Beginning of the Year Documentation Needs

• Optional sample resources for School Health Offices
• Checklist for Students with Special Healthcare Needs (for use by nursing staff only)
• Immunization Referral Letter to Parent
• Mandated Health Appraisal Checklist
• Medication Check In List (ideal for the first day of school!)
• Medication Delivery Form - to document receipt of medication from parents
• Medication Delivery Form for daily ongoing medications
• School Nurse's Self-administration Medication Checklist
• Medication Expiration Date Record
• Determination of Self-Directed Students
• Medication Training & Monitoring Plan for Unlicensed Assistive Personnel (For Self Directed Students Only)

Emergency Care:

• *New* - School Nurse Emergency Care Flow Sheet
• Emergency First Aid Backpack Example

Watch for more soon in this section!

Sample Cumulative Health Record:

• Cumulative Health Record - front (may be customized) - this is NOT a required form
• Cumulative Health Record - back (may be customized)- this is NOT a required form

School Health Office Data Collection and Responsibilities:

• Data Collection Calendar for Secondary School Nurses (can be customized) 2010 - 2011 
• Data Collection Calendar for Elementary School Nurses (can be customized) 2010 - 2011
• SN Worksheet
• Nursing Annual Responsibilities
• Nursing Monthly Responsibilities
• Nursing Quarterly/Semiannual Responsibilities
• School Nurse Monthly Activities Report

Sample Miscellaneous Forms:

• Strep Study Chart
• Screening Worksheet
• Blood Pressure Information Sheet
  • Blood Pressure Monitoring Form
• Signs and Symptoms of Common Health Concerns -  a quick reference chart for school employees
• Mandated Health Appraisal Tracking Form
• Anecdotal Record for the Student with Epilepsy
• Application for Employment Certificate (AT-17) NYSED
• Application for Employment Permit (AT-22) NYSED
• Authorization for Release of Protected Health Information
• Authorization for Use or Disclosure of Health Information
• Bloodborne Pathogens Exposure Control Plan
• Emergency Information Form for Children With Special Needs
• Sample Permission for Medical Treatment on Field Trips Form
• Sample Field Trip Permission Form - Education World
• First Aid for Seizures - Memo to Staff
• Hydrocephalus Shunt Malfunction - Signs of
• Immunosuppressed Child - Memo to Staff
• Individual SOAP Logs for School Nurse Visits
• Infection Control - Memo to School Staff
• Physical Fitness Certification (AT-16) NYSED
• Scoliosis Report Form - Sample
• Single Eye Athlete Resolution Proposal for Physicians
• Vision Screening Parent Notification Form
• Sample Faculty/Staff Emergency Contact Information Form

 End of the Year Documentation Needs

• Optional sample resources for School Health Offices
  • Parent "Healthy Summer Tips" Newsletter
  • Medication Pick Up Letter
  • Medication Permission Form
  • Annual Report Template
  • Emergency Care Plan Letter
  • Mandated Health Appraisal Letter
  • HIPAA Form