Student Health Concern Information & Forms
Many students have health concerns which may need to be addressed or cared for at school. School Registered Nurse Consultants work with Health Care Providers and School Health Clerks to administer medications, treatments and provide care during the school day.
Health care plans (HCPs) are written by the School Registered Nurse Consultant for students who have health conditions for which the health office has specific procedures to follow such as medications, treatments, special directions for emergency care or special precautions.
All students who have diabetes, seizures, severe allergies or need to medications at school should have a HCP. Other disorders may also have specific precautions which would require a HCP. PLEASE contact the School Registered Nurse Consultant or Health Clerk at your student's school if you have concerns about your child.
Not all students with health concerns require a specific HCP unless we have specific medications, treatments, or care that should be given at school.
Health Care Plans, Physicals & Other Forms Related to Student Health
- Medication at School
- Physicals (Preschool or Sports)
- Severe Allergies or Anaphylaxis
- Asthma
- Diabetes
- Seizure Disorder
- Concussion/Head Injury
- Lice and Bed Bugs Information
- Release of Confidential Information
Medication at School
Medication administration at school requires authorization from a licensed healthcare provider (Physician, Advanced Practice Nurse or Physician's Assistant) AND signed parent/guardian permission.
Medication must be provided by the parent/guardian in an individual pharmacy-labeled bottle for the student who is to receive it. Medication will be given as directed on the pharmacy label and according to healthcare providers' specific orders.
Medications include all prescription or over the counter medication (all pills, syrups, injections, inhalers, epipens, creams, sprays, eye drops, cough drops, sunscreen, etc.). Medications may not be expired.
Medications will be given following state laws only. It is required that all medication (except for those approved for self-carry by the school nurse) be kept in the Health Office for the safety of all students.
Forms (Authorized healthcare provider and parent/guardian completes and signs)
MEDICATION AUTHORIZATION - ENGLISH (8/2023)
MEDICATION AUTHORIZATION - SPANISH (8/2023)
Self-carry contracts can be found in the links specific to the condition or disorder (asthma, diabetes, allergies).
Physicals (Preschool or Sports)
Physical Forms (To be completed by health care provider)
DISTRICT 6 PHYSICAL FORM - ENGLISH (6/2023)
DISTRICT 6 PHYSICAL FORM - SPANISH (6/2023)
Severe Allergies or Anaphylaxis
Allergies are among the most common chronic conditions worldwide. Symptoms of allergies range from a runny nose and itchy eyes to life-threatening reactions. An allergic reaction begins in the immune system. Our immune system protects us from invading organisms that can cause illness. If you have an allergy, your immune system mistakes an otherwise harmless substance, called an allergen, for an invader.
An allergic reaction typically triggers symptoms in the nose, lungs, throat, sinuses, ears, lining of the stomach or on the skin. For some people, allergies can also trigger symptoms of asthma. In the most serious cases, a life-threatening reaction called anaphylaxis can occur.
A number of different allergens are responsible for allergic reactions. The most common include pollen, dust, food, insect stings, animal dander, mold, medications and latex.
For the safety of all students with severe allergies, the health office requests a signed health care plan from your health care provider along with an antihistamine and/or Epipen for school use. In extreme cases, middle and high school students who have proficient knowledge of anaphylaxis may “self-carry” an Epipen with a signed health care plan from the healthcare provider, parent/guardian, and the approval of a school nurse. However, a second Epipen is requested to be stored in the health office.
Allergy and Anaphylaxis Action Plan and Medication Orders
CO ALLERGY/ANAPHYLAXIS CARE PLAN (3/2018)
Self Carry Contract
ALLERGY SELF CARRY CONTRACT - ENGLISH
ALLERGY SELF CARRY CONTRACT - SPANISH
Food Allergies and Special Dietary Needs
With a food allergy, the immune system overreacts to a particular protein found in that food. Many food allergies are diagnosed in young children, though allergies may also appear in older children and adults. There’s no cure for food allergies. However, many children outgrow food allergies. Allergic reactions usually occur within a few minutes of eating the trigger food, though reactions can sometimes appear a few hours later. The eight foods responsible for causing most allergic reactions include cow’s milk, eggs, fish, peanuts, shellfish, soy, tree nuts and wheat.
Some symptoms of intolerance and allergies are similar, but the differences between the two conditions are important. If you have a food intolerance, eating the food can leave you feeling miserable. With a true food allergy, your body’s reaction to that food could be life-threatening. Common symptoms include stuffy or itchy nose, sneezing, or itchy, teary eyes; vomiting, stomach cramps, or diarrhea; hives or red, itchy skin. Symptoms of a life-threatening reaction include hives, throat swelling ("closing") and difficulty breathing.
Source: American Academy of Allergy, Asthma and Immunology.
The Special Dietary Needs Documentation Form must be completed by a recognized medical authority and returned to the Kitchen Manager at the site your student attends in order for meal substitutions/accommodations to be evaluated and provided.
SPECIAL DIETARY NEEDS DOCUMENTATION FORM 8.1.2022
Asthma
For the safety of all students with asthma, the health office requests a signed health care plan from your healthcare provider along with an inhaler for school use. Typically, middle and high school students who are proficient users of inhalers may “self-carry” their inhaler with a signed health care plan from a physician, advanced practice nurse or physician's assistant, parent/guardian and approval of the school nurse. However, a second inhaler is requested to be stored in the health office.
Asthma Action Plan
CO STANDARDIZED ASTHMA ACTION PLAN (2/2021)
Asthma Parent Information
ASTHMA PARENT QUESTIONNAIRE ENGLISH
ASTHMA PARENT QUESTIONNAIRE SPANISH
Asthma Self-Carry Contract
ASTHMA SELF-CARRY CONTRACT - ENGLISH
ASTHMA SELF-CARRY CONTRACT - SPANISH
Asthma is a chronic disease involving the airways in the lungs. These airways, or bronchial tubes, allow air to come in and out of the lungs. If you have asthma, your airways are always inflamed. They become even more swollen and the muscles around the airways can tighten when something triggers your symptoms. This makes it difficult for air to move in and out of the lungs, causing symptoms such as coughing, wheezing, shortness of breath and/or chest tightness.
Childhood asthma impacts millions of children and their families. In fact, the majority of children who develop asthma do so before the age of five. There is no cure for asthma, but once it is properly diagnosed and a treatment plan is in place, you will be able to manage your condition, and your quality of life will improve.
For many asthma sufferers, the timing of these symptoms is closely related to physical activity. Staying active is an important way to stay healthy, so asthma shouldn't keep you on the sidelines. Your physician can develop a management plan to keep your symptoms under control before, during and after physical activity.
Source: American Academy of Allergy, Asthma and Immunology. HTTP://WWW.AAAAI.ORG/CONDITIONS-AND-TREATMENTS/ASTHMA.ASPX
Diabetes
For the safety of all students with Type 1 Diabetes, a health care plan signed by a health care provider is required in order to provide related care at school.
All standards and templates for orders and health care plans related to the care of students with diabetes can be found at:
Nutritional Information, including carbohydrate values, for meals served at school can be found HERE.
General Information about Diabetes:
When you eat food, the body breaks down all of the sugars and starches into glucose, which is the basic fuel for the cells in the body. Insulin is necessary to bring glucose into the cells to make energy. There are two main types of diabetes:
Type 1 diabetes:
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The body does not produce insulin because the cells in the pancreas that make insulin have been destroyed.
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Requires insulin injections to use the glucose from their food.
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Usually diagnosed in children and young adults and was previously known as juvenile diabetes. Only 5% of people with diabetes have this form of the disease.
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With the help of insulin therapy and other treatments, even young children with type 1 diabetes can learn to manage their condition and live long, healthy, happy lives.
Type 2 diabetes:
- Happens because the body does not produce enough insulin OR the body’s cells ignore the insulin (insulin resistance).
- May be managed with life-style changes, such as diet and exercise
- Some people may also need oral medication or insulin injections to help their bodies use glucose for energy.
Risks of diabetes:
Diabetes increases the risk for many serious health problems, but with the correct treatment and recommended lifestyle changes, many people with diabetes are able to prevent or delay the onset of complications. Long-term complications of unmanaged diabetes may include problems with the eyes (glaucoma, cataracts), feet (neuropathy, numbness), skin (infections) and increased risk for heart disease (high blood pressure, heart attack, stroke) or kidney disease.
Source: American Diabetes Association HTTP://WWW.DIABETES.ORG/
Seizure Disorder
Seizure Action Plan (to be completed by physician)
Epilepsy (also called a seizure disorder) is a medical condition that produces seizures affecting a variety of mental and physical functions. Seizures happen when clusters of nerve cells in the brain signal abnormally, which may briefly alter a person's consciousness, movements or actions. Instead of discharging electrical energy in a controlled manner, the brain cells keep firing. The result may be a surge of energy through the brain, causing unconsciousness and contractions of the muscles. If only part of the brain is affected, it may cloud awareness, block normal communication, and/or produce a variety of undirected, uncontrolled, unorganized movements.
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There are many different types of seizures. People may experience just one type or more than one. The kind of seizure a person has depends on which part and how much of the brain is affected by the electrical disturbance that produces seizures. The symptoms of a seizure may affect any part of the body. Most seizures last only a minute or two, although confusion afterwards may last longer. Experts divide seizures into generalized seizures (absence, atonic, tonic-clonic, myoclonic), partial (simple and complex) seizures, gelastic seizures, dacrystic seizures, non-epileptic seizures and statusepilepticus. Generally, the most frequent cause of an unexpected seizure is failure to take the medication as prescribed. Other factors include ingesting substances, hormone fluctuations, stress, sleep patterns and photosensitivity.
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While medications and other treatments help many people of all ages who live with epilepsy, more than a million people continue to have seizures that can severely limit their school achievements, employment prospects and participation in all of life's experiences. It strikes most often among the very young and the very old, although anyone can develop epilepsy at any age. In the U.S., it affects more than 300,000 children under the age of15--more than 90,000 of whom have seizures that cannot be adequately treated.
Source: Epilepsy Foundation HTTP://WWW.EPILEPSYFOUNDATION.ORG/INDEX.CFM
Concussion/Head Injury
ACQUIRED BRAIN INJURY
- Any injury to the brain that occurs after birth (excludes hereditary, congenital, degenerative or birth trauma injuries). It includes both traumatic and non-traumatic brain injuries.
TRAUMATIC BRAIN INJURY
- An injury to the brain due to an external bump, blow, or jolt to the head that disrupts the normal function of the brain. This may be an open head injury where the head is penetrated (skull fracture, gunshot wound, etc.) or a closed head injury that causes the brain to move within the skull (whiplash, concussion, shaken baby syndrome, etc.
NON-TRAUMATIC BRAIN INJURY
- An injury to the brain that is caused by internal incident (stroke, anoxic injury [lack of oxygen], brain tumor, brain infections such as meningitis, etc.).
WHAT IS BRAIN INJURY? (3 MIN VIDEO)
CONCUSSION
The Centers for Disease Control and Prevention (CDC) defines a concussion as:
A concussion is a type of traumatic brain injury- or TBI- caused by a bump, blow, or jolt to the head or by a hit to the body that causes the head and brain to move rapidly back and forth. This sudden movement can cause the brain to bounce around or twist in the skull, stretching and damaging the brain cells and creating chemical changes in the brain.
It is important to recognize that concussions can be sustained through a variety of means including: motor vehicle crashes, falls, bicycle crashes, recreational mishaps, etc. A child/ adolescent does not need to experience loss of consciousness to sustain a concussion. The signs and symptoms of a concussion can be found in the CDC chart below.
RESOURCES FOR FAMILIES:
- ROADMAP TO CONCUSSION RECOVERY - Rocky Mountain Hospital for Children
- CONCUSSION COMEBACK PLAN - Children's Hospital Colorado
- Centers for Disease Control
Source: CO KIDS WITH BRAIN INJURY
Lice and Bed Bugs Information
District Lice Policy
HEAD LICE NOTIFICATION - ENGLISH
HEAD LICE NOTIFICATION - SPANISH
Lice Information
CDC Information (CLICK HERE)
NPIC Information (CLICK HERE)
Bed Bug Information
Information for Classrooms (CLICK HERE)
CDC Information (CLICK HERE)
Release of Confidential Information
Releases of information allow appropriate school staff (typically school nurse, psychologist or administrators) to obtain mental and physical health related records as well as discuss health concerns, treatments and care while at school with student’s health care provider. Parent must sign and date any release of information and may revoke the release at any time.
Release of Information (Typically works for most providers, except The Children's Hospital and North Range Behavioral Health)
DISTRICT 6 RELEASE OF INFORMATION - ENGLISH
DISTRICT 6 RELEASE OF INFORMATION - SPANISH
The Children's Hospital
CHILDREN'S HOSPITAL RELEASE OF INFORMATION - ENGLISH
CHILDREN'S HOSPITAL RELEASE OF INFORMATION - SPANISH
North Range Behavioral Health
NORTH RANGE BEHAVIORAL HEALTH RELEASE OF INFORMATION - ENGLISH & SPANISH