NURSING SERVICES

A Credentialed School Nurse (CSN)/Registered Nurse (RN)/Licensed Vocational Nurse(LVN) or health services assistant(HSA - an unlicensed personnel) will be in the health office 5 days a week. The CSN/RN/LVN/HSAwill contact parent(s)/guardian(s) regarding illnesses and injuries that occur during the school day. AllRNs/LVNs/HSAs providestudent health careunder the supervision and direction of the Credentialed School Nurse. RNs/LVNs/HSAs follow the Emergency First Aid Guidelines for Schools when providing first-aid care to students and are CPR/First Aid certified.

EMERGENCY INFORMATION: Ed Code49408

The health office or school administrator will contact parent(s)/guardian(s) in anemergency situation due to illness or injury. It is very important that the health office has current parent/guardian contact information. If there is a change in your child’semergency contact information,please log into Parent Connect and update your information as soon as possible.

FIRSTGRADE PHYSICAL EXAMINATION REQUIREMENT:

California StateLaw (California Codeof Regulations, Title 5, Section 432 (2) (B) requires thateach student have acomplete Child Health and Disability (CHDP) physical examination within 18 months beforeentering first grade or90 days after entering first grade (Health & Safety Code 124040, 124085).

The purposeof thisexamination is for the healthand safety ofyour child and can help identify any health problemsthatmay keep yourchild from doing well in school. Early detection is the best prevention.

A waiver signed by the child’s parent/guardian indicating that they do not want or areunable to obtain the health screening and evaluation services for their children shallbe acceptedby the school in lieu of the CHDP form. If the waiver indicates that the parent/guardian was unable to obtain the services for the child, then the reasonswhy shouldbe included in thewaiver.

The CHDP form is available on the CUSD websiteunder the “Parents” tab.Click “Health Forms” or a hardcopycan be requestedfrom your child’shealth office.

IMMUNIZATIONS

Board Policy 5141.31; A.R. 5141.31; Health and SafetyCode 120325-120375; CCR Title 17,Division 1, Chapter4

To be admitted to school, California law requiresthat all children be fully immunized. There are required immunizationsto attend public elementary and secondary schools, childcarecentersand developmental centers.Schools, and pre-kindergarten facilities arerequired to enforce immunization requirements, maintain accurate/complete immunization recordsof allenrolled children and submit reports. Childrenshall be excluded from school or exempted from immunization requirements only asallowed by California law.

At the time of registration, the schoolsite isrequired to have proof that your child has received all currently due immunizations to completethe enrollment process. If required immunizations are not provided by thefirst day of school, your child will not be able toattend.

As of January 1, 2016, California law SB277 no longer allows for a personal beliefsexemption including religious beliefexemptionsas of July 2016. Any studententering school for the first time in Californiaafter July 1, 2016 will need to befully immunized or have a medical exemption from a California physician.

Medical Exemptions:

Starting January 1, 2021, the only immunizationaccepted is a medicalexemption written by a California physician for studentsthrough CAIR-ME.Any medicalexemptions issued in CAIR-ME shall expirewhen the student enrolls in thenext grade span orthe medical exemption issued was temporarywith anexpiration date.
Refer tocair-me.cdph.ca.go/homeonhow to obtain a medicalexemption or contact your school site health office with questions or needing additional information.

Immunization Exclusion:

Ed Code 48216 (a),(b), & (c); A.R. 5141.31

Studentswho are not in compliancewith their immunizations, parent/guardian will be contacted by the health office informing them of their child’s missing immunizations. An immunization letter will be senthome indicating the immunizationsneeded to be incompliance. Parent/guardian have two (2) weeks or ten (10)school daysto supply evidenceeither theirchild has been properly immunized,or their child will be exempted from school duetonot meeting immunization requirements. Your child will remainexcluded from schooluntil a current immunization record is provided to the health office.

HEALTH ASSESSMENTS

Vision, Hearingand DentalHealth Screening

CA Ed Code 49454; EdCode 49455; Ed Code 49452;BoardPolicy 5141.3; A.R. 5141.6

California Education Code allows qualified districtemployees (sections 49452, 49454) to conduct routine vision, color vision and hearing screenings to each student enrolledin the District. The Stateof California visionand hearing screening isto becompleted in Kindergarten, 2ndgrade, 5th grade, 8th grade and 10th grade, aswell as upon a writtenreferral from parent/guardian or teacher at any gradelevel (California Code ofRegulations, Title 17, Section 2952 (1)).
A written statement must be filed with the Credentialed SchoolNurse by a parent/guardian requesting exemptionof their child from the routine health screenings for vision and hearing.

Oral Health Assessment Requirement CA Ed Code 49452.8

A pupil, while enrolled inkindergarten in a public school, or while enrolled in first grade in a public school if thepupil was not previously enrolled in kindergarten in a public school, no later than May 31 of the school year, shall present proof of having receivedan oral health assessment by a licensed dentist, or otherlicensed or registered dental health professional operating within his or

her scope of practice, that was performed noearlier than 12months before the date ofthe initial enrollment of the pupil.
The parent/guardian of apupil may be excused from complying by indicating on a waiver form that the oral health assessment could not be completed.

TUBERCULOSIS (TB) RISK ASSESSMENT Board Policy 5141.26; A.R. 5141.26

New or Returning Students

Each student seeking admission intoa District school, whether for the first time, or if returning to the District school after being enrolled in another school in California, another state, or,spent 30 or more days in a high risk TB country, shall complywith submitting to a TB Risk Assessment by a school nurse/RN/LVN or provide documentationof a negative TB blood test (IGRA-QuantiFERON or T-SPOT) or TB skin test (TST).
1. All studentsmoving fromout of the countryand/or residing in a high TB risk country will be required to be cleared through the Children’sHealth Center prior toenrollment at their school site.
2. If any blood or skin test is positive, proof ofa negative chest x-ray indicating the student is free from communicable TB must besubmitted to the health office.
3. A student who is assessed of being at risk of having TB shall: get a TB blood test (IGRA-QuantiFERON or T-SPOT) or a TB skintestunless proof of documentation isprovided to the health office showing treatment for current or prior positive IGRA or TST performed in the United States, have a negative chest x-ray or no new risk factors since last documented negative TGRA or TST.

TYPE 1 DIABETES INFORMATION Reference:https://www.cde.ca.gov/ls/he/hn/type1diabetes.asp

In accordance withEducation Code 49452.6, informationregarding Type 1 diabetes, including risk factors is required to beprovided toevery incoming family. For questions or concernsrelated to Type 1 diabetes, please contact yourhealthcareprovider or school nurse.
According to the U.S. Centers for Disease Control and Prevention (CDC), cases of type 1diabetes in youth increased nationally from 187,000 in 2018 to 244,000 in 2019, representing an increaseof 25 per 10,000 youths to 35 per 10,000 youths,respectively.The peak ageof diagnosisof type1 diabetes is 13-14 years, but diagnosiscan alsooccur muchearlier or later inlife.

Contact your child’s health care provider or school nurse if you have questions regarding Type 1 diabetes.

Type1 Diabetic Student

1. Diabetic ordersand HealthRelated Action Plan (HRAP) must be reviewed by the school nurse and parent/guardian prior to starting/returning to school.
2. Diabetic orders MUST berenewedevery school year (A.R. 5141.21). Your child may not be on campuswithout current diabeticordersand supplies, including emergency medication. This is for the healthandsafety of your child.
3. All supplies, including snacks and/or emergency medication mustbeon-site daily. This can be stored inthe healthoffice or on-person.

TYPE 2 DIABETES INFORMATION-REQUIRED FOR INCOMING 7TH GRADE STUDENTS Reference: https://www.cde.ca.gov/ls/he/hn/type2diabetes.asp

Pursuant toCalifornia Ed Code Section 49452.7, local education agencies are required to provide parents/guardians information on Type 2 diabetesto all incoming 7th gradestudents.

This information is provided to parents/guardiansduring the annual enrollment process. The California Department of Educationdeveloped this Type 2 diabetes information incollaboration with the California Department of Public Health, American Diabetes Association, California School Nurses Organization,and Children’sHospital ofOrange County.

Parents/guardians may contact the school nurseat their child’s school site for any questions they may have regarding the information provided about Type 2 diabetes.

FIRST AID, ILLNESSES AND INJURIES

If a student is injured or ill at school, he/she/they will receive careand consideration by the health officestaff. The health office follows the Emergency First AidGuidelines for Schools when providing first-aid care tostudents. Parents/guardians willbe contacted for any serious injury or if the student is too ill toremain at school. Studentswill be released throughthe healthoffice. The credentialed school nurse is available to consult with parents/guardiansregarding health problems upon request,however,any injuries which occur at home should be cared for at home. Parents/guardians should follow-up with the credentialed school nurse regarding any extended illness or injuriesthat require needed care or accommodations while at school.

Assistive Devices

Crutches,wheelchairs,walking boots/shoes, walkers, scooters and castsrequire a medical note or CUSD School Participation Following Injury/Illness form and physical/academic restrictions in order for students to attend school. Refer to Ed Code 48213.
Brace, elastic bandage, sling and splint require amedical note or CUSD School Participation Following Injury/Illness form if the parent isrequesting a PE excuse beyond three (3) days.

When to keep your child homedueto illness:

1. Temperature 100.0 F or greater within24 hours 2. Illness affecting child’s ability to learn
3. Vomiting/Diarrhea

4. Sore throat-difficulty breathing or swallowing, orcontinuousdrooling

5. Cold symptoms-continuous cough, difficulty breathing, uncontrolled wheezing, excessive nasal drainage (excludes seasonal allergies)
6. Ear/Eye irritation-redness with drainage, difficulty seeing or hearing, injury, intolerable pain •	Suspected pink eye-notify healthcareprovider for evaluation and providemedical
documentation to healthoffice.

7.	Rash-worsening, painful, drainage, not healing 8.	Starting antibiotics within 24 hours for an illness

When yourchild may return toschool due to illness:

1. Fever free for24 hours without the use ofa fever reducing medication(s) (Ex. Tylenol or Motrin).
2. Vomiting/Diarrhea-student isable to tolerate liquids and foodand/or stools have improved. 3. Pink eye-medical noteclearing student of disease or two doses of antibiotics to be given
before returning to school.

4. Rashes, such as but not limited to impetigo, ringworm,scabies and pinworms-medical noterequired clearing your student of possible communicable disease ora medical note stating the diagnosis andthat appropriatetreatment was initiated. Notify the healthoffice.

PHYSICAL EDUCATION:

•	Parent Note: Students will be limited to 3 days per quarter for handwritten parental note excusals from PE.A medicalnote from a healthcare provider will be required after 3 days.
•	Medical Note: This noteshould include a diagnosis and specific dateforreturning to PE, as well as any limitationsthat might apply. If your child has an injury that requires them to remain out of PE, they will also be held out of recess and sports.

CONCUSSION PROTOCOL

If your child is suspectedof having aconcussion or has been diagnosed with a concussion, the CUSD Return toLearn-Concussion School Care Plan form needs to becompleted by a physician indicating no evidence ofa concussion or providespecific academic accommodations, if diagnosed.
If your child’s concussion has resolved, a new medical note or the CUSD Return to Learn-ConcussionSchool CarePlan form needs to indicate your student is cleared for full academic participation.

COMMUNICABLE/INFECTIOUS DISEASE Board Policy 5141.22; A.R. 5141.22

The health office refersto the California School Nurses Organization, Guidelines for Communicable Diseases and Common Conditions in the Educational Setting, along with guidance and direction from the Fresno County Department of Public Health (FCDPH). Whennecessary, communicable diseasecases are reported to the FCDPH. When two or more cases ofa communicable diseaseare reportedin a classroom within 14days of each other,a notification letter may be sent homefrom thehealth office.

HEAD LICE:

Clovis Unified School District operates on NO LIVE LICE guidelines. Students will be sent home if evidence of live lice is found. Students must betreated within 48 hoursandhair/scalpare free from live lice. Students must be seen inthe health office and be cleared to return to class. After 48 hours,absenceswillbe unexcused. Classroom checks areno longera part of our guidelines.
Head Lice Guidelines can be found on the CUSD Nursing Services website. https://www.cusd.com/NursingServices.aspx.

MEDICATION AT SCHOOL:

EdCode 49423, 49480; Board Policy 5141.21; A.R. 5141.21

All medications, even over-the-countermedication(s) (including Tylenol, Advil, cough drops,eye drops, essential oils, etc.) requirea physician order and arereviewed bythecredentialed school nurse. Medication orders must beupdated at thebeginning of each school year. The Medication at School form is available in the school healthoffice or on theCUSD website. https://cusd.com/HealthForms.aspx

CA Education Code Section 49423 requires that any medications to be taken at schoolmust be presented with:
•	A writtenstatement fromthe physician detailing the nameof the medication, amount, method, and timemedication is to be taken.
•	A writtenstatement fromthe parent/guardian indicating their consent for the schoolto assist the student inthematters set forth in the physician’s statement
•	Medicationmust beclearly labeledand sentto school in the original container from the pharmacy

Please note: Medication(s) brought to the healthofficewithout following the above guidelines will NOT beaccepted or given at school. TheHealth Office does not keep medication for generaluse.

EMERGENCY ADMINISTRATION OFNALOXONE(NARCAN) NASAL SPRAY

California Education Code (EC) Section 49414.3 authorizes school districts,county offices of education,and charterschools to provide emergency naloxone or another opioid antagonist to school nurses or trainedpersonnel who have volunteered, and to use naloxone or another opioid antagonistto provideemergency medical aid to persons suffering, or reasonably believed to be suffering, from an opioidoverdose.

AIR QUALITY PRECAUTIONS:

Pleasereferto CUSD School Board Policy 3514 for more information about Air Quality Precautions. CUSD Board Policies can be found atthe following website: https://boardpolicies.cusd.com/ClovisUnifiedBoardPolicies.aspx

CHILD PROTECTIVE SERVICES

Penal CodeSection 11166 requiresany Mandated Reporter who reasonably suspects has been the victim of child abuse or neglectmustreport it to Child Protective Services (CPS).
All school personnelaremandated reporters.