Jan Rey RN, School Nurse

Adrenal Insufficiency Action Plan

---

Physician Req. for Special Diet Accommodations

Please read the bottom of the form where it states that the completed form needs to be faxed or emailed to the Nutrition department.  Please do not FORGET to do this.  

---

Anaphylaxis Emergency Action Plan

This form requires the signatures of both your child's physician and the  parent/guardian.

---

Peanut and Nut Allergen-Free Table

If your child has a nut allergy, then you will need to sign this form stating that you "do" or "do not" want your child to sit at the Nut Free table. Understand that if you choose to have your child sit at the Nut Free table, they can only have a friend who has purchased lunch from the cafeteria to sit with them. 

---

Allergy History

This form is filled out by the parent and signed by the parent, NO physician signature required.

---

Asthma Action Plan

This form requires the signature of the child's doctor and the parent/guardian.

---

Doctor Authorization for Medication

Any prescription medication that is going to be given at school needs this form filled out and signed by both the physician and the parent/guardian. This form is NOT required for Over the Counter (OTC) medications.

---

Field Trip Permission Slip

This form is sent home with your child when they are going on a field trip. If your child is going to need medication administered during the field trip, it is the responsibility of the parent/guardian to give the  student's medication to the teacher/field trip leader with instructions on when and how the medication should be given.  Medication must be in the ORIGINAL PHARMACY BOTTLE WITH CURRENT DATE.  Over the counter medication must also be in the original container. 

The Nurse will give the teacher/field trip leader the Epi Pen and Antihistamine. All staff are trained on how and when to use anaphylactic medications.  Parent/Guardian signature required.

---

Overnight Field Trip Medication Consent Form

---

Medical Procedure at School

For any procedure being done at school: Catheterization, Tracheal Suctioning, Tube feeding etc... This form will need the signature of the child's physician and the parent/guardian.

---

Medication Administration Record (MAR) 24-25

This form is signed by parent/guardian, dated, and then to the right of the signature please check whether "you will" or "will not" pick it up at the end of the school year.   All medications not picked up will be destroyed...Medications are not carried over from one year to the next.

---

Parent Permission to Self Carry Emergency Meds.

If a parent feels that their child can assume the responsibility for carrying their Emergency Medications for the treatment of Asthma, Anaphylaxis or seizures, then this form needs to be signed by the Parent/Guardian and the Nurse.  The rescue inhaler, and the Epi Pen, needs to be wrapped with the original pharmaceutical label with the student's name, prescription number, name of medication and the dosage to be administered. 

 Please read the details of the responsibility that your child assumes when carrying medication on their person.

---

Seizure Emergency Action Plan

Physician and Parent/Guardian signatures required. 

Immunizations have proven to be the most effective way to stop the spread of disease. We offer immunizations to children and adults in Maricopa County at our standing clinics and at scheduled community events. Anyone with or without insurance is welcome. Appointments are required at our standing immunization clinics by calling 602-506-6767. Learn more at the Maricopa County public health website.

Asthma

A child with asthma has rights under the law.  HB 2229 (Asthma Rescue Medication Bill) was signed on 4/11/05 and "allows for the possession and self-administration of
prescription medication for breathing disorders by the pupil who has been
prescribed the medication by a licensed health care professional if the pupil's
name is on the handheld inhaler device . . ."  Yearly written permission from
the parent is required (available thru the nurse's office).  Visit the Arizona
Asthma Coalition's website. The National Heart, Lung and Blood
Institute, thru the U.S. Department of Health and Human Services, has a great informational video on asthma and how to control it.

Anaphylaxis/Food Allergies

A child with food or other potentially severe allergies has similar rights. SB 1309 was signed 5/11/05 and allows pupils who have been diagnosed with anaphylaxis, by a specified licensed health care provider, to carry and self-administer emergency medications, including auto-injectable epinephrine, while at school and school-sponsored activities . . ." Yearly written permission from the parent is required (available thru the nurse's office). For more info., visit foodallergy.org.

More than 40 of our students have food allergies. Many of them are allergic to peanuts, tree nuts and/or eggs.  If you want to provide snacks for your child's classroom during a party time and your child's classmate is allergic to one or more of these items, please choose a snack from this site:  http://snacksafely.com/tag/peanut-free/. ALWAYS CONSULT WITH YOUR CHILD'S TEACHER ABOUT ANY SNACKS BEING PROVIDED.

Concussions

As awareness about the dangers of concussion in sports continues to grow, Mayo Clinic has taken measures to provide baseline concussion testing at no cost to every high
school and middle school student athlete in Arizona for the 2011-2012 sports
season.  This is a landmark initiative.  The Computerized Cognitive Assessment
Tool (CCAT) will be made available at no cost.  The test results, which remain
the property of the athlete, can be shared with the health care provider of
their choice.  After a concussion, the test can be repeated multiple times and,
along with a medical evaluation, will assist providers in making a decision
about when an athlete can safely return to the classroom, sports, and other
activities.  For more information, e-mail concussion@mayo.edu.

Bites, Stings, Poison, Drugs

Call Banner Health's Poison
Center Hotline at 1-800-222-1222 for free, fast expert help 24 hours a day, 7 days a week.

Go to Urgent Care or ER?

Good question. 
Click here for information from Phoenix Children's Hospital.

Drugs of Abuse

Visit websites for the latest information:

www.drugabuse.gov
Mental Illness
National Alliance on Mental Illness

Protect Your Kids Online

Wiredsafety.org
KidsHealth, http://KidsHealth.org/   Healthgate, http://www.healthgate.com/

The Latest on Car Seat Safety

New law mandates booster seats for children who are at least 5 years old but younger than 8, and no taller than 4-foot-9 inches tall.
What car seat is best?

Bicycle Safety

Every year we have a few students get hurt while riding to or from school.  Share this great site with your children:  nhtsa.gov/people/injury/pedbimot/bike/kidsandbikesafetyweb/index.htm

Nutrition

Understanding Child Nutrition
pediatrics.about.com/od/nutrition/a/nutrition_hub.htm

Ten Tips for Picky Eaters
mayoclinic.com/health/childrens-health/HQ01107

Free and Reduced Lunch Program
dvusd.org/pages_our_schools/school_menus.htm#

Fun for Kids

Rockin' interactive website sponsored by Kohl's and Phoenix Children's Hospital
kohlskidsrockstars.com

This is a fun game to help your child learn about asthma
Quest for the Code

For teens living with a chronic illness
www.starlight.org
 

Seasonal FLU Information

https://azdhs.gov/preparedness/epidemiology-disease-control/flu/index.php#-basics

www.wearepublichealth.org

www.flu.gov

www.stopthespreadAZ.org

www.cdc.gov/flu/