EXAMPLE School Health Care Plan
1. Fluid Intake.
An adult must monitor (CHILDS NAME) fluid intake at all times. An adult
must ensure that (his/her) water bottle is with (him/her) at all times, and
must remind (him/her) to drink from it regularly. While in school (CHILDS
NAME) must consume 4 ounces of liquid every 1 hour. The amount of fluid
consumed must be monitored, documented in writing, and reported to the
parents daily. (CHILDS NAME) parents will send (him/her) with either an
empty water bottle or full jug of water OR 8 oz. of prefilled spring water
bottles. ((CHILDS NAME) is only permitted to drink liquids sent from home
unless there is an emergency.) If (CHILDS NAME) drinks juice at lunch time
that will count towards (his/her) 4oz of liquid. Parents should be contacted
within 45 minutes of (CHILDS NAME) refusing fluids.
2. Food Intake.
A. Due to allergies, digestive issues, and sensitivities (CHILDS NAME) is only
permitted to consume food sent from home or preapproved by (his/her)
parents.
B. In order to keep (his/her) metabolism at an appropriate level, avoid
energy loss, and reduce the risk of fatigue, (CHILDS NAME) must eat
multiple small meals throughout the day. All snacks will be sent from
home and will be eaten as follows: - a snack at …………., -her lunch at
…………, - and a snack at ………. (CHILDS NAME) should be encouraged to
finish (his/her) snacks and lunch. Parents should be notified in the event
that (he/she) refused food. Any of unfinished food from (his/her) lunch
should be sent home so the parents can fully monitor food intake. If
(CHILDS NAME) requests additional food beyond her scheduled
snack/lunch times (he/she) should be allowed to have an additional
snack.
3. Protocol: Events requiring an immediate trip to the school nurse.
A. (CHILDS NAME) must be escorted in going to the clinic and see the nurse
immediately when (he/she) asks to see the nurse. NO DELAY is
acceptable.
B. (CHILDS NAME) must be monitored throughout the day while working in
class for any of the following, and if they appear, (he/she) must be
brought immediately to the clinic. The nurse will contact the parents for
any of the following: unusual pallor, paleness, flushing, inability to regain
visual focus, cramping of hands-limbs-abdominal, disorientation, chest
pain, irregular heartbeat, dizziness, shaking, trembling, difficulty
breathing, difficulty swallowing, headaches, vomiting, increased body
temperature above 98.6.
C. If (CHILDS NAME) complains of fatigue (he/she) must be escorted to the
clinic and allowed to nap/rest for up to 30 minutes. If (CHILDS NAME)
says (he/she) is ready to go back to class before the 30 minutes is up
(he/she) should be allowed to do so. These rest periods should be
documented and reported in writing to the parents.
4. Protocol: Seizures
(CHILDS NAME) seizure protocol should include the standard seizure
protocol. In addition any additional seizure symptoms such as staring spells,
unresponsiveness for any short periods should be documented in writing
and parents notified.
5. Staff Training.
(CHILDS NAME) health status directly impacts (his/her) ability to perform in
the educational setting. In order to keep (CHILDS NAME) safe and healthy
while at school all staff will complete training/ review educational materials
provided by (CHILDS NAME) medical team/parents prior to the first day of
school. Information will be reviewed regarding (CHILDS NAME) specific
needs in relation to (his/her) mitochondrial disease, bowel disease,
autonomic dysfunction, and temperature dysregulation. This will
include ANY staff that might be alone with (CHILDS NAME) during her school
day.
6. Reduction in physical activity.
A. (CHILDS NAME) requires a modified P.E program/reduction in time or
change in activity depending on (his/her) daily symptoms.
B. If (CHILDS NAME) should start to experience any symptoms during P.E
time (his/her) activity should be stopped immediately and above nurse
protocols should be followed if necessary.
7. Notification of infectious illnesses.
Parents should be notified of any infectious illnesses in the classroom.
8. Transportation Plan.
A. (CHILDS NAME) will only take an air-conditioned or heated bus to and
from school.
B. (CHILDS NAME) will require a bus monitor and all monitors & drivers
will have training on campus specific to (CHILDS NAME)
transportation/health care needs.
C. (CHILDS NAME) will require prompting when it’s time to load/unload the
bus.
D. Monitors MUST make sure that (CHILDS NAME) is buckled in her seat
belt properly.
9. Stress Reduction.
(CHILDS NAME) experiences stress in connection with her effort to cope with
the symptoms of her disease, and this stress can in turn cause further fatigue
and potential progression in (his/her) disease. (He/She) should be assisted
in reducing stress levels by providing the specific supports described above
and by maintaining an encouraging attitude towards (him/her). As the
above protocols, if not followed may have a negative effect to (his/her)
education/health.
Physician Signature
Date