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Explore Program Authorization Form: Revise, Finish and forward

hi my name's Kelly Meyers and I'm your.school nurse at Highland Elementary I.just want to take the time to welcome.all of you to kindergarten and I'd like.to take this time to walk through our.Meridian two-to-three comm website to.let you know how you can locate the.health forms so I'm going to go ahead.and share my screen and you'll be able.to take a look okay so you can see here.that we're at the main more than two to.three org website and from the site.you're gonna go to the department's.scroll down to health services and while.I encourage you to go ahead and explore.each of these we're gonna focus here on.nurses contact and health forms okay so.here you'll see the list of our nurses.for each building you'll see me Kelly.Meyers at Highland in my extensions.two-one-zero to the next I'd like to.draw your attention to this letter here.it says district health requirement.letter to parents so I'm gonna go ahead.and open that up and just share with you.some of things you'll find on that so.what this will give you is a snapshot.view of what requirements we need from.your student your incoming.kindergartener so it'll be a proof of.required physical exam immunizations.as listed proof of a dental exam and.proof of a vision exam please note that.the dental exam is due prior to May 15th.of 2021.whereas the vision exam and physical.exam are due at the time of enrollment.or at the beginning of the school year.um it does say prior to October 15th.that is our deadline for state.exclusions and what that means is if we.don't have these forms by that time we.will have to exclude your student from.school so let's just focus on giving the.forms in um and then we can take it from.there and we understand we're at a.training time right now so dental.appointments vision appointments are not.necessarily a priority however if you.did have a physical exam.within the last year for your student.and that's the same for a vision exam or.dental exam within the last year go.ahead and submit those um and then I.also want you to be aware that we do.offer a dental exam clinic in the spring.so that would be spring 2021 and that's.with on-site dental and doctor granter.okay so let's get a little bit more.involved in some of these forms so we do.have here it's a state school physical.form that's in a standardized form it's.a standard child examination form and.most primary care professions or a nurse.practitioner is wherever your doctor.happens to be for your student they'll.have those forms for you same for the.dental exam and the eye exam the dentist.and the eye doctor will have those forms.for you as well however if these.hyperlinks will open up the form for you.and then you can go ahead and take them.with you to your appointments the next.form is an authorization for.administration of medication permit so.I'm going to open that up and I just.want to walk you through this.information so any medication that's.going to be given at school with the.exception of Tylenol would need to have.a physician's order so that is anything.from you want your student to have.motrin and anything to an inhaler.epinephrine pen and sland so forth so.this is a form that the physician would.fill out and so it's just got some.demographic information student name.birthdate their grade what the name of.the medication is the time to be given.and how often now this will also be.filled out if your student needs to be.on an antibiotic that they need to take.at school if there's an appointment or.cream that you would like me to use on.your student including sunscreen this.form would need to be filled out and.then there's a couple options here that.the physician can choose and that's if.your child's been instructed in and is.approved for self administration so that.would be most essential for an asthma.inhaler epinephrine pen and then it's as.instructed in and approved for carrying.and self administration so it's two.different things can you shouldn't.administer it and these are student.allowed to carry it so if this is.something that needs to go to and from.school such as the inhaler.we just need to know that that has been.approved for them from the physician.there's a space for the physician to.sign and that again includes a nurse.practitioner or physician assistant the.bottom part is for you to be view the.parent to complete and that includes.just a signature phone number and the.date okay so we're going to head back.over to the Meridian two-to-three.website if you do not do immunizations.there is a state of Illinois certificate.of religious exemption forms so you can.open that up and fill it out and submit.that in place of immunizations um.there's also waiver forms for both the.dental exam and eye exam and as I've.stated if that's something that you.either financially can't do it this time.or you don't have insurance to cover it.at this time or maybe just because of.the situation we're in go ahead and fill.out those waiver forms and that will.cover you until you can get those.appointments made okay so we're gonna.scroll down um each one of these is so.major it's a childhood illness medical.condition that we see so there's always.exceptions to these things but these are.the ones we see the most so asthma.diabetes food allergy and insect sting.allergies such as bee stings and then a.seizures so each one of these will have.an action plan these are all hyperlinked.so we would again like you to complete.those take them to the physician who.prescribed the medication and fill that.out and sign it so you'll also see that.for a SMAW there's an asthma action plan.and then that authorization for.medication administration then what.you'll see is an individualized.healthcare plan and that's something.that I would write for your student and.it acts as a communication tool between.me the nurse the student the teachers.that are involved in direct care our.recess aides a lunchroom staff and then.the bus drivers it is just fixed we want.everyone to be aware of what the.treatment plan is for this student in a.one document and so that is also the.same for the rest of these there will be.health plans written if your student has.a medical condition that's not listed.here please talk with me and we can kind.of work on what that should look like to.help your student succeed at school.so if your student as diabetes go ahead.and fill out those two forms it's a.hypoglycemia hyperglycemia in addition.to the medication permit food allergies.now this will be different if your.student just follows a lifestyle choice.such as veganism that would be something.different um and again talk with me.about those lifestyle choices maybe it's.gluten-free maybe you choose you know.organic diet let's talk about that so we.can make sure that we're supporting that.at school and so forth with the in.sexting again that's an anaphylactic.reaction but it is a different form than.the food allergy and anaphylaxis so a.lot that one if it's for insect stings.again primarily bee stings and then the.last one is a seizure action plan and I.would have you complete that with either.the neurologist or your child's primary.provider if this isn't clear enough you.can go ahead and scroll on down and.it'll tell you broken down by grade.level what forms are needed and this is.also important to note if you have a.student new to the district that's going.to be in a different grade so we'll have.here for every student they're gonna.complete this emergency health.information form and then each grades.individual form that will need to be.completed I do want to take a minute to.go through this emergency health.information form so this is a form.that's very crucial that the school.nurses have we will provide this to the.ambulance EMS in the event that we need.to call them so I just wanna go over.this briefly with you and kind of.explain why it's so important for us to.have this this X is a face sheet it.provides EMS with not only your.student's name their birth date.medications that they're taking medical.conditions it also includes if you have.a hospital preference and then it.contact information for you if if the.school has been an unable to reach a.parent so you'll see at the top it's.mostly just that demographic information.students name parents names doctor's.name preferred Hospital there's also a.space if your student is enrolled in all.kids which is a Medicaid program you can.go ahead and provide us that Medicaid in.the ID number this is important here.it's current medications I'm so again.this is anything from a multivitamin.that your student might take once a day.to more severe things like a inhaler.that they use preventative ly or a.rescue inhaler this could also include.if your student regularly takes.ibuprofen or Tylenol then in the next.section it's going to be again some.medical conditions and this is not an.inclusive list so if there's some.medical condition your student has.that's not listed here please complete.the other section just give us on this.line the name of the medical condition.and then me as the nurse I will go into.that and I will talk with the parent and.develop that health plan that we.mentioned earlier and then the next is.just for medical history so any serious.accidents hospitalizations and then if.your students ever had surgery and.there's a couple more questions one is.about if your child has health insurance.and if they do not the school nurses.including myself can help you with.getting health insurance for your.students so go ahead and filled out.section oh and let us know how we can.help you the very bottom is just.permission that you are letting us.release his health information to school.personnel and that you're allowing the.nurse to act in the event that we are in.unable to reach parent for consent so.then you would sign this and date this.and then we do want to point out that a.new form must be completed and turned in.each school year so again if you have a.child on an older grade and you're.thinking I've already filled out this.form we need a new one every year and.then we'd have you sign and date it as.well so I hope this was informative to.you please know that if you have.questions you can reach out to me at.Kaye Myers at male dot or it in two to.three org stay safe thank you.you.you.

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