Exceptional Student Education
School Health and Nursing Services as a Related Service for Students with Disabilities
Overview
School nurse services are services provided by a licensed school nurse. School health services
are services that may be provided by either a school nurse or other qualified person, who has
received appropriate training. This document addresses the scope of health related services that
fall under the related services umbrella and which the school district must provide to students
with disabilities.
Legal Requirement
School health services and school nurse services are included in the Individuals with Disabilities
Education Act (IDEA) definition of related services. The collective term means "health services
that are designed to enable a child with a disability to receive free appropriate public education
(FAPE) as described in the child's individualized educational plan (IEP).
The school district is responsible for providing services necessary to maintain health and safety
of a child, including assistance with breathing, nutrition and other bodily functions (e.g., nursing,
suctioning a tracheotomy, urinary catheterization). While the child is in school, these services
may be provided by someone who has been trained to provide the service.
Key Points

School health and school nursing services include:
 Management of chronic health care - Assistance with ambulating (walking) and
daily living skills (e.g., toileting, feeding);
 Health monitoring & management - Monitoring for fatigue, seizures, heart
issues, respiratory distress, and change in appearance;
 Health Care treatment & procedures –Providing tracheotomy care, tube feedings,
catheter care, and ventilator care;
 Health care coordination & procedures – Escorting students to/from or on bus,
and wheelchair transfers, consultation with parents and/or health care providers;
 Emergency Healthcare – Treating minor wounds;
 Crisis Intervention – Interceding in life-threatening accidents or situations;
 Health Training –Participating in student specific training (e.g., diabetes
management, administration of emergency medications such as EpiPen, from a
registered nurse.

Exceptional Student Education (ESE) Assistants who receive child-specific training and
monitoring from a registered nurse are qualified to provide certain delegated school
health services.
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Exceptional Student Education
School Health and Nursing Services as a Related Service for Students with Disabilities

Authorized qualified school personnel (e.g., ESE Assistants) work under the supervision
of a Registered Nurse when providing appropriate school health services in the
educational setting.

An Individualized Health Plan (IHP) is not required for the provision of all school health
services. At a minimum, the nurse will provide monthly consultation with the student,
teacher, and ESE Assistant.

IHPs are primarily developed for students with chronic medical conditions that may
require emergency intervention, e.g., diabetes, allergies, seizures, asthma. IHPs may be
developed for students with other health conditions as needed.

A “School Health Aide Documentation Log” must be maintained by the ESE Assistant.

Health and nursing services must be documented on the IEP under Related Services
when provided to a student with a disability by either an ESE assistant or a school nurse.

A nurse is a member of the IEP team when a student with a disability is provided school
health services and/or school nursing services.

School health and school nursing services’ contacts, include: the ESE Coordinator, the
District Health Services Coordinator, and/or the Medicaid Manager.
IEP Procedural Steps
1. Schedule an IEP meeting and notify all members, including the school nurse. A
registered nurse must attend the IEP meeting or provide a written statement testifying
that the student requires health and nursing services. An excusal is not necessary as a
nurse is not a mandatory IEP team member.
2. Check “health care” domain on IEP > Cover sheet.
3. Document health and nursing services/monitoring and management as a related service
on the IEP when services are provided by an ESE Assistant.
4. Document health and nursing services as a related service on the IEP when direct
services are provided by a nurse.
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Exceptional Student Education
School Health and Nursing Services as a Related Service for Students with Disabilities
5. Document health and nursing services AND health and nursing services/monitoring and
management under related services when both services are provided by a school nurse
AND qualified school personnel (e.g., ESE Assistant).
6. Maintain copy of the IHP, if required, with the school nurse. The IHP is not an ESE
audit file document.
7. Carefully review the Matrix of Services, Domains C and D, as it relates to the services
documented on the IEP and provided to the student.
8. Notify data entry to input the code “NS” in the “Nursing Services” field on TERMS,
Panel S714.
9. Notify nurse, when not in attendance at the IEP meeting, school health and/or school
nursing services have been documented on the IEP.
10. Child-specific training, as appropriate, will be identified and provided by the registered
nurse. Training provided to relevant school personnel will be documented and
maintained by the nurse.
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