Building Nurse

Emergency Medical Form

Emergency Medical Authorizations

This form must be completed on a yearly basis and updated throughout the year as contact information changes.

Click here for Emergency Medical Form
Name & Address

The top portion of this form provides us with information to update your child’s address in our computer system.

Non-Resident Parent Information

Contact Info

The information in the section allows us to contact you during the day and is utilized as a list of persons eligible to pick up your student in case of illness or injury.

PART 1-Consent for Treatment

This portion allows access to your doctor and dentist during an emergency.

Medical Information

This portion allows emergency services and pertinent school personnel to be aware of child’s medical background.

Consent

This section is signed to enable emergency services to provide care if the parents are unable to be contacted.

PART 2-Refusal of Consent

This part is utilized by signing when consent is not given for medical treatment.

Immunizations

6TH GRADE REQUIRED IMMUNIZATIONS

1. TDAP Booster
(Booster for Tetanus, Whooping Cough, and Diptheria)

2. Meningococcal (serogroup A, C, W, and Y)

11TH GRADE REQUIRED IMMUNIZATIONS
1. Meningococcal (serogroup A, C, W, and Y)

All students must have this immunization after their 16th birthday. Currently only one Meningoccocal vaccine is needed before their senior year.

According to the Ohio Department of Health, all students must have an updated immunization before entering their 7th grade and 12th grade year. The school must have a copy of the immunization on file by the 14th day of their 7th grade year for 6th graders and 12th grade year for 11th graders.

ALL SCHOOL AGE STUDENTS
All school age students have required immunizations by the State of Ohio. These immunizations can be found on the Ohio Department of Health's web site.

Perry County Health Department

http://www.perryhealth.com/

Click on Nursing and then Immunizations for information on clinic times.

Medications

Prescription Medication

A doctor must complete and sign the Authorization for Prescription Medication or Treatment form and the parent or legal guardian must sign the bottom of the form.

Medication must be in its original container with a pharmacy label containing the students name and exact dosage to be administered.
Medications that are taken three times a day should be taken at home and not at school.
All medications will be locked up in the clinic unless they are an emergency medication that has been authorized by the physician..
Emergency Inhalers and Epipens may be carried by a student with written approval by the doctor and parent.

Non-Prescription (Over-The-Counter) Medication

A parent may complete and sign an Authorization for "Over-The-Counter" (Non-prescription) Medication or Treatment form to allow a student to have such medications as Tylenol or Ibuprofen. Students in Thornville, Glenford, or Somerset Elementary must use the Elementary Over-The-Counter form
Medication must be provided by the parent and in its original container (DO NOT place in baggie, etc) and can not exceed the dosage recommended by the manufacturer.

*****NOTE: Please pick all medications up at the end of the school year. They will be destroyed if they are not picked up.

Also medication forms must be completed each year.

General Illness Rules

SCHOOL AND ILLNESS: SHOULD YOUR CHILD STAY AT HOME?

(Information obtained from Handout Children's Hospital)

CHILD IS TOO ILL FOR SCHOOL

Seems very tired and needs bedrest (this is common with flu symptoms)
Has vomiting or diarrhea
Becomes short of breath or has an increase in wheezing during normal activity.
Has a temperature above 100 degrees Fahrenheit by mouth
Has yellow or green drainage from eye(s)

FEVER

Your child should not go to school if his temperature is above 100 degrees Fahrenheit. Your child may return to school 24 hours after their temperature id below 100 degrees and is feeling better.

REMEMBER

School is a child's work. It is important for normal development. If your child is absent often, it may be harder to keep up with their classes. It is important that your child does not miss more than a few days of school a year due to illness.
Ask your doctor or the school nurse when you are not sure about keeping you child home.

Influenza

FLU SYMPTOMS & SEVERITY

Influenza Symptoms

Influenza (also known as the flu) is a contagious respiratory illness caused by flu viruses. It can cause mild to severe illness, and at times can lead to death. The flu is different from a cold. The flu usually comes on suddenly. People who have the flu often feel some or all of these symptoms:

Fever* or feeling feverish/chills
Cough
Sore throat
Runny or stuffy nose
Muscle or body aches
Headaches
Fatigue (tiredness)
Some people may have vomiting and diarrhea, though this is more common in children than adults.

* It's important to note that not everyone with flu will have a fever.

Flu Complications

Most people who get influenza will recover in a few days to less than two weeks, but some people will develop complications (such as pneumonia) as a result of the flu, some of which can be life-threatening and result in death.

Pneumonia, bronchitis, and sinus and ear infections are three examples of complications from flu. The flu can make chronic health problems worse. For example, people with asthma may experience asthma attacks while they have the flu, and people with chronic congestive heart failure may have worsening of this condition that is triggered by the flu.

People at Higher Risk from Flu

Anyone can get the flu (even healthy people), and serious problems from influenza can happen at any age, but some people are at higher risk of developing serious flu-related complications if they get sick. This includes people 65 years and older, people of any age with certain chronic medical conditions (such as asthma, diabetes, or heart disease), pregnant women, and young children.

Flu Severity

Flu is unpredictable and how severe it is can vary widely from one season to the next depending on many things, including:

what flu viruses are spreading,
how much flu vaccine is available
when vaccine is available
how many people get vaccinated, and
how well the flu vaccine is matched to flu viruses that are causing illness.

One study found that during the 1990s, flu-related deaths in the United States ranged from an estimated 17,000 during the mildest season to 52,000 during the most severe season (36,000 average). Over a period of 31 seasons between 1976 and 2007, estimates of flu-associated deaths in the United States range from a low of about 3,000 to a high of about 49,000 people. During a regular flu season, about 90 percent of deaths occur in people 65 years and older.

Web page copied from (http://www.cdc.gov/flu/about/disease/symptoms.htm)

Chronic Conditions

Asthma

Asthma is one of the most common chronic disorders affecting children. Asthma attacks are usually brought on by coming into contact with a certain trigger. Some triggers that may cause these attack are cigarette smoke, exposure to cold air, and exercise. It is very important for students who have had asthma attacks to carry an emergency inhaler. According to the Mayo Clinic (http://www.mayoclinic.com/health/outgrow-asthma/AN01973 ) asthma may improve during adolescence and young adulthood, but most children will not outgrow it. According to Northern Local Policy, a child may carry an inhaler for emergency purposes. Each student carrying an inhaler will need to have a Prescription Medication form completed each school year which is signed by the doctor and a parent or legal guardian.

Severe Allergic Reactions (Anaphylaxis)

A severe allergic reaction known as Anaphylaxis can happen when individuals come in contact with certain foods or from a beesting. Peanuts, treenuts, milk, eggs, soy, and fish and wheat are the most common allergies. According to The Food Allergy Program most children will outgrow their food allergies but peanut, tree nuts, fish, and shellfish are considered to be lifelong.

Typical Allergy Symptoms

SKIN SYMPTOMS	GUT SYMPTOMS	RESPIRATORY SYMPTOMS	Cardiovascular	Neurological
Hives	Cramps	Itchy watery eyes	Reduced Blood Pressure	Feeling impending doom
Swelling	Nausea	Runny nose, Sneezing	Fainting	Weakness
Itchy Red Rash	Vomiting	Coughing	Shock
Eczema flare	Diarrhea	Itchy or swelling lips, tongue, or throat	Chest pain
		Change in Voice
		Difficulty swallowing
		Tightness Chest
		Wheezing
		Shortness of Breath
		Repetitive throat clearing

(CDC School Food Allergy Plan)

A student may carry their Epipen on them for emergency administration. They will need to have a Prescription Medication form completed each year which is signed by the doctor and the parent or legal guardian. All emergency treatment of anaphylaxis will have Emergency Medical Services called and be transported to the hospital for evaluation

Diabetes

According to the National Institutes of Health and the Centers for Disease Control and Prevention, over 12 million Americans have diabetes. Students may have Type 1 Diabetes which requires frequent monitoring of blood sugars and insulin administration for meals and snacks. This type of diabetes is related to an immune system problem that has destroyed the pancreas which is responsible for making insulin.

Type 2 Diabetics may need blood sugar monitoring and require oral medications to treat their disease. Most type 2 diabetics are older adults, but it is increasing in numbers in children due to being overweight and obese. Risk factors for type 2 diabetics include being overweight and having a family member with diabetes.

All diabetic students must have a Diabetic Management Plan for school. This plan allows for proper management of carbohydrate (meal) coverage, corrections for high and low blood sugars, and emergency treatments for very low or very high blood sugars. It is important for the diabetic to monitor their blood sugars frequently as needed to achieve good control of their diabetes.

Diabetes care is crucial

for immediate safety of the student
for long term health of the student
to insure they are ready to learn and participate in school activites
minimize possibility of diabetes-related emergencies

It is essential that students are monitored and effectively manage their blood sugars at school and home. The involvement of school personnel, the diabetic student, parents, and physicians are important in managing the health of these individuals. Whether your child is a Type 1 or 2 Diabetic, it essential that you notify school personnel regarding your child.

(Information from "Helping the Student with Diabetes Succeed", June 2003)

Communicable Diseases

Communicable Disease Chart
(Information obtained from Ohio Department Health)
DISEASES	Symptoms	Method Transmission	Communicable Period	Controls
Chicken Pox	Skin rash blisters, scabs	Direct Contact with drainage, airborne droplets	1-2 days prior to rash appearing through 6 days after sores appear	Exclude until 6 days after onset of rash and sores are dry
Flu	Abrupt onset of chills, fever, headaches, sore muscles, runny nose, sore throat, cough are common	Direct contact with infected person or indirect contact from soiled items with nose and throat discharge from infected person, airborne in crowded areas	1 day before symptoms, up to 5 days after symptoms begin- may be up to 10 days in younger children	Exclusion from school based on child's symptoms i.e fever
Strep Throat	Red throat with pus spots, fever, tender, swollen lymph nodes	Direct contact with secretions from infected person or large droplets, or indirect contact with objects contaminated by infected person	Until 24 hours antibiotics completed	Early diagnosis and treatment is essential in preventing complications
Impetigo/MRSA	Blister like pus filled bumps progress yellow crusted sores	Direct contact with sores or indirect contact with items soiled by drainage from sores	2 to 10 days (sometimes longer), as long as drainage is present	Exclude until no drainage present and after 24 hours of treatment
Mono	Fever, sore throat, swollen lymph nodes (glands), fatigue, headache, spider veins roof mouth,	Direct contact saliva of infected person	Unknown	Need not exclude under ordinary circumstances
Ringworm	Scaly bald patches on scalp or flat ring like rash to skin	Direct contact with infected area or items that have come into contact with skin infections	As long as lesions are present	Exclude until 24 hours treatment given
Scabies	Linear burrows in skin, often found between fingers, inside wrists, elbow, armpits, genital area, intense itching at night	Direct skin to skin contact. Pets do not transmit the mite.	From infestation prior to rash until treatment,	Exclude until 24 hours after treatment, wash and dry clothing, bedding, personal articles. Treat others who have been in contact.
Head Lice	Itchy scalp, feeling something move through hair, white to yellow brown nits attached to hair	Direct hair to hair contact or indirect contact with infested persons combs, hats, or bedding	As long as infested person is infested, live aff hair 24 to 48 hours. Eggs live off host 7 to 10 days	Exclude until pediculocide treatment is given.

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