Patricia O'Brien MSN RN
Roberta Lanning RN
Carol Giannini BSN RN
Jolene Dutkewicz RN
Health Assessment Form
Sports Participation Health Form
2016-2017 Sports Physical Information
Authorization for the Administration of Medication by School, Child Care, and Youth Camp Personnel
The school health office is designed to provide care to students who become ill or are injured while in school. A cumulative health file is maintained for each student. This file includes a record of all immunizations, results of physical examinations, and other pertinent health information.
Mandatory Physical and Immunization Guidelines
The Plymouth Board of Education Policy requires Physical Examinations on the following schedule:
Before entering Pre-Kindergarten: a complete physical exam is required after July 1st of the previous school year and is due before the first day of school. This physical must be filled out on the required State of CT Dept. of Education Health Assessment Record (Yellow Form for Pre K only), the immunization record must be attached and immunizations must be complete according to the current State of CT Dept. of Public Health Requirements.
Influenza: Pre K students are additionally required to receive one (1) dose each year between August 1st - December 31st of the current school year. (2 doses separated by at least 28 days required for those receiving flu for the first time.) Students who do not receive the immunization will be excluded from January 1st until March 31.
Before entering Kindergarten: a complete physical exam is required after July 1st of the previous school year and is due before the first day of school. This physical must be filled out on the required State of CT Dept. of Education Health Assessment Record (Blue Form), the immunization record must be attached and immunizations must be complete according to the current State of CT Dept. of Public Health Requirements.
During Grade 6: a complete physical exam must be completed between July 1st of grade six and before the first day of grade seven. Students who do not return the completed physical form by the first day of grade seven will be excluded from school until the physical is completed. This physical must be filled out on the required State of CT Dept. of Education Health Assessment Record (Blue Form), the immunization record must be attached and all boosters must be up to date according to the current State of CT Dept. of Public Health Requirements.
During Grade 10: a complete physical exam must be completed between July 1st of grade ten and before the first day of grade eleven. Students who do not return the completed physical form by the first day of grade eleven will be excluded from school until the physical is completed. This physical must be filled out on the required State of CT Dept. of Education Health Assessment Record (Blue Form), the immunization record must be attached and all boosters must be up to date according to the current State of CT Dept. of Public Health Requirements.
New Students from Out of State: Connecticut State Law requires students who transfer into a Connecticut Public School from another state to provide documentation of immunizations before the student's first day and a physical exam to be completed within 30 days of entry. A physical exam completed within one year prior to the start date is acceptable as long as it meets all requirements of Connecticut State Law and local health policies. If proper documentation is not provided within 30 days, the student will be excluded until documentation is received.
New Students from Out of the Country: A physical examination completed by an authorized healthcare practitioner licensed in the United States must be done prior to enrolling and must meet all requirements of Connecticut States Law and local health policies. An authorized healthcare practitioner licensed in the United State stationed on a U.S. military base anywhere is also acceptable. A tuberculin skin test is required as per State of Connecticut guidelines. if the requirements are not met, the student will not be allowed to start school.
Annual Sports Physical: According to the Plymouth Board of Education Policy, every student trying out and participating on a school sport team must submit a completed Sports Physical Examination form to the school nurse each year. The sports physical is valid for thirteen (13) months. You may wish to plan ahead to schedule your child's physical to coincide with any necessary sports physical for that school year. A current physical completed on a State of Connecticut Department of Health Assessment Record (Blue form) is acceptable if the parent's portion of the Sports Physical form is complete. Parents with specific questions regarding sports physicals should contact their school nurse.
Annual vision and hearing screenings are given to each student in kindergarten, 1, 3, 4 and 5. Postural (scoliosis) screenings are done annually for females in grades 5 and 7 and males in grade 8.
When the school reports your student acutely ill or injured, it is expected that the parents will make arrangements to immediately transport them home. However, in cases of serious accidents/life-threatening emergencies requiring immediate hospitalization, the student will be sent to the nearest emergency room by ambulance. Parents will be notified immediately in all cases. Please fill out and return the health questionnaire at the beginning of the school year. Any changes in the information provided on these forms should be updated as the need arises.
Students with any medical condition, which within the school setting may expose others to disease, or contagious and infectious conditions, may be excluded from school and referred for medical diagnosis and treatment. Students with contagious bacterial infections must have taken the prescribed dosage of antibiotics for at least twenty-four (24) hours before returning to school. Your child should be fever-free without fever reducing medication for twenty-four (24) hours before returning to school after an illness and no longer be vomiting or experiencing diarrhea. School nurses track illness patterns within the school system. When calling your child out sick, please indicate if your child has symptoms such as fever, cough, sore throat, vomiting or diarrhea or if they have been diagnosed with an illness. If you have questions or concerns regarding symptoms your child may be exhibiting, or whether they are able to attend or return to school, contact the school nurse.
The school district will not discriminate on the basis of disability as required under ADA, IDEA and Section 504 and C.G.S. 10?76a and any similar law or provision.
Homebound instruction shall be provided when a child's condition will cause absence of at least three (3) weeks duration. Instruction shall begin no later than two (2) weeks from the first day of absence, provided nothing in the child's condition precludes it. A note from the child's physician is required stating that the child is unable to attend school for medical reasons. The expected date of return to the school program has to be included in the note. Homebound instruction may also be provided for the following reason(s): child is expelled or excluded from school for safety reasons, a special education program is pending or a pregnancy (also requires a doctor's note).
Students who need to take prescribed medication during school hours must have the medication delivered to the school nurse or principal by the parents or guardian. Students are not permitted to carry medications to school unless they have on file with the school nurse a Self Administration of Medication Authorization/Approval Form completed and signed by both the physician prescribing the medication and the parent. Students who carry their own medications may also have medication stored in the nurse's office. Medications must be in a properly labeled container with the name of the student, physician and medication, date of original prescription, and directions for administering it. The amount must be limited to a ninety (90) day supply. No medication, including over the counter medications, will be given without written permission from both physician and parent on a Medication Administration form. Cough and throat lozenges may be used by students with written permission from the parent and if deemed appropriate by the school nurse. Parents or guardians must pick up unused medication by the last day of school, unless other arrangements are made. The school nurse will dispose of medication not picked up. A new written authorization of medication form is required for each school year.
Exclusion From Physical Education Classes
Students may be excused from physical education classes due to medical reasons. Students needing to be excused should present a dated (including dates of exclusion period) doctor's note to the school nurse, who, in turn, will alert the physical education teacher.
Pediculosis (Head Lice)
Infestation of the hair with head lice is a common condition found among school age children. There is no way of preventing a child from acquiring the condition. The goal should be to detect it quickly and clear it up as soon as possible. Our school health regulations specify that children with live head lice be treated at home with a shampoo that kills head lice. Ordinary shampoo will not work. Following the treatment, the child may return to school if proof of treatment is provided (e.g. pediculicide shampoo box top) and no live lice are found upon examination by the school nurse.
Symptoms of Flu include fever, cough, sore throat, runny or stuffy nose, body aches, headache, chills, fatigue. Some people may also have vomiting and diarrhea. People may be infected with the flu, and have respiratory symptoms without a fever. When calling your child out sick, please indicate if your child has any of the listed symptoms to assist the school nurse in tracking flu like illness in the school system. All ill students must be fever free without fever reducing medication for 24 hours before returning to school and should not be vomiting or having diarrhea.
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