is suspected of being the victim of abuse by a
   boy/girlfriend whom they do not reside with and the Child Abuse hotlines decline to act on the
   report because the abuse is not related to the home living conditions, the procedures set forth
   above must be followed. A CY-47 should still be filed even if the Child Abuse Agency
   declines the oral report.
B. Whenever a staff member becomes aware that a student age 18 or older, may be the victim of
   physical or sexual abuse the principal or the person acting in his/her stead is to be immediately
   notified.
         1.         The principal, taking into consideration the nature of the suspected abuse, any
                    special relationship of trust existing between the victim and professional staff
                    members, the availability of school specialists such a nurse, counselor,
                    psychologist, S.A.P. team members, etc., shall immediately assign staff to meet
                    with the student.
         2.         The assigned staff member(s) shall meet with the student and conduct an interview
                    to try to determine the nature of the problem and, where appropriate, to arrange for
                    the nurse to conduct a physical examination.
         3.         If the student is receptive to seeking social services and/or police or judicial
                    intervention, referrals shall be made to the appropriate agencies set forth in section
                    'B.4' and 'B.5.' below.
         4.         If the student is reluctant or resistant to seeking help from outside agencies, the
                    assigned staff member(s) shall, before the student leaves, consult with one of the
                    City’s approved counseling agencies for further guidance or assistance. These
                    agencies are:
                    a.     Women Against Abuse Hot Line - 215-386-7777 (24 Hours)
                    b.     Women Organized Against Rape - 215-985-3333 (24 Hours)
                    c.     Women in Transition - 215-751-1111 (24 hours)
                    d.     Service and Education for Asian Abused Women - 215-627-3922
                    e.     Congresso de Latino Unidos, Latino Domestic Violence Program - 215-
                           978-1174


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                    f.     Lutheran Settlement House - 215-426-8610
                    These agencies can provide or refer victims to trained counseling staff, legal
                    assistance for obtaining protective orders, temporary housing and other support
                    services.
         5.         While the Police Department usually will not get involved in assault cases unless the
                    victim is ready to press charges, the Philadelphia Police Department has special
                    Domestic Violence Response Teams in each police division. These specially trained
                    teams will look into such reports. Even if the victim is not ready to seek an arrest,
                    these teams will inform the victim of his/her options and will make it clear that a
                    present refusal to press charges does not foreclose a later change of mind.
The appropriate team should be notified whenever there is concern for the safety of the student.
They may be reached at:
                    a.     Central Division- 215-686-3230, 215-686-3231
                    b.     Southwest Division – 215-686-3185
                    c.     South Division – 215-685-1659
                    d.     East Division – 215-686-3242, 215-686-3245
                    e.     North Division – 215-686-3352
                    f.     Northeast Division – 215-686-3153 or 215-686-3154
                    g.     Northwest Division – 215-686-3395




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        C OM M U N IC A B LE
     DISEASE CONDITIONS




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SUBJECT: COMMUNICABLE DISEASE CONDITIONS                             NUMBER 304
CLASSIFICATION:

AIDS/HIV INFECTION                (DEC. 98)



I. Definition1
       AIDS is an acronym for acquired immune deficiency syndrome. As used in this policy,
AIDS includes all levels of infection, from asymptomatic to ... “classic” AIDS, caused by the
AIDS virus. This virus has been designated by scientists and medical authorities as the Human
Immunodeficiency Virus (HIV).

II. Purpose
        A. To protect the health and safety of all students and employees who are diagnosed as
        having AIDS/HIV Infection.

         B. To protect the confidentiality of all students and employees who are diagnosed as having
         AIDS/HIV Infection.

         C. To inform staff of steps to be taken when staff become aware of or suspect a student or
         employee has AIDS/HIV Infection.

III. Confidentiality
        A. When a staff member becomes aware, by any means, that a student or employee has
        been or is rumored to be AIDS/HIV positive, NO DISCUSSIONS ARE TO TAKE
        PLACE AND NO OTHER PERSON IS TO BE CONTACTED.

         B. The strictest rules of confidentiality are to be followed as indicated in this procedure.

IV. Methods of Transmission 2
      A. The HIV Virus is transmitted through these methods:
             1. Sexual exposure and exposure to blood or tissues. (The routes are analogous to
             those of the Hepatitis B virus.)

                    2. Children may also acquire the HIV Virus from their infected mothers in the
                    perinatal period.

         B. The HIV Virus has been found in saliva, tears, urine, and bronchial secretions, but
         transmission after contact with these secretions has not been reported.

         C. Routine social, community, or school contact with an HIV-infected person carries no
         risk of transmission.


1        School District of Philadelphia Policy: Section-Students; No. 236, AIDS/HIV Infection:
         Adopted November 18, 1985, Revised September 1, 1987 and December 17, 1990.
2        Benenson, Abram, editor; Control of Communicable Diseases in Man: American Public
         Health Association, 1990, p3.




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         D. The incubation period varies. “Although the time from infection to the development of
         detectable antibodies is generally 1-3 months. The time from HIV infection to diagnosis of
         AIDS has an observed range of about 2 months to 10 years or longer.” 3

         E. The period of communicability is unknown. It is presumed to begin early after onset of
         HIV Infection and extend throughout life.4

V. Prevention of Opportunistic Infection

         A. Immunosuppressed children (and adults) are at greater risk of suffering severe
         complications from such infections as chickenpox, cytomegalovirus*, tuberculosis, herpes
         simplex, and measles.5

         B. All persons known to be immunosuppressed are to be excluded from school in the event
         that there is an outbreak of the above diseases.




3.       Benenson, Abram, editor: Control of Communicable Diseases in Man: American Public
         Health Association, 1990. p. 4.
4.       Benenson, Abram, editor: Control of Communicable Diseases in Man: American Public
         Health Association, 1990. p. 4.
5.       MMWWR: (Morbidity and Mortality Weekly Report) U.S. Department of Health and
         Human Services/Public Health Service; Vol. 34, No 34 August 30, 1985

*        Also termed salivary gland virus.




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SUBJECT: COMMUNICABLE DISEASE CONDITIONS                                       NUMBER 300
CLASSIFICATION:

INTERAGENCY PROTOCOL BETWEEN SCHOOL
DISTRICT & DEPARTMENT OF HEALTH   (SEP. 02)

                                      INTERAGENCY PROTOCOL
                                              Between
                               THE SCHOOL DISTRICT OF PHILADELPHIA
                                                And
                      THE CITY OF PHILADELPHIA DEPARTMENT OF PUBLIC HEALTH

The control of communicable diseases is a function of the State and City Departments of Health, governed by State
laws and local Department of Public Health regulations. The School District of Philadelphia is a key partner in this
effort.

When The School District of Philadelphia learns of a reportable communicable disease in a member of the school
community the Philadelphia Department of Public Health (PDPH) must be notified @ 215-685-6740. Cases of
possible Tuberculosis are reported to 215-685-6744. Conversely, when the Philadelphia Department of Public Health
(PDPH) knows of a case of communicable disease in a member of the school community, an appropriate School
District official will be notified. Such notice shall occur at the earliest possible opportunity during normal business
hours.

However, there are a small number of special situations which require immediate sharing of information between
both agencies, even during evenings, weekends and holidays. These special situations are:
        • Death of a student from any reportable communicable disease.
        • Any case of bacterial meningitis.
        • Any case of polio.

Confidentiality regarding the identity of the case being reported will be maintained at all times by all parties.

COMMUNICATION PROCEDURES FOR SPECIAL SITUATIONS-OUTSIDE NORMAL BUSINESS HOURS

 When the Health Department learns of a Special Situation outside normal business hours the person
on duty at the Health Department will telephone the School District of Philadelphia Designee @ 215-299-7233.

                    The School District Designee will immediately notify the Chief of Staff and AAO who, in turn,
                    will notify the School Principal.

When the School District of Philadelphia hears “word” of a possible Special Situation outside normal
business hours the person on duty at The School District will contact the City of Philadelphia Department of
Public Health by calling 215-686-5665 and asking for the Disease Control “on call person”.




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COMMUNICATION PROCEDURES-DURING NORMAL BUSINESS HOURS

When the Health Department learns of a Special Situation during normal business hours the person on
duty will telephone one of School Health Services Coordinators below:

                    1. Ms. Jacqueline Guynn @ 215-875-5034 (pager 215-899-6007)
                    2. Ms. Connie Williams @ 215-875-5033 (pager 215-899-8626)
                    3. Ms. Shelley Applegate @ 215-875-5032 (pager 215-899-8637)
                    4. Ms. Rhona Cooper @ 215-875-5035 (pager 215-899-2420)

School Health Services Coordinators will notify the school principal and the School Health Services Director.

         •    The school principal will inform the Academic Area Office.

         •    The Academic Area Office will notify the Deputy Superintendent.

         •    The School Health Services Director or designee and the Chief of Staff or designee will collaborate and
              monitor the situation.

In the event, during normal business hours, there is no response within one hour, Health
Department staff will contact the school directly.

COMMUNICATION PROTOCOL FOR REPORTING OTHER POSSIBLE COMMUNICABLE DISEASES

REPORTABLE COMMUNICABLE DISEASES

Whenever a school hears “word” of possible communicable diseases, regardless of the source:
       • The School Nurse must be notified.
       • The School Nurse will gather all relevant information and contact the City of Philadelphia Department
            of Public Health.
       • The School Nurse will notify a School Health Services Coordinator.
       • The City of Philadelphia Department of Public Health will investigate to confirm the diagnosis.

A LLCASES MUST BE DISCUSSED WITH THE                  CPDPH       BEFORE ANY ACTIONS ARE TAKEN BY
SCHOOL STAFF .

ROLE OF THE CITY OF PHILADELPHIA DEPARTMENT OF PUBLIC HEALTH

In all instances The Health Department will:
         • describe to the school district’s designee the Health Departments’ intended response to the situation.
         • advise the school district’s designee regarding appropriate and necessary health actions needed to be
             taken by the school district to protect the public health of the school community.
         • draft a letter or notice to be sent home to the school community when necessary.
         • make known their availability for continued consultation.
         • remind the SDP of the confidential nature of all information being exchanged.

ADDITIONAL INFORMATION IS AVAILABLE TO SCHOOL STAFF IN THE CITY OF
PHILADELPHIA DEPARTMENT OF PUBLIC HEALTH DIVISION OF DISEASE CONTROL
MANUAL IN ALL HEALTH ROOMS (“THE YELLOW BOOK”)




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SUBJECT: COMMUNICABLE DISEASE CONTROL                             NUMBER 303
CLASSIFICATION:

IMMUNIZATION             (SEPT. 02)


Immunization requirements
 1. Pennsylvania Department of Health School Immunization Regulations, Title 28, chapter 23,
    and Philadelphia Health Code, Title 6, Section 6-210 require that: All pupils must be
    immunized or exempted before admission to any public, Parochial, or private school in
    Pennsylvania.

 2. Written proof of immunization from a physician or other health professional is to be requested
    from the parent. In the absence of written proof, the parent may provide a history of the
    child’s immunization including the month, day, and year of each immunization. Under
    Pennsylvania law, an oral history by the parent is acceptable proof.

 3. Requests for immunization information directed to the child’s health care provider should be
    submitted on a 'Consent for Release of Information '(Form M-68) signed by the parent or
    legal guardian. This request may be submitted to the provider by the parent, by mail, or by
    fax, whatever is most expedient.

 4. Children may be registered without proof of immunizations prior to the start of school.
    However, parents and guardians must be informed that in order to attend school, written
    proof of a minimum of at least one dose of each required vaccine will be required. This is
    called a PROVISIONAL admission .

      When a pupil has been admitted provisionally, a plan for completing the immunizations
      shall submitted by the parent. This plan may be developed in consultation with the school
      nurse. Provisional records must be reviewed every sixty days. If the plan is not followed or
      the provisional period expires before immunizations have been completed, the pupil may be
      excluded from school until evidence of immunization or exemption is submitted. All
      immunizations MUST be completed within 8 months after the first day the child attended
      school.

 5. At the time of registration, the person registering the pupil must enter the required
    immunization information into the Pupil Information Network, Screen S61. If the electronic
    record is completed, it is not necessary to generate a hand-written “Certificate of
    Immunization”. Screen S61 also serves as acceptable documentation of immunization in the
    state auditing process. In the HIS, Screen S61 may be accessed in Main Menu #1,
    Immunization and Contact Information.

      Immunization data must be entered for all pupils entering Kindergarten or Grade 1 for the
      first time. This includes any pupils entering Head Start, Comprehensive Day Care, or other
      Pre-Kindergarten programs, even if these students already have a School District of
      Philadelphia identification number.

      As of October 1, 2000 immunization information for all pupils is to be stored electronically in
      Screen S61 and must be kept current. It must also be readily available for auditing or for
      identification of exempted pupils in the event of a disease outbreak.



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      It is no longer necessary to generate a Pupil Health Record (Form MEH-3). When the pupil
      is added to the school enrollment, an electronic record is automatically generated in the Health
      Information System (HIS) accessed by the school nurse. Existing Certificates of
      Immunization and MEH-3 forms should be stored in the pupil pocket.

      The record of immunization shall follow the pupil when he/she transfers, graduates, is
      promoted, or leaves the school district. The electronic record will be transferred with the
      pupil to any other Philadelphia public school. When a pupil transfers to another school
      district, a printed copy of the immunization record should be placed in the official pupil
      pocket prior to deleting the pupil’s data from the Pupil Information Network

 6. There are two categories of EXEMPTION from the immunization requirements which must
    be entered in the exemption screen accessed via the Screen S61:

         Religious exemption – Pupils need not be immunized if the parent or guardian objects,
         in writing, to the immunization on religious grounds or a strong moral or ethical conviction
         similar to a religious belief.

         Medical exemption – Pupils need not be immunized if a physician or his/her designee
         states, in writing, that immunization may be detrimental to the health of the child. This may
         be either a temporary or permanent status. When the physician determines that the
         immunization is no longer detrimental to the health of the child the exemption ceases to be
         valid and the child must be immunized. Temporary exemptions are also granted for a
         limited period of time when it has been verified that the supply of vaccine is not available or
         when the spacing between doses in a vaccine series has been exceeded. Temporary
         exemptions must be manually deleted from the exemption screen accessed via Screen S61.

         Parents of all exempted pupils should be informed that if the Philadelphia
         Department of Public Health declares an epidemic of a disease for which
         immunization is an admission requirement, pupils who are exempted will
         not be permitted to attend school for the duration of the epidemic.

         A “CERTIFICATE OF IMMUNIZATION” WITH THE PARENT’S OR PHYSICIAN’S
         STATEMENT OF EXEMPTION AND SIGNATURE SHOULD BE KEPT ON FILE.

         Questions regarding the immunization status of an individual pupil should be
         discussed and resolved in consultation with the school nurse or School Health Services
         staff at (215) 875-3490 or (215) 875-3749.




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8. IMMUNIZATION REQUIREMENTS 2002-2003 ALL GRADES (K-12)
           This table represents a summary of the Pennsylvania Department of Health
           and the Philadelphia Department of Public Health Immunization Requirements
           for School Entry, September 2002

                GRADES                Requirements (Recommended Vaccines)
 K-2ND          Diphtheria           4 Doses: at least one dose after the 4th birthday (DTaP/DTP/DT/Td)*
                Tetanus              4 Doses: at least one dose after the 4th birthday (DTaP/DTP/DT/Td)*
                Polio                3 Doses (OPV/IPV)
                Measles              2 Doses: both after the 1st birthday (MMR)*
                Mumps                1 Dose: after the 1st birthday (MMR)*
                Rubella              1 Dose: after the 1st birthday (MMR)*
                Hepatitis B          3 Doses: properly spaced (HBV)*
                Varicella (Chickenpo 1 Dose: after the 1st birthday OR a history of disease (VARIVAX)***
 3RD-5TH        Diphtheria           4 Doses: at least one dose after the 4th birthday (DTaP/DTP/DT/Td)*
                Tetanus              4 Doses: at least one dose after the 4th birthday (DTaP/DTP/DT/Td)*
                Polio                3 Doses (OPV/IPV)
                Measles              2 Doses: both after the 1st birthday (MMR)*
                Mumps                1 Dose: after the 1st birthday (MMR)*
                Rubella              1 Dose: after the 1st birthday (MMR)*
                Hepatitis B          3 Doses: properly spaced (HBV)*
 6TH-7TH        Diphtheria           3 Doses (DTaP/DTP/DT/Td)* (6th grade students who entered school since 1997
                                      must have a total of 4 doses with one dose after the 4th birthday)
                Tetanus              3 Doses (DTaP/DTP/DT/Td)
                Polio                3 Doses (OPV/IPV)
                Measles              2 Doses: both after the 1st birthday (MMR)*
                Mumps                1 Dose: after the 1st birthday (MMR)*
                Rubella              1 Dose: after the 1st birthday (MMR)*
                Hepatitis B          3 Doses: properly spaced (HBV)**
                Varicella (Chickenpo 1 Dose OR a History of disease**** (if ≥ 13 yrs: 2 doses separated by 28 days)
 8TH-10TH       Diphtheria           3 Doses (DTaP/DTP/DT/Td)
                Tetanus              3 Doses (DTaP/DTP/DT/Td)
                Polio                3 Doses (OPV/IPV)
                Measles              2 Doses: both after the 1st birthday (MMR)*
                Mumps                1 Dose: after the 1st birthday (MMR)*
                Rubella              1 Dose: after the 1st birthday (MMR)*
                Hepatitis B          3 Doses: properly spaced (HBV)**
 11TH-12TH      Diphtheria           3 Doses (DTaP/DTP/DT/Td)
                Tetanus              3 Doses (DTaP/DTP/DT/Td)
                Polio                3 Doses (OPV/IPV)
                Measles              2 Doses: both after the 1st birthday (MMR)*
                Mumps                1 Dose: after the 1st birthday (MMR)*
                Rubella              1 Dose: after the 1st birthday (MMR)*

               References: ****2001 Philadelphia Board of Health Regulation RE: Adolescent Varicella
                            *** 2000 Philadelphia Board of Health Regulation RE: Varicella Vaccine
                             ** 1998 Philadelphia Board of Health Regulation RE: Adolescent Hepatitis B Vaccine
                              * 1997 Pennsylvania School Immunization Law




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9. Recommended Practices to Facilitate Management of the School Immunization
   Program
ASSESSMENT:
• Utilize data from the Health Information System (HIS), Certificates of Immunization, and the
   Reports of Private Physical Examination (MEH-1) to:
   • Identify students who are inadequately immunized and refer these students for update of their
      immunizations immediately.
   • Identify students who are provisionally admitted and develop plans with their families for
      completion of required immunizations;
   • Identify students who are admitted with medical and/or religious exemptions:

PLANNING:
• As early as possible, arrange to meet with the principal or the principal’s administrative designee
  to discuss the findings of the assessment process.
• The principal or designee should be able to identify all exempted students in the event that there
  is an outbreak of a vaccine-preventable disease for which exempted students must be excluded
  from school attendance.
• The priority activities should be focused on students whose records indicate an inadequate
  immunization history.
• All students who are provisionally admitted should have a plan for the completion of the required
  immunizations submitted by their parents. The plan must be in writing and made a part of the
  student’s health record and be reviewed every 60 days.

IMPLEMENTATION:
• Contact families of students with inadequate immunization histories immediately in an attempt to
   bring every student to at least provisional status.
   • Assist parents to gather the required information from all current and previous sources of primary
       health care.
   • A Consent for Release of Information (M-68) may be completed by the parent and submitted
       to the provider directly or by the school via fax to expedite the exchange of medical
       information.
   • School nurses may utilize the immunization database maintained by the Philadelphia
       Department of Public Health at (215) 685-6784.
   • Refer families to either their primary providers or the nearest public health center for
       immediate immunization update.
• Monitor/review the records of students admitted provisionally and remind parents at appropriate
   intervals to visit their health providers for update of the required immunizations.
• Take advantage of all opportunities to interact with parents such as Back to School Nights, School
   Assemblies, Home and School gatherings, Report Card Conferences, etc.
• Update the student’s record in the HIS immediately upon receipt of data from the student’s primary
   health care provider.

EVALUATION:
• By October 15 of each school year, all students will be attending school with at least provisional
  immunization status.
• The status of all provisionally admitted students will be monitored at least every 60 days and parental
  contact will be maintained until all required immunizations are obtained.
• All required immunizations will be obtained within 8 months of the date of provisional admission.
  If not, the principal will be advised to undertake suspension procedures, in accordance with the
  PA School Code.

            School nurses should use every contact with parents as an opportunity to assure
              that every student has health insurance and access to primary health care.




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SUBJECT: COMMUNICABLE DISEASE CONTROL                                   NUMBER 301
CLASSIFICATION:

PEDICULOSIS CAPITIS                   (SEP. 01)

I.       PURPOSE
         A.   To prevent the spread of pediculosis (lice) among school children.
         B.   To detect pediculosis in the early stages in order to prevent secondary bacterial
              infections caused by scratching.
         C.   To comply with state regulations regarding communicable disease control: TITLE
              28 Health & Safety (28 Pa. Code ch. 27) Section 27.71. Exclusion for specified
              diseases and infectious conditions.

                    “Each teacher, principal, superintendent, or person in charge of any school shall
                           exclude students from school who have been diagnosed by a physician or
                           are suspected of having the disease by the school nurse for the indicated
                           period of time...”

                    “Pediculosis capitis- following the first treatment with an effective pediculicide.
                           Removal of nits is not required if effective treatment has been given.”

I.       DEFINITIONS/ TRANSMISSION
         A.   Pediculosis Capitis is an infestation of the scalp and hair by the head louse. It feeds
              on the host and perishes within two to three days after removal. The eggs are laid
              attached to the hair shaft and reach maturity within two to three weeks.
         B.   Transmission is by direct contact with an infested person, especially their clothing,
              bedding, hats, hairbrushes or combs.
         C.   Transmission by fomites is highly unlikely, but possible.
II.      SCHOOL MANAGEMENT
         A.   Screening for head lice of an entire school is not generally indicated. The school
              nurse will discuss the degree of infestation with the principal and will determine if
              the infestation situation warrants more extensive screening and how that will be
              accomplished.
III.     SYMPTOMS
         A.   Severe itching of scalp.
         B.   Scratch marks or rash on scalp or nape of neck.
         C.   Infected sores on scalp.
         D.   Presence of eggs (nits)
              A nit is a louse egg. Nits are teardrop in shape, approximately 1/8 inch in length,
                      and vary in color from yellowish-brown to white. They are attached to the
                      hair shaft with a waterproof, cement-like substance. Clusters of nits may be
                      found in any section of the hair, often near the scalp at the nape of the neck
                      and/or behind the ears. In light infestations, a careful examination of the
                      entire scalp may be necessary to detect them. Nits cannot be washed out or
                      brushed out like dandruff.




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         A.         Presence of lice
                    Head lice are elongated insects approximately 1/4 inch in length, and are grayish
                           white with dark margins. Lice do not have wings and cannot fly. They
                           move quickly, but do not jump. This quickness makes them difficult to see
                           and an infestation identification is often made on the basis of nits only.

I.       ROLE OF THE SCHOOL NURSE
         A.   Suspected cases of head lice
              1.       Examine the student for lice or nits by using a tongue blade or wooden
                       applicator stick, part the hair and look for marks, redness and/or nits.
                       Utilize sufficient strong lighting to make identification easier.
              2.        If a suspected nit is identified, use the tongue blade or applicator to try and
                       dislodge the nit. If it adheres to the hair shaft, it is much more likely to be a
                       nit than dandruff, skin or hair spray flakes or other debris in the hair.
         B.   Discard the tongue blade or wooden applicator after each individual student; using a
              new one for each student.
         C.   Differentiate between active and inactive infestation.
              1.       Active: actual lice seen, and or the presence of whitish nits within 1/4 inch
                       of the scalp.
              2.       Inactive: nit shells which appear translucent and are farther than 1/4 inch
                       from scalp.
         D.   All students free of infestation may return to the classroom.
         E.   Immediately exclude any student who has an active case of head lice until evidence
              of appropriate treatment is submitted to the school or until the school nurse indicates
              the student is infestation free.
              1.       Notify the parent/guardian of the infestation and the exclusion.
              2.       Issue the Pediculosis Letter to Parent when the parent/guardian picks the
                       student up at school.
         F.   Examine all students in the same classroom as the infested student. Exclude as
              indicated.
         G.   Examine all siblings or other students who live in the same home. Exclude as
              necessary. Examine that classroom in its entirety as indicated.
         H.   Notify other schools of siblings or home mates if indicated.
         I.   Notify the teacher of the screening results. Emphasize to the teacher that an
              excluded student may not return to class until evidence of effective treatment has
              been submitted.
         J.   Provide a list of excluded students to the principal.
         K.   Rescreen students excluded for pediculosis, and all students in that classroom once
              a week for three weeks or until in the school nurse’s judgment the classroom is
              infestation free.
         L.   In a situation of chronic infestation or multiple students being infested, the school
              nurse will bring it to the principal’s attention. The nurse will discuss with the
              principal the advisability of sending a letter of notification of the infestation problem
              to the parents of all students not known to be infested at the present time. It is the
              principal’s responsibility to inform the parents of non-infested students of the
              infestation problem.




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II.      PREVENTIVE MEASURES DURING A PEDICULOSIS OUTBREAK
         A.     Classroom activities involving frequent body contact between students should be
                temporarily suspended. This includes in-class dance activities, certain games,
                wrestling in physical education classes, etc.
         B.     Group work activity around classroom tables should either be temporarily
                suspended or children should be allowed to occupy only every other seat at the table
                in order to minimize person-to-person contact.
         C.     Clothing and equipment
                1.      A policy of assigning hooks in cloakrooms should be initiated.
                2.      Hats should be kept in coat sleeves or pockets rather than in piles on shelves
                        or on the floor
                3.      Separation of clothing should occur in those areas in which facilities for
                        hanging coats are not available (i.e. Gymnasium, cafeteria, workshops,
                        etc.).
                4.      Classroom dress-up activities should be curtailed temporarily.
                5.      Resting mats, towels, and pillows for students should be permanently
                        assigned and be kept separated during use and storage.
              Carpeted classrooms should be vacuumed daily. This is more important in pre-k,
            kindergarten and first grade classes because of the time the lower grades spend on the
                                                     floor.




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                                                   SAMPLE
                                         SCHOOL DISTRICT OF PHILADELPHIA
                                             SCHOOL HEALTH SERVICES

Dear         Parent/Guardian                  of________________Room/Grade_________

Upon examination, the school staff has found that your child has HEAD
LICE/NITS (eggs).
• Having head lice is not something to be ashamed of and DOES NOT mean your
    child is dirty.
• Head lice do not carry disease.
• Head lice do spread to others and must be treated at once.
YOUR CHILD CANNOT COME BACK TO SCHOOL UNTIL HE/SHE HAS BEEN
TREATED! AN ADULT MUST bring the child and proof of treatment to a school
staff member, who will recheck the child’s hair.

Treatment for Head Lice
• There are lice killing treatments which you can buy at the drug store or health food
   store. You can also get a prescription from your doctor.
• Be sure to follow ALL the instructions on the box\bottle EXACTLY!
• Check everyone in the house for lice/nits. Treat everyone who has head lice/nits at
   the same time.
• The BEST WAY TO STOP HEAD LICE from coming back is to pull out all the nits
   (eggs) from the hair. You can use a fine-tooth comb or pull them out with your
   fingers.

Cleaning the Home and Household Items
Everything that touches the head or shoulders can spread lice and should be cleaned
as follows:
• All hats, hair ribbons, scarves, clothes, pajamas, coats, towels, sheets, blankets
   and bedspreads should be cleaned by machine washing in hot water and dried
   using the hot cycle of a dryer for at least 20 minutes.
• Anything that cannot be washed such as stuffed animals or pillows would be dry-
   cleaned or sealed in a plastic bag for 2 weeks.
• Combs and brushes should be cleaned by soaking in very hot water for 10
   minutes.
• Vacuum everywhere including rugs, mattresses, upholstered furniture and car
   seats.

Certified            School             Nurse_____________________Date_________


M-45 (Rev. 5/2000) – COMM. CODE 61602445243




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      Sample Parental Letter for Schools with Pediculosis Capitis Infestation

Dear Parent/Guardian:

A growing number of cases of head lice have recently been detected in our school. Of all
communicable childhood diseases, only the common cold occurs more often than head lice.
Consequently, whenever we learn that a student has head lice, that student is excluded from school
until adequate treatment has begun.

Lice infestations can happen to anyone. In fact, clean heads are more likely to become infested than
dirty or dandruffed ones. Lice do not normally spread disease, but they can spread rapidly if
preventive measures are not taken as soon as the lice or their eggs have been detected. Careful
parents can, and must, help us to eliminate this problem at our school and in our community.

Head lice are generally transmitted from one person to another by direct personal contact and by
sharing of personal items such as combs and brushes, hats, scarves, and coats.

I am asking for your cooperation and request that you please follow the instructions below:

Examine your children for indication of infestation. Head scratching and intense itching of the
scalp are the main signs of head lice. Use good light and a magnifying glass to inspect the hair and
scalp. Look for tiny grayish crawling forms and/or tiny whitish oval eggs stuck to the hair shafts
about 1/4” from the scalp.

ALTHOUGH AN ANNOYING PROBLEM, HEAD LICE INFESTATION SHOULD NOT
TRIGGER UNDUE ALARM...JUST IMMEDIATE ACTION. In most cases, all that is required
is shampooing with a good anti-lice preparation, a medicated shampoo available at your local
pharmacy without a prescription, or by prescription from your family doctor. All persons in the
infested individuals household should also be examined for the presence of lice and eggs. All
infested persons should undergo treatment.

In addition to shampooing, where possible, all combs and brushes, clothing, bedding, and
upholstery should be disinfected.

Infestations usually occur when infested people fail to report them due to a misguided notion of a
social stigma attached to the problem. But once detection, immediate reporting, and proper
treatment procedures are instituted, the problem can be quickly and easily eliminated.

For further information on lice detection and prevention, contact your school nurse.

                                              Sincerely,


                                              Principal




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SUBJECT: COMMUNICABLE DISEASE CONTROL                                 NUMBER       302.0
CLASSIFICATION:

SEXUALLY TRANSMITTED DISEASES                         (DEC. 98)

PURPOSE

1. To make certain that students with sexually transmitted diseases obtain treatment.

2. To prevent the spread of sexually transmitted diseases.

3. To expedite the investigation of contacts of students who have or have been exposed to
sexually transmitted diseases.

4. To facilitate cooperation with the City of Philadelphia, Department of Public Health .

I.        Rationale

          Sexually transmitted diseases (STDs) constitute a large public health problem which affects
          a substantial number of teens and young adults. The certified school nurse may be the first
          medical person the student approaches with suspected symptoms. STDs which must be
          referred for treatment are:

                    Syphilis                       Chlamydia
                    Gonorrhea                      Hepatitis B
                    Genital Herpes                 HIV
                    Genital Warts

II.       Symptomatology

          Early symptoms vary depending on the specific STD. Complaints of urethral or vaginal
          discharge, pain or burning when urinating, genital lesions, painful sores, or meatal
          swelling and redness, need to be investigated. Symptoms of HIV and Hepatitis B are not
          localized and may be more difficult to recognize. Unlike the other STDs, these two may or
          may not have been contracted through sexual activity.

          The school nurse should keep in mind that an STD may be present without causing
          symptoms. Therefore, any student known to be sexually active should be warned about
          the possibility of undetected disease.

III.      Role of the Certified School Nurse

     A. A referral to a city STD clinic should be made when the school nurse suspects the presence
        of, or exposure to an STD.

                    Note: In accordance with Pennsylvania Law [35 PS 521.14 (a)], School District
                    personnel need not notify parents of students who are referred to health centers for
                    treatment of STDs. It is, however, School District policy that students be
                    encouraged to involve their parents in their treatment programs.



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  B. The school nurse should assist the student in making an appointment for evaluation and
     treatment. A “Report of Visit to Health Services” (M34) should be completed and sent
     with student to clinic. Follow the regular early dismissal procedure.

                    Note: No student may be excused from school to attend an STD
                    clinic without parental permission.


  C. STDs found in children under the age of twelve are generally evidence of sexual abuse. A
     “Report of Suspected Child Abuse and Neglect” (CY47), must be made.

  D. Students will not be excluded from school unless otherwise instructed by treating agency.

  E. The school nurse should monitor the need for, and adherence to, additional clinic
     appointments.

  F. Student contacts whom the Department of Public Health have not been able to locate at
     home, may be interviewed at the school. Arrangements will be made through an
     administrator or the school nurse.




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                  MEDICATION
                ADMINISTRATION




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SUBJECT: MEDICATION ADMINISTRATION                                  NUMBER 400
CLASSIFICATION:

ACETAMINOPHEN              STANDING ORDERS            (SEP. 02)

I. Who May Administer

         School District supplied acetaminophen maintained in the Health Room may be administered only
         by the Certified School Nurse or School Nurse Practitioner.

II. Purpose

         The health room management of a student or school staff member with a non-chronic complaint
         may be facilitated by providing medication for the relief of apparently minor symptoms. In most
         instances, this will make it possible for the students to return to the classroom or the staff member
         to work.

         For persistent or recurrent complaints, students or staff must be referred to their family physicians.

III. Procedure

         The Certified School Nurse will:

                    1. Take a history to determine:
                           a. The nature of the complaint.
                           b. The degree of discomfort and/or disability.
                           c. Duration of symptoms.
                           d .The likelihood of a more serious problem existing, e.g., in case of a headache
                           inquire about head injury, vision problems, dizziness, etc. For abdominal pain
                           inquire about food eaten, nausea, vomiting, diarrhea, location of pain,
                           tenderness, fever, etc.
                           e. The presence or absence of allergies or drug reactions.
                           f. Whether or not the student/staff is taking any other medication, and for what
                           purpose.
                           g. The presence of conditions that may be compromised by using
                           acetaminophen.
                           h. Acetaminophen should not be administered without consulting the primary care
                           provider or parent of persons who:
                                    1). Have allergies.
                                    2). Are taking other medications
                                    3). Who have conditions that may be compromised by using
                                        acetaminophen.

                    2. Administer acetaminophen

                    3. Record in the Electronic Health Information System
                           a. Go to 'Health Log Inquiry and Maintenance'
                                   1). In the 'treatment' field enter;
                                            a) 'TY1' for one 325 mg Tablet of Acetaminophen
                                            b) 'TY2' for two 650 mg Tablets of Acetaminophen


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                                   2). In the Notes field, document the nursing assessment and all other
                                   relevant information. Be sure your name appears in the note.


                    4. Where the Electronic Health Information System is not available, record on the Student
                    Health Record.
                           a). Use the MEH 3 or Temporary Problem List.
                                   1). Document the nursing assessment and all other relevant information.
                                   2). Record the visit on the M-98 [Record of Illness or Injury]

                    5. For employees record all relevant information on the M-98.

IV. STANDING ORDERS (See Next Page)




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                           THE SCHOOL DISTRICT OF PHILADELPHIA

                                          School Health Services

                                       POLICY AND PROCEDURE
       SUBJECT                     CLASSIFICATION             DATE ISSUED         NUMBER
   ADMINISTRATION OF                ACETAMINOPHEN
      MEDICATION                   STANDING ORDERS            SEPTEMBER 2002           400




         If indicated, acetaminophen may be administered as follows:

                       Acetaminophen 325 mgm tablet

                       Dose:            Student / staff under 125 pounds = 1 tablet
                                        Student / staff over 125 pounds = 2 tablets

                       Dispense:        Two dose maximum

                       Instructions:    One - Two tablets every 4 to 6 hours




         Physician’s Signature on File in Student Health Services Office




       ISSUED BY                   SUPERSEDES             REVIEW BEFORE               PAGE
     SCHOOL HEALTH
        SERVICES                                              AS NEEDED               1 OF 1




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SUBJECT: MEDICATION ADMINISTRATION FOR                            NUMBER       404
         RELIEF OF DYSMENORRHEA
CLASSIFICATION:

IBUPROFEN - STANDING ORDER                   (SEP. 02)

I.       Who may administer
         School District supplied ibuprofen maintained in the Health Room may be administered by
                the Certified School Nurse only.

II.      Purpose
               The Health Room Management of a student or school staff member with non-
               chronic dysmenorrhea may be facilitated by providing medication for the relief of
               minor discomfort associated with menses. In most instances, this will make it
               possible for the student to return to the classroom or the staff member to work.

III.     Procedure
         A.     The Certified School Nurse will:
                1.    Take a history to determine:
                      a)       Symptoms
                      b)       The degree of discomfort and/or disability
                      c)       Duration of symptoms.
                      d)       Health care previously sought for dysmenorrhea in past.
                      e)       What the student/staff has done for dysmenorrhea at home and the
                               response to that therapy.
                      f)       The presence or absence of allergies or drug reactions.
                      g)       The presence or absence of pre-existing conditions in which
                               Ibuprofen would be contraindicated.
                      h)       Whether or not the student/staff is taking any other medication, and
                               for what purpose.

                    2.   Ibuprofen should not be administered without consulting the primary care
                         provider or parent of student or staff who :
                         a)     Have allergies.
                         b)     Are taking other medications.
                         c)     Who have conditions that may be compromised by using ibuprofen.

                    3.   Administer ibuprofen.

                    4.   Students or staff seen for three consecutive menstrual cycles for
                         dysmenorrhea requiring ibuprofen for relief of symptoms will be referred
                         for gynecological evaluation. Ibuprofen will not be administered to these
                         individuals until the referral is complete and MED 1 is completed for PRN
                         administration of ibuprofen.




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                    5.   Record in the Electronic Health Information System.
                         a)     Go to ‘Health Log Inquiry and Maintenance’
                                (1)     In the ‘treatment’ field enter;
                                        (a)      ‘IB 1’ for one 200 mg. Tablet of Ibuprofen.
                                        (b)      ‘IB 2’ for two 200 mg Tablet of Ibuprofen.
                                (2)     In the Notes field, document the nursing assessment and all
                                        other relevant information. Be sure your name appears in
                                        the note.

                    6.   Where the Electronic Health Information System is not available, document
                         the nursing assessment and intervention on the Student Health Record.
                         Record the visit on the M-98 [Record of Illness or Injury.

                    7.   For employees, record all relevant information on the M-98.

IV.      Standing Orders (See next page)




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                              THE SCHOOL DISTRICT OF PHILADELPHIA

                                            School Health Services

                                        POLICY AND PROCEDURE
       SUBJECT                       CLASSIFICATION             DATE ISSUED        NUMBER
      MEDICATION                        IBUPROFEN
  ADMINISTRATION FOR                 STANDING ORDERS           SEPTEMBER 2002            404
       RELIEF OF
    DYSMENORRHEA




STANDING ORDERS

         If indicated , Ibuprofen may be administered for dysmenorrhea as follows:

                    Student or staff over 125 pounds: 400 mg P.O. q 4 to 6 hours prn

                    Student or staff under 125 pounds: 200 mg P.O. q 4 to 6 hours prn




         Physician’s Signature on File in Student Health Services Office




       ISSUED BY                     SUPERSEDES             REVIEW BEFORE               PAGE
     SCHOOL HEALTH
        SERVICES                                                AS NEEDED               1 OF 1




September 1, 2002                                                                         Page   91
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SUBJECT: MEDICATION ADMINISTRATION                               NUMBER        506
CLASSIFICATION:

ADMINISTRATION OF LONG TERM MEDICATION -
SCHOOL BOARD POLICY    (DEC. 98)

On February 25, 1980, the Board of Education adopted the following resolution:
WHEREAS, Public Law 94-142 requires that handicapped children receive certain supportive
services in order to enable them to benefit from special education programs, and
WHEREAS, such children often require the administration of medication and/or medical equipment
in order to derive such benefits, therefore, be it
RESOLVED, That the administration of such medication and/or medical equipment take place in
school and be performed by School District personnel when such has been shown to be necessary
and cannot be limited to those hours when the youngster is not in school and be it
FURTHER RESOLVED, That this policy shall apply only to medication, equipment or machinery
necessary to maintain the pupil in the classroom; equipment requested for acute conditions or
recovery purposes will not be approved, and be it
FURTHER RESOLVED, That this policy will be implemented by the procedures appended hereto
and will be applicable to all parent-initiated requests to have medication and/or medical equipment
administered in school to their child, and be it
FURTHER RESOLVED, That, when it has been medically determined to be necessary, and in
accordance with laws governing the placement of children with handicapping conditions, every
effort will be made to place a child requiring medication and/or medical equipment in a school
where there is already a person trained in the administration of such medication and/or medical
equipment.




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SUBJECT: MEDICATION ADMINISTRATION:                                NUMBER       210
CLASSIFICATION:

USE OF MEDICATION/MEDICAL EQUIPMENT
SCHOOL BOARD POLICY    (DEC. 98)

1. Purpose

         1. The Board of Education recognizes that a number of students have medically certified
         conditions requiring medication, equipment, or machinery to be administered during school
         hours in order to maintain health and to function in the school setting.

2. Definition

         1. This policy shall apply only to medical measures necessary to maintain a student in
         school and which can be administered by school staff. Medication, equipment, and
         machinery requested for acute conditions or for recovery purposes shall not be approved .

3. Delegation of Responsibility

         1. The Superintendent shall have authorization to determine procedures for staff
         development in the use of medication and equipment, assign responsibility for delivery of
         services, and school placement of students with such medical needs .

4. Criteria

         1. Medication shall be administered by the school nurse. In the nurse's absence, medication
         shall be administered by the principal or his/her designee.

         2. All prescriptions and/or medical procedures must be approved by the Division of School
         Health Services.

         3. The Division of School Health Services shall provide instruction to school staff for use
         of equipment and administration of medication.

         4. Regulations for the use of medication/medical equipment shall be made available in the
         manuals of the Division of School Health Services and of the Office of School Operations.
         Such regulations shall include:

         1. Administration of medication in school
         2. Use of medical equipment and/or machinery in school
         3. Processing of parental requests for in school administration of medication or equipment
         4. Receipt and storage of medication and/or equipment
         5. Maintaining records of use of medication and equipment.

References:

PL 94-142




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SUBJECT: ADMINISTRATION OF MEDICATION,                             NUMBER        506.1
               UTILIZATION OF MEDICAL
               TECHNOLOGY
CLASSIFICATION:

PRESCRIBED MEDICATION                 (SEP. 02)

I. PURPOSE

        Ideally, the administration of medication or utilization of equipment should take place at home.
However, students with health problems may require medication (administered at prescribed intervals) or
suction, oxygen, or other types of equipment in order to permit them to function at as close to a normal
level as possible in the classroom. Consequently, a need exists to provide these services to students who
require them to make it possible for them to remain in school.

       This procedure applies only to medication, equipment, or machinery necessary to maintain the
student in the classroom, as prescribed by the family health care provider. THE SCHOOL DISTRICT
OF PHILADELPHIA DOES NOT DIAGNOSE STUDENT CONDITIONS OR
PRESCRIBE MEDICATION/TREATMENT.

     NO MEDICATION/TREATMENT WILL BE ADMINISTERED IN SCHOOL
WITHOUT A COMPLETED AND APPROVED MED-1 (REQUEST FOR
ADMINISTRATION OF MEDICATION OR USE OF SUCTION, OXYGEN OR OTHER
EQUIPMENT IN SCHOOL. [SEE NOTE IN II, A, 3 REGARDING PROVISIONAL
ADMINISTRATION OF MEDICATION.]

         Medication is to be administered by the Certified School Nurse (Certified School Nurse). In the
         absence of the Certified School Nurse, it may be administered by the principal or his/her designee.

         Certified School Nurses will provide instruction for administration of medication or use of
         equipment to all school staff.

         ALL APPROVED REQUESTS WILL EXPIRE ON AUGUST 31 OF EACH YEAR OR
         WHENEVER A CHANGE IN DOSAGE OR TYPE OF EQUIPMENT IS REQUESTED.

         THIS PROCEDURE MUST BE CARRIED OUT IN ITS ENTIRETY EVERY YEAR.

         A WRITTEN ORDER, BY A PHYSICIAN, ON A PRESCRIPTION OR LETTERHEAD IS
         ACCEPTABLE FOR A CHANGE OF DOSE OR EQUIPMENT.

II. CRITERIA

         A. The following criteria have been established as a basis for consideration of requests for
         administration of medication in School:

                    1.   The medication cannot be given at home.

                    2.   The purpose of the medication is to enable the student to function in the classroom.




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                    3.   All medication must be prescribed by a qualified health care provider on Form
                         MED-1.
                         No medication or treatment will be administered without form MED-1.
                         [Medication which is packaged and labeled by a registered pharmacist
                         may be approved and administered by the school nurse for a period
                         not to exceed 14 calendar or 10 school days. This will allow the parent
                         time to get the MED-1 form completed and signed. The school nurse must confirm
                         the order by calling the prescribing physician. A written order by a physician on a
                         prescription pad or letterhead is acceptable for changes in dosages or changes in
                         equipment.]


                    4.   OTC medications require written confirmation by a qualified health care provider ( a
                         prescription blank or letterhead is acceptable. Faxed documentation is also
                         acceptable.)

                    5.   Written parental approval is required.

                    6.   The prescription (MED-1) must be approved by the Certified School Nurse, or
                         School Physician, or School Health Services Coordinator.

                    7.   The parent will supply the medication, properly labeled and packaged as described
                         in II, A,7 below.

                    8.   Medication will be retained by the school only if it has been packaged and labeled
                         by a Registered Pharmacist according to accepted pharmaceutical standards. The
                         medication label must include:
                         • Patient Name
                         • Pharmacy Name
                         • Pharmacy Address and Phone
                         • Prescription Number
                         • Prescription Date (must be current)
                         • Name of Medication, Dosage, Form, and Expiration Date (if relevant)
                         • Instructions for Administration
                         • Name of prescribing health care provider

                         •   Medication must be packaged with a Safe-T Closure Cap

                    9.   OTC medications must be in the original manufacturer’s container with directions
                         for use intact on the label or box.

         B. The following criteria have been established as a basis for consideration of requests for use of
         equipment / machinery in school:

                    1.   Similar equipment is kept by the student’s family at home.

                    2.   The purpose of the equipment is to enable the student to function in the classroom.

                    3.   The equipment/machinery must be prescribed by a qualified healthcare provider on
                         Form MED-1.

                    4.   Written parental approval is required.

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                    5.     The prescription (MED-1) must be approved by the Certified School Nurse, or
                           School Physician, or School Health Services Coordinator.

                    6.     The parent will supply and service the necessary equipment / machinery.

                    7.     Operating instructions must accompany equipment.

III. PERSONNEL RESPONSIBLE FOR ADMINISTRATION OF MEDICATION

         A. The PRINCIPAL shall:

                    1.     Consult with the Certified School Nurse (Certified School Nurse) to select a person
                           to administer/monitor medication when the Certified School Nurse is not in the
                           building.

                    2.     Notify the person designated/selected in writing, or in accordance with school
                           policy for designation of assignments.

                    3.     Make provision for the Certified School Nurse to instruct the principal and designee
                           in the proper administration, supervision and monitoring of students and their
                           medications.

                    4.     Notify the parent that if the Certified School Nurse is not available, AND THE
                           PARENT CANNOT COME TO THE SCHOOL, the principal or the principal’s
                           designee, having been trained by the Certified School Nurse, will administer the
                           medication.

                    5.     Designate an area for administration of medication which will afford the student
                           privacy, and insure safe storage of medication.


IV. REQUEST: ROLES AND RESPONSIBILITIES
[A parent who requests that administration of medication, suction, oxygen, or other types of equipment be
provided in school shall be referred to the certified school nurse, principal or his / her designee.]

         A. The certified school nurse, principal or his/her designee will:

                    1. Explain the criteria and process to the parent.

                    2. Issue “Request for Administration of Medication or use of Suction, Oxygen, or other
                        Equipment in School” (MED 1) to the parent. Review the letters to the parent and
                        physician which are on the reverse side of the MED-1.

                    3. Advise the parent to have the MED-1 completed by the family health care provider and
                       returned to the school nurse. Explain that the medication or treatment can ONLY be
                       given provisionally for ten (10) school days without the MED-1. The MED-1 will then
                       be reviewed and approved by the Certified School Nurse, or School Physician, or
                       School Health Services Coordinator.

                    4. Obtain written parental consent on the MED-1. If the medication is being administered
                       provisionally, the parent must submit a written request, along with the properly
                       packaged and labeled medication prior to administration.

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         B. The certified school nurse will:

                    1. Review the completed MED-1. All requests shall include:
                           a.      the full name and date of birth of the student
                           b.      the date prescribed
                           c.      diagnosis
                           d.      medication dosage, route of administration, time schedule, and starting and
                                   ending date.
                           e.      possible side effects or contraindications,
                           f.      special instructions for school staff regarding activities to be curtailed.
                           g.       a listing of any other medication (prescribed or OTC) being taken by the
                                   student.
                           h.      the signature and phone number of the prescribing qualified health care
                                   provider
                           i.      the written request and consent of the parent/guardian, including consent to
                                   contact the primary care provider.

                    2. Call the prescribing provider for clarification, when necessary.

                    3. Document any corrections or additions on MED-1, date and sign full signature.

                    4. Complete the appropriate approval process as described.

                    5. Submit a copy of the completed MED-1 to the School Health Services Coordinator
                       for medications which are not in the computer.

V. RECEIVING THE MEDICATION IN SCHOOL
         A. The school nurse, principal or his/her a competent designee, will receive the medication,
            equipment or machinery from the parent in accordance with safe standards which include proper
            labeling and packaging by the pharmacy.
         B. Documentation of receipt of the medication/equipment is required.
            Include the date, name of child, name of medication, amount of medication, and signatures of
            the persons who delivered and who received the medication on Form MED-4.

VI. STORAGE OF MEDICATION IN SCHOOL

         A. Storage of medication must be in a secure area which meets the following criteria:

                    1. Medication and supplies (such as syringes) must be stored in a LOCKED CABINET
                       (preferably in the health office) which is convenient to the person responsible for
                       administering the medication.

                    2. Medication requiring refrigeration will be stored in the refrigerator in the School Health
                       Room.

                    3. Only emergency medication which must be administered quickly to prevent serious harm
                       to the student should be stored in a teacher’s desk or in the principal’s office. Examples
                       are bee sting kits, asthma inhalers, and/or glucagon.

                    IT IS ALSO PERMISSIBLE FOR STUDENTS WHO REQUIRE THESE
                    EMERGENCY MEDICATIONS, AND WHO ARE CAPABLE OF SELF-

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                    ADMINISTERING IN ACCORDANCE WITH COMPETENCY BASED
                    CHECK LIST 'ASSESSMENT CRITERIA FOR STUDENT SELF
                    ADMINISTRATION OF MEDICATION', TO CARRY THE MEDICATION
                    WITH THEM.

VII. ROLE OF THE CERTIFIED SCHOOL NURSE

         [The Certified School Nurse shall be the primary person responsible for administration of
         medication/treatment.] The Certified School Nurse shall:

         A. Where the Electronic Health Information System (HIS) IS available.
               1.      Enter information for each medication or treatment on the 'Student Med1 Screen'.
                       Use August 31 as the end date.
               2.      Each day, 'Build Daily Med1 Log'.
               3.      Use 'Daily Med1 Log' each day to record that medication was administered.

         B. Where the Electronic Health Information System is not available
               1.      Record on the (MEH-3)Student Health Record:
                       a. Name of Physician
                       b. Diagnosis
                       c. Medication and Dose
                       d. Date
                       e. Type of Equipment
                       f. Date of Approval
                       g. Date Medication Administration/Equipment started
                       h. Documentation of any and all relevant activities/encounters.

         Note: Daily entries on the MEH-3 for medication administration/equipment
         use are not required.

                    2.     Enter on the Medication/Equipment Log (MED 3).

                    3.     Prepare a Student’s Record of Medication Administered or Equipment Used (MED-
                           2) for each student who receives medication/equipment.
                           a.      Complete demographic data.
                           b.      Insert the name of the medication/equipment, the dosage, the administration
                                   route, and special instructions in the first column.
                           c.      Insert the time of administration.

         C. Develop a written individual health plan (IHP) for the student which includes staff development
            for all persons who need to know.

         D.         Assess the ability of the student to self-administer the medication/equipment and document
                    the competencies demonstrated and the dates.




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         E. Orient / instruct the person authorized by the principal to monitor / administer
            medication/treatment (or observe / monitor self-administration) and document the competencies
            demonstrated and the dates. (See VIII below)

         F. Assess the status of the student’s health, and continuing need for medication/treatment in
            accordance with the IHP.

         G. Confer periodically with the student/parents/guardians/teacher regarding the student’s response
            to the medications/treatments and health care needs.

         H. Provide written reports to the prescribing health care provider as indicated.
            (These reports can be given to the parent or sent, with parental consent, directly to the
            provider).

         I. When medication/equipment is discontinued or changed, indicate on MED-2 and MED-3 as well
            as on the Student Health Record.
                                                           OR
         Using the Electronic Health Information System go to "Student Med1 Screen". Enter the Line # of
         the medication to move the cursor to that line. Hit enter until the cursor is in the 'End Date' Field.
         In the 'End Date' Field type the last date given. Hit enter until the cursor returns to the bottom
         prompt.

         Enter 'A' for Add. The cursor will move to the next available line. Enter the new medication.

         J. Inform principal’s designee for medication/treatment administration of any of the above
            changes and document.

         K. Retain the MED-1, MED-4, and copies of any correspondence in the School Health Room at
            the end of the school year.

         L. Retain the MED-3 and MED-2 in the School Health Room where the electronic system is not
            available..

VIII. ORIENTATION TO ADMINISTRATION OF MEDICATION

         A. All staff who are designated by the principal to administer or monitor self administration of
            medication/treatment to students shall be oriented/instructed by the Certified School Nurse as to
            the plan of care for the individual student.

         B. Staff must demonstrate competency to the Certified School Nurse prior to administration of
             medication/equipment or supervision of self-administration.

         C. Competency shall be defined by the Certified School Nurse and shall include as a minimum the
         ability to:

                    1.       Understand that information about a student’s medical condition/ medication is
                         confidential.

                    2. Read and demonstrate understanding of the medication label.

                    3.       Follow the directions on the MED-2 (Student’s Record of Medication Administered
                         or Equipment used) or print out of medication to be given.


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                                                                  OR

                    Use the Electronic Health Information System Daily Med1 Log" if available.

                    4.   State the times medication/treatment is to be taken.

                    5.   Remind the student when to take the medication/treatment.

                    6.   Wash hands properly.

                    7.   Locate the necessary equipment and medication.

                    8.   Procure water for taking oral medication.

                    9. Open the container/bottle, if necessary.

                    10. Co-sign the medication sheet with the student.

                    11. Recognize any changes in a student’s appearance and/or behavior which need to be
                        communicated to the Certified School Nurse. Inform the Certified School Nurse
                        BEFORE allowing the student to take the medication. Do not give.

                    12. Consult the Certified School Nurse if any change occurs in the regular schedule,
                        route, and or dosage of administration. Do not give the medication unless instructed
                        by the Certified School Nurse.

                    13. Receive prior approval from the Certified School Nurse for all medication which is to
                        be taken on an “as needed” (PRN) basis, except bee sting kits, asthma inhalers, or
                        glucagon.

                    14. Recite the five rights: student, dose, time, route, medication.

         D.         In the event the Certified School Nurse determines that the designated
                    individual is incapable of any of the above competencies, the principal shall
                    be notified and shall select another designee.
         E.         Medication may NOT be pre-poured.


IX. ASSESSMENT CRITERIA FOR STUDENT SELF-ADMINISTRATION OF MEDICATION

In specific cases, individual students will be allowed to be directly responsible for the maintenance and
administration of their medication with minimal supervision. This will occur after a nursing assessment,
approval of the parents and family health care provider and instruction of the student about the expectations
related to this responsibility.

         A. To self-medicate/treat, the student must demonstrate the ability to:

                    1.     Respond to his/her name.
                    2.     Recognize visually his/her name.
                    3.     Identify his/her medication.


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                    4.    Wash hands properly.
                    5.    Measure, pour and administer the prescribed dosage of the medication.
                    6.    Sign the medication sheet as acknowledgment of having taken the
                          medication/treatment.
                    7.    Demonstrate a cooperative attitude in all aspects of self-administration of
                          medication/treatment.
                    8.    Notify adult when medication is gone.

         B. To carry medication, the student must, in addition to the above, demonstrate the ability to:

                    1.    State the importance of maintaining safe storage of the medication in school,
                          including carrying medications.

                    2.    State the importance of not allowing other students to use the medication/
                          equipment.

                    3.    State name, dosage, and frequency of medication/treatment.

                    4.    State the purpose of medication/treatment.

                    5.    State reason/symptom for using PRN medications/treatments.

                    6.    State the dangers of exceeding the prescribed dose.

                    7.    Identify his/her medication/equipment.

                    8.    Perform the procedure

                    9.    Notify the school nurse or designated staff that a dose of medication has been
                          taken.

                    10.   Sign the medication sheet as acknowledgment of having taken the medication.
                                                               OR

                                   Using "Daily Med 1 Log" enter Self Administered.

                    11.   State results that should occur after taking PRN medication.

                    12.   State appropriate action to take if symptoms not improved e.g., advise school
                          personnel, contact parent, notify physician.

X. UNUSED OR EXPIRED MEDICATION

         A.     Unused or expired medication must be returned to the parents for disposition.
         The school nurse should:
                    1.    Ask the parent to pick up the medication in person, or send written authorization
                          with a responsible adult in place of the parent.


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                    2.   Record the date, time, amount, and type of medication being sent home on the
                         health record (Use 'Health Inquiry and Maintenance Screen H7).
                    3.   Obtain the signature of the person receiving the medication and, if it is not the
                         parent, a copy of the written parent authorization. Retain with the MED4.
                    4.   If the parent or authorized responsible adult does not pick up medication within 10
                         days of notification, the Certified School Nurse shall destroy / discard unused or
                         expired portions. THERE MUST BE A WITNESS IF THE MEDICATION IS A
                         CONTROLLED, SUBSTANCE, E.G., RITALIN.
                    5.   Record all of the above on the Health Information System, Health Inquiry and
                         Maintenance , Screen H7 (or the MED-2 where the HIS is not available)). Where
                         there was a witness, the witness should also sign the MED-2 or be named in H7.

XI. APPROVAL OF MEDICATION REQUEST (MED1)
Administration of medications / equipment prescribed by a qualified health care provider which fall within
the parameters specified in the PDR (Physicians Desk Reference) can be approved by the Certified School
Nurse.
                                  No other signature is required.

         A. When the Medication is initiated by the Certified School Nurse, the Certified School Nurse will
         indicate the date administration commenced, sign the appropriate section on the MED-1, and:
                 a.      Retain the original.
                 b.      Forward a copy to the parent.
                 c.      Forward a copy to the School Health Services Coordinator for medications
                         which are not on the computer.
         B. If the prescription is not within the stated parameters, the Certified School Nurse shall contact
            the family health care provider.
                 1.      If the family health care provider changes the dose, time, or method of
                         administration, the Certified School Nurse shall write the changes on the MED-1;
                         date and sign as a verbal order.
                    2.   If the family health care provider does not change instructions which fall outside
                         parameters, the Certified School Nurse will document on the student health record
                         (Screen H7) that the physician was notified that the medication or dosage falls
                         outside the parameters. The documentation should include precisely what the
                         provider was told, and precisely what the provider responded. Use direct quotes.
                    3.   Send a letter of confirmation to the prescribing provider detailing the conversations
                         and any changes or agreements. Send a copy of the letter to the parent.
                    4.   Complete the approval process as described in A above , and initiate administration
                         of medication/equipment.
                    5.   Submit a copy of the completed MED-1 with a copy of the confirmation letter
                         attached, to School Health Services, JFK Center.

XII. THIS PROCEDURE MUST BE CARRIED OUT IN ITS ENTIRETY EVERY YEAR.

XIII. MEDICATION ERRORS
       In the event that a medication/treatment error has occurred, the certified school nurse or the
       principal or his/her designee will notify the School Health Services office at 215-875-3490, as
       soon as possible.

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                                SAMPLE

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             MED –2 (SAMPLE MAY NOT BE MOST CURRENT VERSION)


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                    SAMPLE MAY NOT BE MOST CURRENT VERSION)




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             MED – 4 (SAMPLE MAY NOT BE MOST CURRENT VERSION)




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    NON-COMPUTERIZED
      H E A L T H ROOM
 THIS SECTION OF THE SCHOOL NURSE PROCEDURE MANUAL (PAGES 107 - 123) IS
AVAILABLE AS A SEPARATE FILE AND WILL BE SENT AS A SEPARATE ATTACHMENT
FROM THE REMAINDER OF THE PROCEDURE MANUAL. PLEASE CONTACT SCHOOL
        HEALTH SERVICES AT 215-875-3490, OR 3749 FOR ANY QUESTIONS.




                                                               PAGE 107
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                     RESOURCES




September 1, 2002                                      Page   124
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                       Listing of Multiple Resources
AMERICAN DIABETES ASSOCIATION         AMERICAN HEART ASSOCIATION
Diabetes Information Service Center   S.E. Pennsylvania Affiliate
1660 Duke Street                      408 E. 4th Street
Alexandria, Va. 22314                 Bridgeport, Pa. 19405-1823
1-800-232-3472

AMERICAN LUNG ASSOCIATION             ASTHMA AND ALLERGY FOUNDATION OF
Philadelphia & Montgomery County      AMERICA
1100 E. Hector Street                 1125 15th St., N.W., Suite 502
Conshohocken, Pa. 19428               Washington, D.C. 20005
1-215-825-3443 or 735-2200            1-202-466-7643

CARING FOUNDATION FOR CHILDREN        DIABETES NURSE SPECIALIST
P.O. Box 13449                        Dept. of Public Health/
Philadelphia, Pa. 19101-9552          District Health Center #2
1-800-464- KIDS                       1720 S. Broad Street
                                      Philadelphia, Pa. 19145
                                      1-215-685-1840

EPILEPSY FOUNDATION OF AMERICA        GETTING HEALTH CARE FOR CHILDREN AND
4351 Garden City Drive                TEENS
Landover, Md. 20785                   A Manual for School Counselors and Nurses
1-800-EFA-4050 Library Service for    Philadelphia Citizens for Children and
Professionals                         Youth
1-800-EFA-1000 General Information    Patricia Redman or Barbara Sanchez
                                      Sept. 1996
                                      1-215-563-5848
HUMAN GROWTH FOUNDATION               NATIONAL HEMOPHILIA FOUNDATION
7777 Leeburg Pike                     110 Greene Street, Suite 303
Box 3090                              New York, NY 10012
Falls Church, Va. 22043               1-800-42-HANDI
1-800-451-6434

PHILADELPHIA CITIZENS FOR CHILDREN    PROGRAM TO IMPROVE EDUCATIONAL
AND YOUTH                             OUTCOME IN STUDENTS WITH SICKLE CELL
7 Benjamin Franklin Parkway           DISEASE
Philadelphia, Pa. 19103               COMPREHENSIVE SICKLE CELL CENTER
1-215-563-5848                        The Children’s Hospital of Philadelphia
                                      1-215-590-2232

SHRINERS HOSPITAL                     The PHILIP JAISOHN MEMORIAL CENTER
3551 N. Broad Street                  4818 N. Broad Street
Philadelphia, Pa. 19140               Philadelphia, PA 19140
1-215-430-4000                        224 -2000
1-800-281-4050                        Medical, Health Care, and Social Services
                                      Available



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SUBJECT: RESOURCES                                                       NUMBER       701.0
CLASSIFICATION:

PUBLIC SCHOOL HEALTH FUND: DEFINITION/
PURPOSE AND ELIGIBILITY STANDARDS    (SEP. 02)


A.       Definition/Purpose

The Philadelphia Public School Health Fund is a private foundation which assists with the payment of
costs for correction of some pupil health problems. Initially, the nurse should ensure that the parent has
exhausted the regular source of health care as well as other funding possibilities prior to seeking assistance
from the Public School Health Fund. PCCY Child Health Watch and City Health Centers are important
resources for the uninsured or those with insurance limitations.

         NOTE:             Public School Health Fund approval is only for payment for the initial evaluation.


B.       Eligibility Standards

         1.         The pupil must be enrolled in a Philadelphia Public School.

         2.         Except for routine vision, a report from the treating physician is required. The
                    report should include the diagnosis, services for which aid is requested, and
                    the cost of the service.

         3.         There must be no other available means of obtaining service.

         4.         The family must be approved for financial assistance by the Philadelphia Public
                    School Health Fund prior to provision of any service. Reimbursement will NOT
                    be made for services which have already been provided, or where the child is
                    already under treatment. Proof of income is required. (See Form M-106 Request
                    for Dental-Medical Vision).

         5.         In some instances (orthodontia, orthopedics, etc.) the family may be expected
                    to make partial payments to the care provider.

C.       Services Available

         1.         Routine Vision
         2.         Dental
         3.         Orthodontia
         4.         Other health needs which are standard medical practice, e.g., wigs, prosthesis,
                    helmets, orthopedic appliances, etc., when there is no other available means of
                    obtaining service

D.       For ALL requests to the Fund the School Nurse/School Nurse Practitioner shall:

         1.         Provide form M106 (Request for Medical or Dental Services) to the family.

         2.         Advise the parent to complete M106 in entirety and attach appropriate
                    proof of income.

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         3.         Review the M106 for completeness, accuracy and proof of income. Attach physician’s
                    reports and cost estimates where required. Make certain that proof
                    of income is attached.

         4.         Sign the completed M106.

         5.         Send the M106 and attachments to Public School Health Fund, Room 500,
                    JFK Center.

         6.         Await notification from Public School Health Fund re: eligibility and appointment
                    procedure.

         7.         Monitor to see that appointment is kept.

         8.         Record physician’s/dentist’s findings on Pupil Health Record or Dental Record.

E.       For vision services requested to be paid by the Public School Health Fund (Routine
         examination and eyeglasses, if needed) the Certified School Nurse shall:

         1.         Complete M106 prior to submission by writing in:
                    a.    Visual acuity without and with correction
                    b.    Parent’s choice of one of three approved resources:
                          1)      The Eye Institute - Pa. College of Optometry - 1200 W. Spencer
                                  Street
                          2)      Scheie Eye Institute - Presbyterian University of Pa.
                                  51 N. 39th Street
                          3)      Wills Eye Hospital - 9th and Walnut Streets


         2.         If the application is approved, the School Nurse will receive the appointment card from the
                    Physical Health Office:

                    a.     remind parent of the appointment date, time and place.

                    b.     issue M144, Vision Screening Referral to the parent to be completed by the
                           provider.

                    c.     instruct parent to sign permission on the appointment card and to take the card to the
                           provider.


F.       For other problems the School Nurse/School Nurse Practitioner shall complete M106
         as stated and advise the parent:

         1.         to submit a physician’s report, including diagnosis, and a description of services
                    for which aid is being requested, including the estimated cost and vendor names.

         2.         to submit proof of income.

         3.         they may be expected to make partial payments to the care provider.



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SUBJECT: RESOURCES                                                    NUMBER       701.2
CLASSIFICATION:

PUBLIC SCHOOL HEALTH FUND: DENTAL SERVICES
(SEP. 01)

G.       Routine Dental Services:

         1.         Pupils who have no source of routine dental care should be referred to the City of
                    Philadelphia Department of Public Health Dental Clinics.

         2.         Routine dental services include: examination, x-rays, fillings, crowns, extractions,
                    prophylaxis and root canal therapy (endodontics).

                           The clinic locations are:

                           CLINIC LOCATION                                PHONE NO.

                           1720 S. Broad St., 19145                       215-685-1822
                           43rd & Chester Ave., 19104                     215-685-7506
                           44th & Haverford Ave., 19104                   215-685-7605
                           20th & Berks St., 19121                        215-685-2938
                           301 W. Girard Ave., 19123                      215-685-3816
                           131 E. Chelten Ave., 19144                     215-685-5738
                           2230 Cottman Ave., 19149                       215-685-0608

         3.         Signed parental permission is required at the initial visit. Appointments can be made by
                    calling the clinic. (A supply of consent forms can be obtained by calling the clinic.)

         4.         If a problem arises which the City Dental Clinic is not equipped to treat, the School Nurse/
                    School Nurse Practitioner should submit documentation and a completed M106 to:

                                   Public School Health Fund
                                   School Health Services
                                   John F. Kennedy Center
                                   Room 500
                                   734 Schuylkill Ave.
                                   Phila., PA 19146




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SUBJECT: RESOURCES                                                   NUMBER      701.3
CLASSIFICATION:

PUBLIC SCHOOL HEALTH FUND: ORTHODONTIA
(SEP. 02)

H.       Orthodontia:

         1.         The School Nurse/School Nurse Practitioner will:

                    a.     Provide form M106 to the family.

                    b.     Review the M106 for completeness and accuracy. Make certain that income
                           verification is attached. (Copy of latest income tax form 1040)

                    c.     Include the name of desired clinic from list below.

                                   -      Drs. Magill and Mankad
                                          Rittenhouse Plaza, Suite 206
                                          1901 Walnut Street
                                          Phone: 215-567-5949

                                   -      Einstein Northern Division
                                          York & Tabor Roads
                                          Phone: 215-456-6600

                                   -      University of Pa., School of Dental Medicine
                                          4001 Spruce Street
                                          Phone: 215-898-8982

                                   -      Temple University Dental School
                                          3223 N. Broad Street
                                          Phone: 215-707-2863

                    d.     Sign the completed M106.

                    e.     Send M106 for review to:

                                   Public School Health Fund
                                   School Health Services
                                   John F. Kennedy Center
                                   Room 500
                                   734 Schuylkill Ave.
                                   Phila., PA 19146

         2.         After processing and approval. the Fund then sends the form, REQUEST FOR
                    FINANCIAL ASSISTANCE FOR CORRECTION OF MALOCCLUSION, back to the
                    school nurse who then gives it to the parent. (This form is colored yellow)

         3.         The parent then makes an appointment and takes the form with the child to one of the
                    approved clinics for an evaluation.

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         4.         The evaluation/diagnosis is completed by the orthodontist and returned to the school nurse,
                    who sends it to the Public School Health Fund, care of School Health Services, JFK
                    Center, Room 500.

         5.         The Fund must then give a SECOND AND FINAL APPROVAL, after which, NOTICE
                    OF ELIGIBILITY LETTERS are sent to the:

                           parent
                           school nurse
                           pupil’s file
                           treating clinic

         6.         The Fund then prepares the FUNDING MEMORANDUM, copies of which are sent to the:

                           treating clinic
                           pupil’s file
                           parent
                           Executive Secretary’s file

         7.         Only after the treating clinic receives a copy of the FUNDING MEMORANDUM, may the
                    clinic start treatment and bill the Fund for the treatment rendered.




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                    STUDENTS WITH
                    SPECIAL NEEDS




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SUBJECT: STUDENTS WITH SPECIAL NEEDS                                NUMBER       800.0
CLASSIFICATION:

LEGAL BASIS / PURPOSE                (DEC. 98)

I.       Introduction

         The School District of Philadelphia has a legal responsibility to provide state mandated
                services to all children. Additional health services may be required for specific
                purposes to maintain children with special needs in the least restrictive educational
                environment and to enhance their educational program.

         These services are not intended to be clinical or therapeutic. In other words, daily therapy
                for the purpose of strengthening, stretching, etc. is not a related service provided by
                the School District. Related services are intended to allow the student access to
                his/her educational program and to make it possible for the student to benefit from
                his/her educational program. Examples of such services include teaching the student
                to use assistive devices that will make it possible for him/her to write, teaching the
                student how to climb and descend stairs safely, developing an adapted physical
                education program that will accommodate the student’s limitations, providing
                access to intermittent nurse service to assist the student with bladder catheterization
                during school hours, etc.

II.      Legal Basis

         The Individuals with Disabilities in Education Act, 20 U.S.C., Section 1400 ET SEQ),
                states that “the term ‘related service’ means transportation, and such developmental,
                corrective, and other supportive services (including ... physical and occupational
                therapy, recreation, and medical and counseling services, except that medical
                services shall be for diagnostic and evaluation purposes only) as may be required to
                assist a handicapped child to benefit from special education ...”

         Section 504 of the Rehabilitation Act of 1973, provides that “no otherwise qualified
                handicapped individual ... shall, solely by reason of ... (the) handicap, be excluded
                from participation in, be denied the benefits of, or be subjected to discrimination
                under any program or activity receiving federal financial assistance.” This section
                applies to the School District, which is, accordingly, obliged to provide “non-
                academic and extra-curricular services and activities in such manner as is necessary
                to afford handicapped students an equal opportunity for participation in such
                services and activities.” The “non-academic ... services ... may include counseling
                services, physical recreational athletics, transportation, health services ... “




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         PA Law (22 PA Code Chapter 14) provides regulations for implementing the federal law
               which assures the necessary accommodations that will permit a student who has a
               disability to benefit from his/her educational program or specially designed
               instructional program. These students are generally considered Special Education
               students, and all academic and non-academic services are included in the student’s
               Individual Education Plan (IEP).

         PA Law (22 PA Code Chapter 15, Section 2) provides regulations for implementing the
               federal law which assures the necessary accommodations that will permit a student
               with a handicap to have access to his/her educational program. A student whose
               handicap significantly limits or prohibits participation in or access to his/her
               educational program, and who does not need a specially designed instructional
               program, may be considered a Protected Handicapped student. Accommodations
               for a Protected Handicapped student are written on a Service Agreement.

III.     Purpose
         A.   To identify those students with special health and safety needs which impact on
              their ability to learn.

         B.         To identify those students with special health and safety needs who require a
                    barrier-free environment.

         C.         To assist in meeting the requirements of P. L. 94-142 and Section 504 of the
                    Rehabilitation Act of 1973.

         D.         To utilize the professional skills of the Certified School Nurse in working with
                    other disciplines to provide an appropriate educational environment and necessary
                    accommodations for students with special needs.




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SUBJECT: STUDENTS WITH SPECIAL NEEDS                                NUMBER 207
CLASSIFICATION:

DO NOT RESUSCITATE ORDERS - SCHOOL BOARD
POLICY   (DEC. 98)

1. Purpose

         1. This policy is to inform and instruct school personnel and families. The Board of
            Education directs that:

2. Implementation

           1. "Do Not Resuscitate" orders offered by parents or legal guardians cannot and shall not
               be honored by any School District staff at anytime.

           2. All procedures for responding to accident and/or illness of students shall be consistent
              with this policy.

           3. Parents or legal guardians who offer "Do Not Resuscitate" orders shall be informed of
              this policy by building principals at the time such orders are presented.

References:

School Operations Policy Number 511.0 to 511.4




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SUBJECT: STUDENTS WITH SPECIAL NEEDS                                   NUMBER 801
CLASSIFICATION:

SERVICES OF SPECIAL EDUCATION CONSULTANT
(SEP. 01)



SERVICES OF SPECIAL EDUCATION
MEDICAL CONSULTANT

Examination by the Special Education Medical Consultant is a formal evaluation used for the
purpose of determining if a student needs Physical Therapy or Occupational Therapy (PT/OT)
services that will make it possible for him/her to access the educational program and/or benefit
from the educational program. The Special Education Medical Consultant, in consultation with the
Physical Therapist / Occupational Therapist and the Certified School Nurse, will develop a plan
that will meet the student’s needs.

I.       Initial Referrals

         A.         When the Student Support Team (SST), a private health care provider, or a parent
                    request evaluation for PT/OT services during school hours, such a request will be
                    brought to the attention of the Certified School Nurse.

         B.         The Certified School Nurse will request necessary medical information from the
                    student’s primary care provider and other health care providers as indicated. A
                    signed Request for Release of Information must be obtained from the
                    parent/guardian for each provider from whom records will be requested.

         C.         The Certified School Nurse will contact the Physical/Occupational Therapist
                    assigned to the school where the student is enrolled. If it is not known who the
                    Physical/Occupational Therapist is, the Certified School Nurse may call School
                    Health Services at 215-875-3490 to find out who is assigned to provide PT/OT
                    services to the school.

         D.         Upon being notified of the request, the Physical/Occupational Therapist will arrange
                    to do an initial screening of the student.

         E.         If the Physical/Occupational Therapist determines that the student may qualify for
                    PT/OT services during school hours, he/she will call the School Health Services
                    Coordinator to schedule an evaluation by the Special Education Medical Consultant.

         F.         The Physical/Occupational Therapist will arrange to obtain a Permission to
                    Evaluate form (T-700) to be signed by the parent/guardian.

         G.         The Physical/Occupational Therapist will notify the Certified School Nurse and the
                    parent of the date and time on which the medical evaluation is scheduled.

         H.         If it is determined that the student does not qualify for PT/OT services during
                    school hours, the Physical/Occupational Therapist will notify the parent.

         I.         If it is determined that the student qualifies for PT/OT services during school hours,

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                    the Physical/Occupational Therapist will develop the Individual Education Plan
                    (IEP).

II.      Role of the Certified School Nurse During the Evaluation

         A.         Prior to the day of the evaluation, the Certified School Nurse will:

                    1.     Gather pertinent medical information from health care providers.
                    2.     Screen the student for vision, hearing and growth.
                    3.     Arrange for the student to be released from class at the time of the
                           evaluation.

         B.         At the time of the evaluation, the Certified School Nurse will:

                    1.     Have available the student’s school health records and information provided
                           by health care providers.
                    2.     Assist the physician as needed.
                    3.     Consult with the Special Education Medical Consultant and the
                           Physical/Occupational Therapist as indicated.
                    4.     Sign form S866 (Medical Assessment of Special Education Children).
                    5.     Record the results of the evaluation in the student’s school health records.

         C.         After the evaluation, the Certified School Nurse will:

                    1.     Distribute copies of form S866 accordingly.
                    2.     Notify the parent/guardian (if not present) of referrals recommended by the
                           Special Education Medical Consultant.
                    3.     Assist the parent/guardian as necessary to follow up on referrals.

III.     Reevaluations

         A.         Students who need to be reexamined by the Special Education Medical Consultant
                    are scheduled in accordance with the following criteria:

                    1.     On the same year as the IEP review date.
                    2.     As determined by the Physical/Occupational Therapist or the Special
                           Education Medical Consultant,
                    3.     Upon request by the parent.

         B.         The Certified School Nurse will be notified that an evaluation has been scheduled
                    by the Physical/Occupational Therapist assigned to the school in which the student
                    is enrolled.




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I.   SUBJECT: STUDENTS WITH SPECIAL NEEDS                        NUMBER       807.0
CLASSIFICATION:

PROTECTED HANDICAPPED STUDENTS: HEARING
PREPARATION    (SEP. 01)

I.     Purpose
       A. To ensure compliance with the requirements of the law and the Protocol and Guidelines
          for the Delivery of Services to Protected Handicapped Students adopted by the Board
          of Education on August 18, 1992.
       B. To provide all staff with guidelines for managing the preparation for an impartial due
          process hearing.
       C. To assist staff in determining which materials should accompany the Due Process
          Hearing Request.

II.    Criteria
       An impartial due process hearing is indicated for a student when:
       A.     A parent/guardian requests a hearing to the School District for any reason.
       B.     The School District has not been able to obtain consent for an individual evaluation
              from the parent/guardian.
       C.     The parent/guardian and the School District disagree regarding the identification of a
              student as a Protected Handicap Student.
       D.     The parent/guardian and the School District disagree regarding the related aids,
              services and accommodations the student needs.
       E.     The parent/guardian and the School District disagree as to whether or not the School
              District is providing the related aids, services and accommodations specified in the
              student’s Service Agreement.
       F.     The parent/guardian and the School District disagree as to whether or not the School
              District has failed to comply with the procedures in the Protocol and Guidelines for
              the Delivery of Services to Protected Handicapped Students.

III.   Informal Pre-hearing Conference
       A.    When a parent/guardian of a student with special needs informs any School District
             employee that he/she is in disagreement with the School District regarding the
             identification or accommodation of the student as a Protected Handicapped Student,
             the principal shall be notified at once.
       B.    If the parent intends to request a due process hearing, the principal will obtain the
             request in writing.
       C.    Within ten days of the request, the principal will arrange for an informal pre-hearing
             conference in an attempt to resolve the disagreement. The pre-hearing conference is
             desirable but voluntary. Either side may decide to waive the pre-hearing conference
             and proceed directly to the due process hearing.
       D.    If an informal pre-hearing conference is held, the Certified School Nurse will be in
             attendance along with other staff as deemed necessary by the principal.
       E.    The principal will instruct the staff that every effort will be made to reach an
             amicable solution.
       F.    The principal, along with the Certified School Nurse, will prepare and provide all
             student records which support the appropriateness of the recommended program.
       G.    If an agreement is reached, the principal will ensure that the Service Agreement is
             implemented.
       H.    If an agreement is not reached, the principal will notify the AAO and the
             Compliance Officer that a due process hearing is indicated.


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      I.     The principal will ensure that the parent/guardian receives documentation of the pre-
             hearing conference.

IV.   Due Process Hearing
      A.   When a due process hearing is indicated regarding the identification or
           accommodation of a student as a Protected Handicapped Student, the Certified
           School Nurse will be designated the Case Manager.
      B.   The Certified School Nurse will collect all data, request necessary evaluations,
           request necessary reports from health care providers, complete necessary forms,
           document all activities leading up to the due process hearing, and submit the Due
           Process Materials Checklist along with necessary documentation to the principal.
      C.   The principal will notify the AAO that a due process hearing is indicated and will
           forward to the Compliance Officer the Due Process Materials Checklist along with
           all necessary documentation.
      D.   The Compliance Officer will review all pertinent documentation and request
           additional information if necessary.
      E.   The Compliance Officer will summarize the status of the case in a letter to the
           parent/guardian with copies to the principal and the AAO, and will send to the
           parent a copy of the Due Process “Letter to the Parent.”
      F.   The Compliance Officer will forward all pertinent materials to the Legal
           Department.
      G.   The Legal Department will notify the principal and the AAO which school staff
           members need to attend the due process hearing.




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SUBJECT: STUDENTS WITH SPECIAL NEEDS                              NUMBER       801.0
CLASSIFICATION:

REFERRAL TO STUDENT SUPPORT TEAM (SST)
(DEC. 98)

I.     Initial Referrals
       A student is initially referred to the SST by any staff member or by the student’s parent. A
                parent who wishes his/her child to be assessed by the SST should be assisted to put
                the request in writing and to submit it to the principal. A staff member making a
                referral should complete the appropriate referral form used by the school and should
                submit it to the chair or facilitator of the SST.
II.    The Certified School Nurse as a member of the SST will:
       A.       Review the reason for referral.
       B.       Review the student’s current health record (HIS or MEH-3).
       C.       Verify that a routine physical examination has been done within the past year. If
                absent or outdated, refer the student to his/her primary care provider.
       D.       Perform vision, hearing and growth screenings.
       E.       Interview the student.
       F.       Complete a Confidential Medical History (S864).
       G.       Complete a Student Health Status form (S865) if indicated.
       H.       Request documented verification and recommendations regarding the student’s
                health status and limitations, if any, from the student’s primary physician and other
                health care providers as indicated. The student must have been examined by the
                provider within the past year. A signed Release of Information Form must be
                obtained from the parent/guardian for each practitioner from whom health records
                will be requested.
       I.       Prepare an individual Health Plan for the student if indicated.
       J.       Record on the referral form significant health and medical data.
       K.       Record on the student’s health record any referrals for additional evaluations
                (Physical exam, eye exam, etc.)
       L.       Interpret medical and other health-related information for members of the SST.
       M.       Make recommendations to the SST regarding necessary reasonable
                accommodations.
       N.       Serve as Case Manager if indicated.
    O. If the student is identified as a Special Education Student, necessary health-related
       accommodations must be documented in the IEP.

III.   Reevaluations
       A. Students are referred to the SST for reevaluation at the Individual Education Plan (IEP)
          review date (every two years) or a sooner if needed.
       B. The Certified School Nurse, as a member of the SST, will follow the same procedure
          indicated above to update pertinent health and medical information, if indicated.




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SUBJECT: STUDENTS WITH SPECIAL NEEDS                              NUMBER        808.0
CLASSIFICATION:

PROTECTED HANDICAPPED STUDENTS                     (SEP. 02)

 I.    DEFINITION

A protected Handicapped Student is one who meets the following criteria under PA Law (22 PA
       Code Chapter 15, Section 2):

       A. Is of an age at which public education is offered by the School District.

       B.     Has a physical or mental disability which significantly limits or prohibits
              participation in or access to an aspect of the student’s school program.

       C.     Is not eligible for special education services or programs, or is eligible but is raising
              a claim of discrimination.

II.    PROCEDURE FOR IDENTIFYING A STUDENT AS A PROTECTED HANDICAPPED
       STUDENT AND PROVIDING NECESSARY REASONABLE ACCOMMODATIONS
       (See section III for examples of reasonable accommodations.)

       A.     A student may be considered for identification as a Protected Handicapped Student
              if he/she needs special accommodations in order to have access to or to be able to
              participate in his/her educational program. If a student’s needs are being adequately
              met, there is no need for identification as a Protected Handicapped Student. The
              parent/guardian or any member of the school staff, however, may initiate a request
              to have the student assessed for possible identification and accommodation as a
              Protected Handicapped Student.

       B.     Initial Referral:

              1.      A parent/guardian may initiate a request for special accommodations under
                      Chapter 15 by sending a request to the school principal either verbally or in
                      writing. If the initial request is verbal, the parent should be assisted in
                      preparing and submitting a written request. Upon receipt of the written
                      request, the Principal will notify the Certified School Nurse and the Chair of
                      the Student Support Team.

              2.      Any member of the school staff may initiate a written referral to the Student
                      Support Team indicating the student’s needs and circumstances which might
                      warrant identification and accommodations under Chapter 15. Upon receipt
                      of the written request, the Chair of the Student Support Team will notify the
                      Certified School Nurse.

       C.     The Certified School Nurse will:

              1.      Serve as a member of the Student Support Team.

              2.      Conduct a nursing assessment of the student’s health history and current
                      health status. School District Forms S864 and S865 should be completed.


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             3.      Perform vision, hearing and growth screenings.

             4.      Assess the extent of the student’s handicap which limits his/her access to or
                            participation in the educational program.

             5.      Request documented verification and recommendations regarding the
                     student’s health status and handicap from the student’s primary physician
                     and other health care providers as indicated. The student must have been
                     examined by the provider within the past year. A signed Release of
                     Information Form must be obtained from the parent/guardian for each
                     practitioner from whom health records will be requested.

             6.      Prepare an Individual Health Plan for the student.

             7.      Interpret medical and other health-related information for members of the
                     Student Support Team.

             8.      Make recommendations to the Student Support Team regarding necessary
                     reasonable accommodations.

             9.      Serve as Case Manager, if the student is identified as a Protected
                     Handicapped Student, to facilitate the planning and implementation of
                     necessary accommodations.

      D.     The Student Support Team will:

      1. Include the parent/guardian, principal or his/her designee, the Certified School Nurse
         and other members of the school staff who need to collaborate in the planning and
         implementation of necessary accommodations ( counselor, teachers, school
         psychologist, etc.)

      2. Evaluate the student’s needs based on available medical and other health-related data.

      3. Determine if the student meets the criteria to be classified as a Protected Handicapped
         Student.

      4. Request additional evaluations if indicated.

      5. Determine which accommodations, if any, the student needs.

      6. Determine if and how the necessary accommodations can be provided in the student’s
         current school assignment.

      7. If the student meets the criteria to be identified as a Protected Handicapped Student,
         prepare a Service Agreement based on what the student needs.

      8. Plan and implement necessary accommodations. It is expected that every effort will be
         made to accommodate the student in his/her current school assignment.



      9. Advise the principal if necessary accommodations cannot be provided in the current


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            school assignment.

       10. Advise the parent in writing regarding procedural safeguards and the right to due
           process.

       11. Carry out this procedure within twenty-five days of the initial request.

       E.      The parent/guardian will:

               1.     Be considered a member of the Student Support Team.

               2.     Provide medical and other health-related records as deemed necessary by the
                      Student Support Team.

       F.      The principal will:

               1.     Serve on the Student Support Team or appoint a designee.

               2.     Give final approval for recommendations made by the Student Support
                      Team before accommodations are implemented.

               3.     Consult the AAO regarding an appropriate school assignment for a
                      Protected Handicapped Student whose needs cannot be accommodated in
                      the current school assignment.

               4.     Send the Service Agreement to the receiving school if the student is
                      assigned to another school.

               5.     Forward copies of the completed Service Agreement to the Director of
                      School Health Services.

       G.      If the student is identified and accommodated as a Protected Handicapped Student,
               the Student Support Team will review and revise the Service Agreement at least on
               a yearly basis, preferably at the beginning of the academic year.

       H.      The parent/guardian will be given a copy of the completed and signed Service
               Agreement. A copy will also be maintained in the student’s confidential school
               health record.

III.   The following are examples of reasonable accommodations.

       A.      An extra set of books for a student who cannot carry books to and from school.

       B.      Access to school nurse services during school days for intermittent bladder
               catheterization.

       C.      Access to an elevator .

       D.      Roster to minimize need for stair climbing.

IV.    Accommodations are NOT considered reasonable if they :

       A.      Require the job description of a school district staff member to be significantly


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             altered.

      B.     Require a significant alteration in the educational program of the school as a whole.

      C.     Place an unreasonable burden on another student.

      D.     Prevent another student from having access to or participating in his/her educational
             program.




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SUBJECT: STUDENTS WITH SPECIAL NEEDS                             NUMBER       803.0
CLASSIFICATION:

SPECIAL CASE FILE           (SEP. 02)




I.     DEFINITION
       The Special Case File is a compilation of all students who have health problems which
             require supportive services in school.

II.    CRITERIA
       A.   All medical and special health problems included in the Special Case File shall be
            verified by a treating agency.
       B.   All students deemed appropriate by the School Nurse or School Nurse Practitioner
            may be included.
       C.   The following health problems should be included. However, this list should not
            be considered exclusive or exhaustive.
            1.      Allergies
            2.      Asthma
            3.      Blood dyscrasias
            4.      Cardiac problems
            5.      Diabetes
            6.      Seizure disorders
            7.      Orthopedic problems
            8.      Skin conditions
            9.      Renal diseases
            10.     Significant sensory impairments

III.   PROCEDURE
       At the beginning of the school year the Certified School Nurse will:
       A.      Identify students
               1.      Review the Special Case File from the previous school year
               2.      Review student health records (MEH 3 or HIS) on all new admissions to
                       the school.
               3.      Conference with students, parents, and staff to identify students with health
                       problems not previously known to the Certified School Nurse.
       B.      Gather current information
               1.      Send Student Health Status (S865) to parent/guardian of all students
                       identified for Special Case File.
               2.      Review completed Student Health Status for completeness and accuracy.
               3.      Conference with student and/or parent as needed.
       C.      Maintain file
               1.      Alphabetize completed Student Health Status forms by last name of student
                       and keep in binder.
               2.      Update student HIS if there are significant changes in diagnosis, treatment,
                       recommendations, health provider or emergency contacts.




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      D.     Maintain confidentiality
             1.     Review the file with the principal as needed.
             2.     Discuss with the principal whether and how information will be shared with
                    staff who have contact with the student.
             3.     Share information with appropriate staff on a need to know basis. Include
                    instructions for implementation of an emergency plan.
      E.     Forward information
             1.     In schools where there is not a computer, send Student Health Status to new
                    school to alert the receiving Certified School Nurse when a student
                    transfers.
             2.     In all schools, send a copy of the Student Health Status to shared time
                    nurses for students enrolled in shared time programs.

IV.   PROBLEM MANAGEMENT
      A student who has been diagnosed with a chronic health condition by a qualified health care
      provider will have an Individual Health Plan (IHP) developed in order to manage his/her
      condition during the school day.
      The Nursing Process will be used to develop a management plan, including emergency
      plan, which will be updated at the beginning of each school year.
      A.      Use the reverse side of the Student Health Status (S865) to develop an IHP by
              means of the Nursing Process.
              1.     Assessment
                     a)       Gather information, subjective as well as objective
                     b)       Analyze information
                     c)       Diagnose need(s)
              2.     Plan
                     a)       Identify the specific action to be taken
                     b)       Prioritize the problem(s) that need attention
              3.     Implementation
                     a)       Translate plan into action
                     b)       Describe an individualized approach that is systematic and sequential
              4.     Evaluation
                     a)       Anticipate goal(s) to be attained
                     b)       Describe how progress will be measured
      B.      When available a standardized IHP may be used in lieu of the reverse of the S865
              (Student Health Status). Each phase of the Nursing Process is identified in the IHP
              with specific categories that may or may not apply to a particular student.
              1.     Assessment
                     a)       The School Nurse or School Nurse Practitioner will assess the
                              student and determine which categories in the assessment section of
                              the IHP apply to the student. The nurse will initial each category
                              that applies to the student.
                     b)       On the back of the IHP form the School Nurse or School Nurse
                              Practitioner will document the findings of each assessment that
                              applies to the student.
                     c)       As part of the nursing assessment the School Nurse or School
                              Nurse Practitioner will communicate with the student, the parent, the
                              teacher, and the health care provider as appropriate. A signed
                              Consent for Release of Information must be on file before the nurse
                              may release any information to the health care provider. If the
                              student’s condition involves a behavior disorder, a completed
                              ACTeRS Rating Form will be secured.



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             2.     Nursing Diagnosis
                    a)     Identification of nursing diagnoses must follow directly from
                           problems identified in the assessment.
                    b)     The School Nurse or School Nurse Practitioner will initial each
                           nursing diagnosis that applies to the student.
             3.     Goals
                    a)     Each goal identified must correspond with an identified problem
                           and/or nursing diagnosis.
                    b)     The School Nurse or School Nurse Practitioner will initial each goal
                           that applies to the student.
             4.     Nursing Intervention
                    a)     Each nursing intervention selected must contribute toward the
                           meeting of an identified goal.
                    b)     The School Nurse or School Nurse Practitioner will initial each
                           nursing intervention that applies to the student.
             5.     Expected Outcomes
                    a)     Expected outcomes should be the direct result of selected
                           interventions.
                    b)     The School Nurse or School Nurse Practitioner will initial each
                           expected outcome that applies to the student.
             6.     Evaluation
                    a)     The School Nurse or School Nurse Practitioner will use
                           communications with the student, parent, teacher, and health care
                           provider to evaluate the student’s progress.
                    b)     If the student’s condition involves a behavior disorder, the ACTeRS
                           Rating Form will also be used to evaluate the student’s progress.
                    c)     Documentation will identify each expected outcome as having been
                           met, not met, or partially met. A description of the specific behavior
                           which demonstrates how the expected outcome was met, not met, or
                           partially met must be included.
                           EXAMPLE: Expected Outcome-Student will describe what to do
                                    if an asthma attack occurs.
                                    Partially met. Student accurately verbalizes that he is to take
                                    two puffs of his inhaler medication. Student does not
                                    consistently cease strenuous activity when he experiences
                                    wheezing.




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SUBJECT: STUDENTS WITH SPECIAL NEEDS                               NUMBER       801.8
CLASSIFICATION:

EXTENDED SCHOOL YEAR (ESY) (SEP. 02)

                               EXTENDED SCHOOL YEAR (ESY)

I.     Some students will be assigned to the Extended School Year Program offered during the
       summer.
II.    In order to provide continuity of care for these students, The School Nurse is requested to
       complete the following tasks:
               •       Obtain the list of students from your principal.
               •       Use the Health Information System to review the Health Record of each
                       student.
               •       Update all screens, including H1 or H9, to reflect current health information
                       for each student.
               •       Assure that a current MED-1 with an end date of Aug. 31 is documented on
                       the Health Information System for all students who will receive medication
                       or special treatment.
               •       Make a hard copy (both sides of the form) of the existing Student Health
                       Status Update (S865) for each student. This is to be done regardless of
                       documentation on the HIS. Place in each student's ESY folder.
III.   Prepare a care summary (using information from the MED 1, the S865 (both sides) and
       anecdotal information) on Nurses Notes (Screen H7) for each student.
               NOTE: When creating a care summary for ESY students, sending nurses should
                       consider what information would help them to care for a particular student if
                       they were seeing that student for the first time. For example:
                       •       Are there conditions which require clinical monitoring?
                       •       Is there a “best” position for carrying out a procedure?
                       •       Can the student assist with any aspect of a procedure?
                       •       Is there something to “watch out” for, e.g., have you noticed that
                               certain activities cause respiratory or cardiac distress for a student?.
IV.    All hard copy materials will be returned to the sending school at the close of the ESY
       program.




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SUBJECT: STUDENTS WITH SPECIAL NEEDS                           NUMBER       203.0
CLASSIFICATION:

PREGNANT STUDENTS             (SEP. 02)

I.     PURPOSE
       A.  Early identification of pregnant students.
       B.  To ensure prompt access to prenatal care.
       C.  To promote positive pregnancy outcomes.
       D.  To encourage continuation of education.

II.    MANAGEMENT
       The School Nurse/School Nurse Practitioner will:
       A.    Interview student and assess immediate physical/emotional needs.
       B.    Encourage student to involve parents if they are unaware of
             pregnancy.
       C.    Provide emotional support and involve school counselor and/or ELECT teen
             parenting personnel.
       D.    Refer student for pregnancy test and appropriate medical care.
       E.    Take a baseline blood pressure and weight, and record in nurses notes (Health
             Inquiry and Maintenance, Screen H7, code PREG).
       F.    Meet with student regularly to evaluate progress and to ascertain whether student is
             keeping prenatal appointments.
       G.    Discuss health problems, future child care and educational plans with student.
       H.    Inform student and family that ONLY documented medically/obstetrically
             complicated pregnancies will be considered for Homebound Instruction (see
             Procedure 806.1, Homebound Instructional Programs).
       I.    After student delivers, discuss importance of keeping well-baby and post-partum
             appointments. Answer any questions she may have concerning parenting and child
             development.

III.   DOCUMENTATION
       A.  Case management of pregnant students by the School Nurse/School Nurse
           Practitioner must be documented on the HIS in Health Inquiry and Maintenance,
           Screen H7, code PREG.




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SUBJECT: STUDENTS WITH SPECIAL NEEDS                            NUMBER 805
CLASSIFICATION:

TRANSPORTATION REQUESTS FOR MEDICAL
REASONS   (SEP. 02)

I.    Goal
      Requests for transportation for students with severe medical needs will be processed in an
            efficient, professional, and timely manner with schools having maximum discretion
            in determining how to best serve their students.

II.   Roles and Responsibilities
      A.    The certified school nurse is the designated case manager for students with severe
            medical needs who request transportation
      B.    For students in nonpublic schools which do not have assigned School District of
            Philadelphia Nurse Service, the certified school nurse at the neighborhood school
            that the student is eligible to attend will act as the case manager. All inquiries from
            students, parents and nonpublic school personnel should be directed to the school
            nurse at the neighborhood school.
      C.    When a request for transportation for students with severe medical needs is
            submitted to the school, the school nurse will:
            1.      contact the parent to obtain information regarding the student’s condition
                    and source of care.
            2.      provide “Request for Transportation for Medical Reasons” to the parent or
                    request written information from the student’s physician which explains
                    why the student will need transportation. This should include the diagnosis,
                    duration, and reason the student is unable to get to school without
                    transportation.
            3.      complete a nursing assessment which includes data on mobility, pain level,
                    medication, frequency of visits to primary care provider (PCP),
                    participation in activities of daily living (ADL), socialization, and other
                    relevant information.
            4.      bring the case to the school support team for review and planning.
            5.      participate in the school support team and continue to manage the case.
            6.      when the student attends a nonpublic school which does not have School
                    District of Philadelphia Nurse Service, inform the nurse or other responsible
                    school staff at the student’s nonpublic school of the school support team’s
                    decision.
            7.      In June of each year assess needs for the following year.
      D.    The school support team will:
            1.      review all documentation and determine necessity for transportation,
            2.      contact the School Health Services office (215-875-3490) if medical
                    consultation is needed,
            3.      determine eligibility based upon information provided by team members and
                    the student’s physician,
            4.      if transportation is approved, sign the authorization letter,
            5.      no other approvals are needed.




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       E.     The principal or designee will:
              1.     notify parent/guardian of school support team decision,
              2.     sign and forward the authorization letter to:

                                      Transportation Department
                                      JFK Center, Room 480
                                      Attention Mr. Nick Di Matteo

III.   Extensions and/or Renewal of Approval
       Requests to extend or renew transportation service beyond the length of time initially
       approved must be considered through repetition of the above procedure.




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                 THE SCHOOL DISTRICT OF PHILADELPHIA
                             JOHN F. KENNEDY CENTER
                         734 SCHUYLKILL AVENUE - RM. 500
                        PHILADELPHIA, PENNSYLVANIA 19146
                                                                            SCHOOL HEALTH SERVICES
                                                                                        (215 )875-3490
                                                                                   FAX: (215)875-5036

          REQUEST FOR TRANSPORTATION FOR MEDICAL REASONS
                      (RETURN TO SCHOOL NURSE)


Student’s Name _______________________________________ID#______________________

Home Address_________________________________________ Date of Birth______________

School ______________________________Location #_________ AAO__________________

        The above student is requesting transportation to and from school by the School District of
Philadelphia for medical reasons. This request is under consideration. Please document in detail the
medical justification for the same with the following information:

1.     Diagnosis ________________________________________________________________

2.     Date of Onset ______________

3.     Medical reason(s) student cannot walk or take public transit to and from school: _________
       _______________________________________________________________________
4.     When do you expect the student to be able to get to and from school?_________________
       ________________________________________________________________________

5.      The student will be picked up and dropped off at a designated school bus stop unless this
       is contraindicated. Please give medical reasons student cannot be picked up and dropped
        off at a designated bus stop:
       ________________________________________________________________________
       ________________________________________________________________________



Name of Physician (Print) ____________________________________

Signature of Physician _______________________________________

Address __________________________________________________ Phone _______________

Date Signed _______________________________


     To be completed by the student’s physician and returned to the
                              school nurse



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SUBJECT: STUDENTS WITH SPECIAL NEEDS                                           NUMBER          805.1
CLASSIFICATION:

TRANSPORTATION REQUESTS FOR MEDICAL
REASONS; AUTHORIZATION LETTER   (SEP. 02)

                                                      SAMPLE


                                                                                   Date______________

Transportation Services
John F. Kennedy Center
734 Schuylkill Avenue
Philadelphia, PA 19146

Dear Mr. Lombardi:

The student named below suffers from a medical condition which makes it difficult to walk to school. It is the
opinion of the school support team that it is in the best interest of this student to receive transportation to and from
school.

Students Name                                                      ID number                male_____female______

Home Address and Zip Code                                          Home Phone

Parent/Guardian Name                                               Emergency Phone

School Student Attends                                             AAO and Location Number


                                         TYPE OF SERVICE NEEDED
                 Curb to Curb pick up and delivery
                 Corner pick up and
                 delivery at:
                 Nearest designated school bus stop pick up and delivery
                 Medical concerns that will require intervention
                 Special equipment, e.g. harness, seat belts, etc.
                 Free tokens
                 Other

APPROVED BY:
School Support Team Member                                      School Nurse


School Support Team Member                                      Principal




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SUBJECT: STUDENTS WITH SPECIAL NEEDS                            NUMBER      806.1
CLASSIFICATION:

HOMEBOUND INSTRUCTIONAL PROGRAMS (SEP. 02)


I.     Purpose of Homebound Instructional Programs
       •     The primary function of Homebound Instruction is to provide a continuation of the
             instructional program for any student who will be absent from school for a period
             of at least four weeks for certified medical reasons.
       •     Homebound Instruction can be provided for the duration of a specific time of
             limited illness, e.g., recovering from surgery or for repeated short absences during
             episodes associated with a chronic illness, e.g., severe asthma attack.
       •     The certified school nurse is the designated case manager for all requested
             homebound services and all students on homebound or instruction in the home
             services.

II.    Goal
       •    Requests for Homebound Instruction will be processed in an efficient,
            professional, and timely manner with the school having maximum discretion in
            determining how to best serve their students, and flexibility in the use of
            homebound services.

III.   Roles and responsibilities
       A.    When a request for homebound services for health reasons is submitted to the
             school, the school nurse will:
             1.      contact the parent to obtain information regarding the student’s condition
                     and source of care.
             2.      provide the parent/guardian with a Physician’s Certification Form to be
                     completed by the Primary Care Provider (PCP).
             3.      complete a nursing assessment which includes data on mobility, pain level,
                     medication, frequency of visits to the primary care provider (PCP),
                     participation in activities of daily living (ADL), socialization, and other
                     relevant information including anticipated length of time homebound
                     services will be required.
             4.      complete the Reporting Form for Special Education Students if the
                     student is receiving special education services and submit it to the
                     Homebound Office.
             5.      present case to the Comprehensive Support Process to determine eligibility
                     and planning for services.
             6.      monitor progress and need for ongoing homebound instruction based on
                     medical evaluation/reports
             7.      document information on the Health Information System (HIS), in Screen
                     H7 of Health Inquiry and Maintenance, using code HOBD. In H1 screen, in
                     Health History, add HMBD code and start and end dates. Delete this code
                     (SHIFT-underscore) once Homebound service has ended. Non-
                     computerized schools will document the information on the health record for
                     the student (MEH-3).




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      B.    The school support team will:
            1.       (School Support Team members include, but are not limited to, an
                     administrator or designee, parent, nurse and any relevant staff).
            2.       review all documentation and develop a plan, with input and agreement
                     from the family, to service the student.
            3.       develop a plan to transition the student from homebound services to school
                     (if homebound service is approved).
            4.       obtain parent permission for an evaluation for special education (T700) if
                     documentation indicates an evaluation is appropriate.
            5.       complete a CER and, if the student is found to be eligible, an IEP.
                                                       OR
                     complete Protected Handicapped Student evaluation and, if the student
                     is found to be eligible, a Chapter 15 service agreement.
      C.    The principal or designee will:
            1.       identify a teacher through the T-IV process. If no teacher applies for the
                     position contact the Homebound Office at : 215-875-3749.
            2.       will record the teacher hours on the EBAR system, regardless of which
                     school the student attends..
            3.       monitor teacher hours through use of the S19.
      D.    The Homebound Office will:
            1.       provide training and technical assistance to school staff.
IV.   Instruction Hours
      B.    If the school support team approves the medical referral for a minimum of four (4)
            weeks, but less than ten (10) weeks, homebound instruction will consist of:
            1.       Elementary Level-Two (2) one hour sessions weekly.
            2.       Secondary Level-Three (3) one hour sessions weekly.
            3.       Graduating High School Seniors Five (5) one hour sessions weekly.
      C.    If the school support team approves the medical referral for ten (10) weeks or more,
            homebound instruction will consist of:
            1.       Elementary Level-Five (5) one hour sessions weekly.
            2.       Secondary Level-Five (5) one hour sessions weekly.
            3.       Graduating High School Seniors Five (5) one hour sessions weekly.
      D.    If the school support team approves the medical referral for Chronic Intermittent
            service, homebound instruction will consist of:
            one (1) one hour session for each day missed, not to exceed five (5) one hour
                     sessions in a week.

V.    Renewal or Extension of Approved Service
      Requests to extend homebound service beyond the length of time initially approved must be
            considered through repetition of the above procedure.
      A.    When Homebound Service is being provided to a student, the following attendance
            and payroll procedures must be followed:
            1.       The completed S19 (Daily Time Report) must be turned in to the principal
                     on a bi-weekly basis for review and signature.
            2.       The parent must sign after each instructional session.
            3.       One-half hour for preparation and travel time will be added for each home
                     visit.
            4.       The principal or his/her designee will compute the preparation allowance
                     and add it to the instructional hours.
      B.    The Homebound Office is available to give additional support for the effective
            delivery of Homebound Instruction by calling (215) 875-3749.




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                                      SAMPLE LETTER (FRONT)




                                   The School District Of Philadelphia
                                     School Health Services
                   Physician’s Referral for Homebound Instruction

                                                                 DATE:

Dear Physician:

The School District of Philadelphia believes that all students benefit from attending regular school.
School nurses develop Individual Health Plans (IHP)for students who have special needs. An IHP
may make it possible for your patient to attend school.

Consideration for Homebound will be given for students who will not be able to attend school for
four weeks or longer. Maximum Homebound Instruction is five hours per week. Requests should
be limited to those patients who absolutely cannot attend school.

Please furnish all information requested on the reverse of this letter and any additional information
which will facilitate a timely response to this referral.

All information will be reviewed by the School Support Team where the final decision regarding
this request will be made.

You may contact the school nurse directly at any time.




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         PHYSICIAN’S REFERRAL FOR HOMEBOUND INSTRUCTION
Name of Student                      Address                              Phone Number


Name of Parent/ Guardian             Zip Code                             Student DOB


School                               Grade                                R/S/B


School Nurse                                                              School Phone Number




Date of Examination_________________                   Date of Next Appointment ___________________


Diagnosis:
Date of onset of illness:                              Date of onset of Injury:


Prognosis:


What Physical or Clinical findings make it not possible for this student to attend school ?



What medication/s is this student taking?_________________________________________________



Will the student require medication in school?        Yes________                 No_________

When do you believe this student will be able to return to school ? _______________________

What, if any, accommodations do you believe will be necessary to facilitate an early return to school ?


Physician’s Name PRINTED                               Physician’s Signature


Physician’s Address PRINTED                            Physician’s Telephone




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SUBJECT: STUDENTS WITH SPECIAL NEEDS                               NUMBER       514.0
CLASSIFICATION:

SUICIDE PREVENTION/INTERVENTION GUIDELINES
(SEP. 02)

I.     The School District of Philadelphia will use the resources of the School District to assist
       students who may be at risk for suicide.
II.    The School District considers students as suicidal or potentially suicidal if they exhibit the
       following behaviors:
       A.      Students who express, verbally or in writing, the desire or intention to self-inflict
               serious or life-threatening injury.
       B.      Students who intentionally self-inflict or attempt to self-inflict any serious or life-
               threatening injury (including substance overdoses).
III.   The School District of Philadelphia has developed the following guidelines to provide all
       staff with procedures for handling students who may be at risk for suicide.
       A.      The staff member who identifies a potentially suicidal student, or receives
               information identifying a potentially suicidal student, must immediately notify and
               involve the principal. The nurse and counselor, if they are in the building, must
               also be notified.
       B.      The principal or her/his designee (who may be an assistant principal, counselor or a
               school based Student Support Team member) is to take the following steps:
               1.      If the student is violent or out of control contact the Office of Mental health,
                       at (215) 685-6440 and ask to speak to a mental health delegate. Explain the
                       situation to the mental health delegate and ask for advice. Call “911”, if it is
                       suggested to do so.
               2.      The student is never to be left alone. During this time, the principal or
                       designee should provide assurance and support to the student. It is
                       important to be calm, open lines of communication and encourage the
                       student to share her/his feelings.
               3.      If the student needs immediate medical treatment, follow the procedures for
                       sending the student to the nearest hospital for emergency treatment.
               4.      Contact parents/guardians immediately. Apprise them of the situation and
                       request that they come to school at once or go to the hospital or mental
                       health facility if the student has been removed from school.
               5.      When the parents arrive in the school - inform the parents of the situation;
                       stress the seriousness of the incident and the need for further professional
                       help. Give the parents information about appropriate community resources;
                       complete "Report of Emergency Conference” form in Triplicate, give
                       original to the parents, file one copy and attach the other copy to the
                       Counselor's report and send to the Office of Special Services, JFK Center,
                       734 Schuylkill Ave., Room 581, Philadelphia, PA, 19146; Attention:
                       Behavioral Health.
               6.      The principal or designee must also file a Serious Incident Report
       C.      Community Resources that might be used in these situations are listed below:
               1.      Crisis Response Centers (CRC) and the SAP team (if applicable) can be
                       used to provide professional intervention for students and their families.
               2.      Suicide and Crisis Intervention Services (215-686-4420) can be consulted
                       in these situations.




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             3.      Department of Human Services (215-686-6100) should be contacted when a
                     suicide threat or attempt is associated with child abuse and/or neglect, or the
                     student is known to D.H.S.
             4.      Base Service Units and private psychiatric/psychological agencies can be
                     used to provide professional intervention for students and families.
             5.      The parents should be sent a follow-up letter. This letter will indicate the
                     referrals and recommendations made by the school staff during the parental
                     conference following the incident.
      D.     If the parents do not come school regarding this incident or refuse to participate, the
             following procedures are the course of action for the principal or designee.
             1.      Children under 14 years of age may receive an involuntary emergency
                     psychiatric examination by a physician if the behavior is observed by the
                     school staff or police.
                     a. Contact the Office of Mental health at (215) 685-6440, to determine
                         whether an involuntary psychiatric examination is appropriate.
                     b. If an involuntary psychiatric examination is appropriate, the Office of
                         Mental Health can send a mobile emergency team to the school to
                         provide a “302” petition form and assist the school in completing the
                         “302 “ petition.
                     c. Contact the police for transportation to the Crisis Response Center
                         (CRC) after receiving a verbal or written approval (302 petition form)
                         for the involuntary emergency psychiatric examination from the Office
                         of Mental health.
                     d. Accompany the student to the CRC {person(s)}who witnessed the
                         behavior.
      2. Children 14 years of age and older may authorize his/her own evaluation. Where the
         student refuses to cooperate or where his/her mental condition precludes a rational
         understanding of the treatment offered, the procedures for an involuntary examination
         must be followed. For an involuntary examination, the student's dangerous conduct
         must have occurred within the last 30 days.
                     a. A "302" Emergency Involuntary Treatment Form must be completed.
                           If the forms are not in the school, the mobile team can provide them.
                           The petition must be completed by the person or persons with first
                           hand knowledge of the suicide attempt or ideation.
                     b. The mobile emergency team can advise school staff on how to
                           complete a “302” petition.
                     c. School staff can call the Office of Mental Health (215) 685-6440, to
                           arrange for the mobile emergency team to provide assistance at the
                           school.
                     d. The police should be contacted to transport the child to the hospital as
                           soon as the examination is authorized.
             3.      The Department of Human Services may decline to become involved in
                     mental health matters such as suicide. However, once a psychiatrist
                     determines that a student needs treatment, out-patient or in-patient, the
                     failure of the parent(s) or guardian to follow through with treatment
                     constitutes reportable child/abuse neglect and the procedures set forth in
                     School Operations Policy and Procedure for suspected child abuse must be
                     followed.
             4.      A student who threatens self-inflicted harm must be sent home with the
                     parent. If the parent declines , DHS must be called..
             5.      The letters of notification must be complete, listing the information provided
                     to the parents, the fact of the non-cooperation of the parents, and signed by
                     the staff members who made the parental contact(s).


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      E.     If the student is receiving treatment, all school services should be coordinated,
             wherever possible, with the mental health provider treating the student.
             1.       When the student returns to school, following crisis intervention, the
                      Comprehensive Support Process (CSP) team, must implement an approved
                      plan for counseling follow-up. The student's counselor must be involved in
                      the plan for counseling follow-up.
             2.       If the student is hospitalized as a result of an attempted/threatened suicide,
                      the student's counselor must be involved in the CSP team meeting to plan
                      follow-up services.




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                           SCHOOL DISTRICT OF PHILADELPHIA
                           OFFICE OF SPECIAL SERVICES
                REPORT OF EMERGENCY CONFERENCE WITH PARENTS*


DATE



I/We,                                                                         ,
the parent(s) of                                                        was/were involved in a
conference with school personnel at                                           School. I/We have
been advised that our child appears to be in a crisis situation. I/We have
also been advised that we should seek further professional consultation/help immediately.


I/We have been provided resource information.



                                             Parent or Guardian



                                             Parent or Guardian



                                             Counselor



                                             Principal


                                             School


       1.   Prepare in triplicate
       2.   Give 1 copy to parent
       3.   Maintain 1 copy for file
       4.   Forward 1 copy to the Office of Special Services, JFK Center, 734 Schuylkill Ave.,
            Room 581, Philadelphia, PA, 19146; Attention: Behavioral Health




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                   SAMPLE FOLLOW-UP LETTER TO PARENTS


Note:
        1.   Use school stationery
        2.   Prepare in triplicate
        3.   Give 1 copy to parent
        4.   Maintain 1 copy for file
        5.   Forward 1 copy to the Office of Special Services, JFK Center, 734 Schuylkill Ave.,
             Room 581, Philadelphia, PA, 19146; Attention: Behavioral Health


                                              DATE


Dear _____________________,
      This is a follow-up of our conversation concerning your child, _______________on
      ___________, 20___ We are very concerned that he/she may be in a crisis situation
      which warrants immediate, professional help.


        Below is a list of resources which we discussed. Please contact the counselor for follow-
        up planning.


RESOURCES


1. ______________________________________________________


2. ______________________________________________________


3. ______________________________________________________

                                              Sincerely,

                                              _______________________
                                                 Principal

                                              _______________________
                                                 Counselor

                                              _______________________
                                                 Telephone


cc: Behavioral Health.




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SUBJECT: STUDENTS WITH SPECIAL NEEDS                              NUMBER 804
CLASSIFICATION:

VISUALLY IMPAIRED             (DEC. 98)

I. Definition
      A. Students are accepted into the program for visually impaired (either full-time or itinerant
      support) if they meet State mandated guidelines.

       A student is Visually Impaired when he or she has:

               1. Visual acuity of 20/70 (15/50, 6/22) in the better eye after correction
                                                        OR
               2. Reduced peripheral vision to an angle of not greater than 20 degrees. (Central
               vision field of 20° or worse).
                                                        OR
               3. Major problems related to surgery, injury, progressive disease, or pathology of
               the eye. Examples include visual impairment of physiological origin which
               adversely affects educational performance, e.g., retinal problems, macular
               degeneration, glaucoma, albinism, Lebers, Stargardts, Marfans, severe myopia or
               any other condition or syndrome with a visual involvement.

II. Basic Information / Procedures

       A. A complete Ophthalmologic examination not more than one year old is required. The
       Ophthalmologist’s report must include a visual acuity, a diagnosis and prognosis.
       (School Nurse screening is acceptable for referral, but not for placement).

       NOTE: Visual perception problems do NOT qualify students for services for the
       visually impaired.

       B. Final determination of eligibility for vision services are made by the Itinerant Vision
       Consultant and Administrator of the Program for the Visually Impaired and will be reported
       and documented at MDE.

       The Itinerant Vision Consultant MUST be present at MDE and IEP meetings.
       Recommendations made for programs, and/or service without the itinerant's agreement are
       not valid.

III. Vision Services-Itinerant Program

The purpose of the Itinerant Program is to provide a continuum of service for visually impaired
children in regular grades K-12, and children ages 5-21 years in all types of special education
placements.

Vision Consultants, who visit schools on a frequency basis determined by the individual needs of
the students, provide itinerant service. The basic role of the Vision Consultant is to provide the
necessary materials and support to help maintain the student in the least restrictive environment.




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Responsibilities of the Vision Consultant include:
      • Perform Vision evaluations for those thought to be visually impaired.
      • Participate as an active member of all School Support Teams for students thought to be
           visually impaired, including all IEP conferences.
      • Provide IEP's (or vision component thereof) for every visually impaired student.
      • Consult with appropriate staff members of a school regarding educational adjustments
           to meet the visual needs of each student.
      • Set up and monitor vision stimulation programs to be carried out by the classroom
           teacher.
      • Provide large print, Braille and recorded books, tests, magnifiers, and other special
           materials as needed.
      • Refer students to community, city, and state agencies that serve the visually impaired.
      • Determine student eligibility for free eye clinic located at the Overbrook Educational
           Center.

IV. Vision Services-Full Time Program

A full time program exists for blind and partially sighted students at the Overbrook Educational
Center (OEC). This program serves regular education children in need of a full time adaptive
program at the elementary level. OEC also serves desegregation students in grades 1-8.

An extensive integrated education program is available which includes an MG program, Macintosh
computer labs, an extensive music program, an adaptive art program a language arts program
focusing on whole language instruction and an integrated approach to writing.

Vision specialists provide support in specific areas such as orientation and mobility, Braille and the
use of an extensive array of adaptive technology for visually impaired students. Speech and
hearing services are available where appropriate, as is occupational therapy.

V. Referral for Vision Services:

For all students thought to be eligible for vision services the School Nurse will:

       •   Contact the parent and discuss the need for a current examination, i.e., within the
           current calendar year, by an Ophthalmologist.

       •    Assist the parent in accessing this service.

       •   Contact the Vision Consultant regarding the free eye clinic at Overbrook Educational
           Center if resources are not available.

       •   Document this contact in the student health record. Use Main Menu #2, Screen H7.

       •   Issue form M-144 (Report to Parents of Vision Testing) for Ophthalmological
           examination if most recent examination is more than one year old.

       •   Document results of the Ophthalmological examination in the student health record.
           Use Main Menu #2, Page H3. Additional documentation may be done on Screen H7.

       •   Obtain form T-700 (Permission to Evaluate) for Functional Vision Evaluation from the
           Vision Consultant in accordance with current evaluation procedures.



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       •   Notify Itinerant Vision Services of the results of the Ophthalmological examination.
           Forward the original completed M-144 to:

                                   Itinerant Vision Services
                           Overbrook Educational Center, Location 448
                                      6720 Lansdowne Ave
                                    Philadelphia, PA 19151
                                  Telephone: 215-581-5517

At all times, the Itinerant Vision Consultant is available for consultation at 215-581-5517-or via
voice mail (call 215-299-8811 and use the option in which a name is entered to reach a voice
mailbox.).




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             MISCELLANEOUS




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SUBJECT: MISCELLANEOUS                                           NUMBER       809.0
CLASSIFICATION:

ACCESS BILLING PROCEDURE                (SEP. 02)

I.     INTRODUCTION:
       The School District of Philadelphia may bill Medical Assistance (MA) through the
              ACCESS program for certain services which are medically necessary. These
              billable services include many of the services being performed by school nurses
              such as: Administration of prescribed medications, tube feedings and urinary
              catheterizations.

II.    CRITERIA FOR ELIGIBILITY:
       A.   The student has Medical Assistance.
       B.   The student has been classified as Special Education, Chapter 14.
       C.   The parents have been notified of the School District’s intent to bill MA and a dated
            copy of the letter has been placed into the student's file.
       D.   A medical diagnosis and physician's certification of need are on file. The Request
            for Administration of Medication/Equipment, MED-1), meets this criteria.
       E.   The student must be receiving a service that is specified on the MED1 (daily,
            weekly, 3 x week). PRN services are billable when the MED1 covering the service
            is on file, i.e. nebulizer treatment.***
       F.   The service must be listed on the student’s Individual Education Plan (IEP). The
            following phrasing is to be used to include nursing services on the IEP:

                    "ADMINISTRATION OF MEDICATION/TREATMENT PER
                  PHYSICIAN'S ORDERS, AS PROVIDED BY PARENT AND IN
                      COMPLIANCE WITH SCHOOL DISTRICT POLICY"

III.  PROCEDURE:
The Certified School Nurse will:
      A.       Obtain and review documentation of medical necessity, diagnosis, and physician
               signature on the Request for Administration of Medication/Equipment (MED-1) in
               all cases.
      B.       Ascertain that the following statement is on the IEP: “Medication/treatment per
               physician's orders, as provided by the parent and in compliance with School
               District Policy.” If it is not listed, the nurse should meet with the IEP Chair/LEA
               representative at the school and make arrangements to have the service added in a
               manner that maintains the integrity of the IEP.
      C.       Document administration of medication/treatment on computer medication log or,
               when unavailable, on “Student’s Record of Medication Administered or Equipment
               Used” (MED-2).
      D.       Prepare Service Description Slips at the end of each month for those students that
               have been identified as Chapter 14 Access Eligible and submit them to the Medical
               Assistance Reimbursement Coordinator for their AAO. The nurse may only bill for
               those dates when he/she is in the building providing (or overseeing) the service and
               the student is available . Services may not be billed for dates when the
               medication/treatment is provided by another individual because the nurse is not in
               the building..
      E.       Complete all relevant columns on Service Description Slip including: Diagnosis,
               Date, Therapy or/Evaluation or Collateral, Progress Indicator and Service Time and


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             Type . The Activity/Treatment must be written on the service slip for each date of
             service, however a descriptive may be used rather than writing the full sentence
             each time. A one-to-two line monthly summary note must be provided in the section
             labeled Monthly Progress Summary and should be specific as to the student's
             progress with his/her service. Arrows and ditto marks are not allowed and the
             Diagnosis section must be completed on each slip (as it does not preprint). Retain
             the original white copy of the Service Description Slip in the health room and
             forward the completed yellow and pink copies to the Medical Assistance
             Reimbursement Coordinator. White copies must be retained for four years from the
             date of service.

*** If a student has been determined ACCESS eligible, the school nurse may bill
ACCESS for collateral services provided to support the care of the student, such
as administrative paperwork, telephone calls and conferences with teachers and
parents.




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SUBJECT: MISCELLANEOUS                                        NUMBER       1003
CLASSIFICATION:

CALENDAR OF ACTIVITIES            (SEP. 02)

I.    Introduction
      A.    The School District of Philadelphia fully recognizes that every community is
            different from every other school community. However, there are basic services
            and programs that are common to all. This calendar of activities provides a guide
            for accomplishing services in a timely fashion.
      B.    A screening program is complete only when follow-up is accomplished. Therefore,
            parents should be contacted as soon as an individual problem is identified in order
            to allow sufficient time to respond.
      PLEASE NOTE: THE HEALTH INFORMATION SYSTEM, WHERE
            AVAILABLE, IS THE ONLY STANDARD OF DOCUMENTATION.

II.   Calendar
      A.    SEPTEMBER
            1.   Write a school health plan. Include a process for teacher referrals. Establish
                 health room hours in consultation with the building administrator. Provide a
                 tentative weekly schedule of your activities, such as routine hours for
                 screenings, medications, non-emergency health room hours. Arrange to
                 discuss your school health plan with the principal and faculty.
            2.   Prepare the Health Room Suite for opening of school, including setting up
                 your computer, decorating bulletin boards and making health education
                 material available. Inventory health room supplies.
            3.   Where it is available, use the Health Information System (HIS) to revisit the
                 health insurance status of students. Consult with relevant school staff to
                 assure that new information from emergency contact forms is used to revise
                 the S62 or H1 screens. Where HIS is not available, create a tickler file to
                 monitor the health insurance of students. Use every parent/guardian/student
                 contact to obtain insurance information.
            4.   Review health histories/records of all students new to the school and issue
                 appropriate documents (S865, MED-1, etc.).
            5.   Review incoming MED-1s (Request for Administration of Medication...)
                 for the current year. Interview parents and students. Document all activities.
            6.   Where it is available, use HIS to review immunization data of students by
                 printing an "Immunization Compliance" report. Where HIS is not available,
                 create a tickler file to monitor provisionally immunized students. Print a list
                 of students who are inadequately
                 immunized and/or who have religious and/or medical exemptions. Discuss
                 the list with the principal. (Inadequately immunized students must be
                 excluded.)
            7.   Assure that all immunization data is entered on HIS by
                 October 1, yearly.
            8.   Review incoming S865s. Interview parents and students.
            9.   Write health plan and emergency plan for each student on the back of the
                 S865. Document all activities on the HIS.
            10.  Review incoming gym excuses. Interview parents and students.
            11.  Begin outreach to ensure all students in mandated grades receive a dental



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                     and/or physical examination by sending a letter and assessment forms
                    home.
             12.    Begin to identify all students with special health needs. Use HIS, where
                    available, by printing a "Chronic Conditions" report.
             13.    Identify School Support Team members and determine meeting schedule.
             14.    Revisit the school plan and add to it any pertinent information from
                    health/emergency plans for students with special health needs, immunization
                    compliance reports, or other health issues identified through assessment of
                    the school community. Design the school health plan to be a "snapshot" that
                    quantifies the school health program. Provide the updated plan to the
                    building administrator and keep a copy in the health room for use by
                    substitute nurses.

      B.     OCTOBER
             1.   Continue outreach to ensure all students have health insurance.
             2.   Continue outreach to ensure all students in mandated grades receive a dental
                  and/or physical examination by linking families with their PCP and helping
                  families enroll in MA, CHIP, and other health insurance programs.
             3.   Begin growth, vision and hearing screening on all entry level grades and
                  new students.
             4.   Begin to review/identify unresolved student health problems from the
                  previous year for follow-up. Delete students who are no longer on roll

      C.     NOVEMBER
             1.  Continue outreach to ensure all students have health insurance.
             2.  Continue outreach to ensure all students in mandated grades receive a dental
                 and/or physical examination by linking families with their PCP and helping
                 families enroll in MA, CHIP, and other health insurance programs.
             3.  Encourage teachers to refer all students in whom they suspect a problem for
                 screening. Follow-up on all referrals.
             4.  Begin scoliosis screening in sixth and seventh grades.
             5.  Continue screenings, rescreenings and follow-up on all failures
             6.  Continue case management of students provisionally admitted with
                 incomplete immunizations.

      D.     DECEMBER
             1.   Continue screenings, rescreenings, and follow-up on all failures. Contact all
                  parents or guardians to assess barriers to care. Conduct outreach to ensure
                  that all students receive service by linking families with their PCP and
                  helping families enroll in health insurance programs.
             2.   Complete Scoliosis Screening and continue follow-up.
             3.   Consult with the Principal and School Team regarding progress toward
                  achieving goals that were set in the school health plan. Discuss strategies to
                  insure continued progress. Reinforce Health Room Hours.
             4.   Continue case management of student provisionally admitted with
                  incomplete immunizations.

      E.     JANUARY
             1.   Conduct outreach to ensure that all students receive service by linking
                  families with their PCP and helping families enroll in health insurance
                  programs.
             2.   Continue case management of student provisionally admitted with
                  incomplete immunizations.


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             3.     Continue screenings, rescreenings, and follow-up on all failures.
             4.     Contact all parents or guardians to assess barriers to care.

      F.     FEBRUARY
             1.   Continue screenings, rescreenings, and follow-up on all failures. Contact all
                  parents or guardians to assess barriers to care. Conduct outreach to ensure
                  that all students receive service by linking families with their PCP and
                  helping families enroll in health insurance programs.
             2.   Continue case management of student provisionally admitted with
                  incomplete immunizations.
             3.   Assess accomplishments. Revise plan for achieving program goals
             4.   Enlist the support and assistance of the Student Support Team.

      G.     MARCH-APRIL
             1.  Continue screenings, rescreenings, and follow-up on all failures. Contact all
                 parents or guardians to assess barriers to care. Conduct outreach to ensure
                 that all students receive service by linking families with their PCP and
                 helping families enroll in MA, CHIP, and other health insurance programs.
             2.  Review admission requirements re: kindergarten registration for next term
                 with the Principal, relevant school staff and other members of the Student
                 Support Team.
             3.  Identify public school students for camperships (ages 7 to 12) and develop a
                 plan for them to be in compliance with camp requirements for physical
                 examinations and immunizations. Follow directions that accompany the
                 applications. Do not promise attendance until you have actually received a
                 returned application.

      H.     MAY-JUNE
             1.   In consultation with appropriate personnel, identify students who will attend
                  the Extended School Year (ESY) program and prepare all materials in
                  accordance with instructions (see School Nurse Procedure #801.8).
             2.   In anticipation of summer programs, review Student MED1 screens to
                  ensure that an August 31 end date is entered where appropriate and that all
                  students with special health needs or conditions are entered in the Health
                  History Screen (H1, H9) of HIS Main Menu #2, Health Inquiry and
                  Maintenance.
             3.   Review health records of students who are upper level transfers to ensure
                  that all data, particularly immunizations (Main Menu #1) and health
                  conditions (H1, H9) have been entered on HIS. In non-computerized health
                  rooms, review all records and enter same data before transferring student
                  health records (MEH3).
             4.   Prepare and submit Annual Reports.
             5.   Continue to work on follow-up.
             6.   Issue forms for physical examinations, medication, and Pupil Health Status
                  to relevant students for completion during the summer.
             7.   Make appropriate arrangements to secure the health suite computer and/or
                  health records.
             8.   Assess and plan for accommodation of students with special needs for
                  school opening.




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SUBJECT: COMMUNICABLE DISEASES                                NUMBER 901

CLASSIFICATION :

INFECTION CONTROL PRECAUTIONS: CONTACT WITH
BODY FLUIDS (APR. 02)

I. PURPOSE
      A.   The body fluids of all persons should be considered to contain potentially
           infectious agents.
      B.   Students and staff in the school environment may be at risk of accidental
            exposure to body fluids.

II. DEFINITION
       A.    The term “body fluids” includes: blood, semen, drainage from scrapes and
              cuts, feces, urine, vomitus, respiratory secretions (nasal discharge).
       B.    Decontamination means the use of physical or chemical means to remove,
             inactivate or destroy potentially infectious agents

III. MANAGEMENT
       A.  Direct contact with body fluids should be avoided, if possible. In all
           cases, disposable gloves may be used as a protection from such contacts. B.
           Gloves should be removed and appropriately disposed of as soon as the
           period of contact has ended, followed by liberal hand-washing, using
           soap and water. Disposable gloves should not be washed or used in contacts with
           multiple persons.
           1. Appropriate handwashing
                   a. Use soap and warm, running water.
                   b. Wash all surfaces thoroughly, including wrists, palms, back of
                      hands, fingers and under fingernails.
                   c. Rub hands together for at least 10 to 15 seconds.
       C.  All breaks in skin, bleeding or oozing cuts, or abrasions in either a
           caregiver or other persons should be covered (gauze, bandages, etc.)
           whenever possible.
       D.  Unanticipated contact with body fluids should be followed by immediate
           washing of hands and other affected areas with soap and water.
       E.  Surfaces contaminated with blood or body fluids should be decontaminated with a
           solution of one (1) part bleach and ten (10) parts water, using gloves. Materials
           used in cleaning up the area should be
           disposed of in double plastic bags, as described below (paragraph F).
       F.  All materials used in treating body fluids, either during health care or
           during cleaning of the environment should be stored in such a manner as
           to prevent odor nuisances, leakage, spillage, safety or health hazards, and access by
           insects or rodents. This can be accomplished by using two
           disposable polyethylene bags or equivalent material with a total bag
           thickness of at least three mils for onsite storage. The bags should be
           individually tied.




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