STUDENTS
Regulation 723-4
June 22, 2005
Tuberculosis Screening Requirements
All pre-school, school age, or adult students who are seeking admission to Prince
William County Public Schools who have been out of the United States and U.S.
territories (Puerto Rico, Guam, U.S. Virgin Islands, American Samoa and the Northern
Mariana Islands) for a period of three or more consecutive months during the previous
five years will be required to submit to a tuberculosis screening test prior to admittance
according to the following procedures (see Attachment I):
I. Before being granted admission to Prince William County Public Schools, each student
shall present documentary evidence of one of the following:
1. A written report of a negative PPD test (Mantoux method) administered within 30
calendar days prior to school entry. If a student was in an area where TB is
endemic less than three months prior to desired school entry, a TB symptom
assessment shall be completed (see Attachment III), and if negative, PPD
placement or chest x-ray (CXR) shall be delayed until 10-12 weeks after the date
of entry into U.S. or U.S. Territories from the endemic area. If the symptom
assessment is positive, a PPD shall be placed and the student shall have a chest xray and evaluation for active disease before school entry.
or
2. A written report from the Prince William Health District (PWHD) or a licensed
physician that a recent chest x-ray (within 30 calendar days prior to school entry)
indicates that the student was free from communicable tuberculosis (see
Attachment II).
or
3. A medical exemption to the testing requirement issued by a licensed physician or
nurse practitioner or a local health department in Virginia. If the exemption is
temporary, the exemption document must indicate the conditions of the
exemption and the date the exemption expires. A TB symptom assessment shall
be done (see Attachment III). If the TB symptom assessment is positive, the
student shall have a chest x-ray and evaluation for active disease before school
entry.
or
Regulation 723-4 STUDENTS June 22, 2005 Page 2
D. A negative risk and symptom screen will be acceptable for those who can present
written documentation of having completed prophylaxis treatment for TB infection and
have not been out of the country to an endemic area for more than three consecutive
months.
II.
III.
IV.
V.
Based upon changing circumstances or other medical reasons, any incoming
student may be required to submit to these procedures.
If the tuberculosis screening is positive, the student shall not be admitted to Prince
William County Public Schools until the student has had a chest x-ray and has
been cleared by a local health department in Virginia, or a licensed physician, or
nurse practitioner for attendance to school.
If the tuberculosis screening is negative, the student shall be admitted to Prince
William County Public Schools.
Staff members shall refer any concerns regarding documentation provided by
students to the school nurse for further evaluation. The school nurse shall consult
with the Supervisor of School Health Services and the Prince William County
Health District.
The building principal, appropriate associate superintendent, and the Director of Student
Services are responsible for implementing and monitoring this regulation.
PRINCE WILLIAM COUNTY PUBLIC SCHOOLS
Attachment I Regulation 723-4
STUDENT'S NAME
_____________________SCHOOL___________________________
Dear Parent/Guardian:
The Public Health Department and Prince William County Public Schools regulations
require that enrolling students, who have spent at least three consecutive months outside
of the United States and U.S. territories (Puerto Rico, Guam, U.S. Virgin Islands,
American Samoa and the Northern Mariana Islands) during the previous five years,
submit proof of tuberculosis screening at the time of enrollment.
Such students are required to present documentary evidence as follows:
1. A written report of a negative PPD test (Mantoux method) given within 30
calendar days prior to school entry. The written report must be certified by the
Department of Health, a physician, or nurse practitioner licensed to practice
medicine in the United States.
2. A written report from a licensed physician that a chest x-ray taken within 30
calendar days prior to school entry indicates that the student was free from
communicable tuberculosis.
3. A medical exemption to the testing requirement issued by a licensed physician,
nurse practitioner, or a local health department in Virginia. If the exemption is
temporary, the exemption document must indicate the condition of the exemption
and the date the exemption expires. A TB symptom assessment shall be done (see
Attachment III) by the school nurse.
Please check the statement below which applies to the enrolling student:
__________ The enrolling student has not resided outside the United States for three
consecutive months in the past five years.
__________ The enrolling student has resided outside the United States for at least three
consecutive months within the past five years and I understand that I must present
evidence of tuberculin screening as described in this document.
___________________________________ ___________________________
Parent/Guardian Signature Date
Prince William County
Public Schools P.O. Box 389 Manassas, VA 20108 (703)791-7200
Dear Licensed Health Care Provider:
Please provide the following information for:
Name of Student:____________________________________________
I certify that the above named student has had a chest x-ray and _____is/_____is not free
from communicable tuberculosis.
Name of Licensed Physician or Nurse Practitioner:
Address: Phone:
__________________________________________
__________________________________________
__________________________________________
_________________________________________ ______________________________
Signature Date
Attachment II Regulation 723-4
Attachment III Regulation 723-4
Student’s Name Date of Birth School
Tuberculosis Symptom Assessment
Cough for more than three weeks Unexplained fever
Coughs up blood
Unexplained weight loss Unexplained chest pain
Night sweats
Poor appetite
FOR CHILDREN UNDER SIX YEARS OLD Wheezing
Failure to thrive
Decreased activity and/or energy
Lymph node swelling
Personality changes
Comments
School Nurse’s Signature Date
If student presents with one or more of the above symptoms, refer to PWHD for further
evaluations prior to school entry.