CLINIC MANAGEMENT
TABLE OF CONTENTS
State Requirements
 Introduction
 School Physical Requirements
 Immunization Requirements
 Birth Certificate Requirements
 Requirements for Educational Facilities
 Health Room Equipment and Supplies
Emergency Health Standards
 Guidelines
 Emergency Preparedness
Injury/Illness Assessment Guidelines
 Introduction
 Guidelines
Clinic Records
Clinic Maintenance & Warehouse Supplies
Poisoning – Overdoses
 Table: possible overdose substance, effects and procedure
Mandatory Child Abuse Reporting
 Physical & Behavioral Indicators of Child Abuse & Neglect
Clinic Volunteers and Procedures
 Responsibilities
 Clinic Procedures
 Measurement of Body Temperature
 Measurement of Pulse
 Measurement of Respirations
 Measurement of Blood Pressure
 Application of Ice
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STATE REQUIREMENTS
INTRODUCTION
The intent of the immunization and physical examination is to assure a healthy, protected school
population and to identify and correct any problems or potential problems that might interfere with
learning. Entrance requirements are based upon Florida Statute, regulations of The Department of
Health and policies of the Pinellas County Schools Board.
At the time of school registration, a State of Florida Department of Health, Cumulative School Health
Record (DH Form 3041) should be opened and all health information placed inside. DH Form 3041 can
be obtained through Health Services 588-6320.
SCHOOL PHYSICAL REQUIREMENTS
INITIAL ENTRANT
1.
3.
4.
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6.
7.
A school physical (original or photocopy), signed or stamped by a licensed examiner and dated within one
year prior to enrollment, is required for each student initially entering a Florida school FS 1003.22.. An
appointment for a school physical is unacceptable for registration purposes. (Special consideration is
given to students that are homeless. (S.390016)
School physicals may be documented on the State of Florida, Department of Health, Student Health
Examination (DH Form 3040) or any other form that is inclusive of the same data (i.e., height, weight,
review of systems, any lab results, etc.). Middle School and High School Health Examination Forms
(athletic physicals), Florida Special Olympics Medical Release and Head Start physicals are examples of
acceptable entrance physicals, if signed by a licensed examiner and dated within one year prior to
enrollment.
Any health professional who is licensed in Florida, another state or a foreign country (refers primarily to
foreign exchange students) where the student resided at the time of the physical and is authorized to
perform a general health examination under such licensure (medical doctor, osteopath, chiropractor,
nurse practitioner) is acceptable to certify that the physical examination has been completed.
Infants, toddlers, and children registered in all pre-kindergarten programs are required to have a school
physical dated within one year prior to enrollment and a new school physical each year thereafter until
they become eligible for kindergarten registration. The school physical on file expires one year from the
date that it was performed. When these children become eligible for kindergarten registration, the school
physical on file must be dated within one year prior to the date of kindergarten registration.
* A tickler system is recommended to assure follow-up after the expiration of pre-kindergarten
yearly physicals.
Any currently or previously enrolled student, regardless of the length of his/her enrollment in a Pinellas
County School, who does not have a valid physical examination on file will be given 30 days to produce
proper documentation. If unable to produce, the student will then be temporarily excluded from school
until documentation is provided by the parent/guardian. A copy of the physical examination used for the
student’s original registration in a Florida school is acceptable.
Any student will be exempt from the requirement of a physical examination upon written request of the
parent/guardian stating his objections to such an examination on religious grounds. A homeless student
as defined in S. 1003.01 shall be given a temporary medical exemption for 30 school days.
If a parent/guardian is unable to produce evidence of birth for registration purposes as stated in F.S. an
affidavit of age signed by a public health officer or physician based on physical examination is acceptable.
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STATE REQUIREMENTS (continued)
SCHOOL PHYSICAL REQUIREMENTS (continued)
TRANSFER STUDENT (from another Florida school only)
1. A student transferring from another Florida public school or re-entering a Pinellas County
Public School must produce evidence (school physical used for original enrollment) of
compliance with Florida school entry health examination statute at the time of initial
enrollment.
2. A student transferring from any Florida private school must present a valid school physical
prior to enrolling in a Pinellas County Public School. The physical used for original
registration in any Florida school (public or private) is acceptable.
3. The cumulative health folder should be transferred to the requesting school upon student
transfer. The folder should contain all health records including the Cumulative School
Health record (DH 3041) and any health screenings which are not included on the DH Form
3041, such as vision, hearing and scoliosis screening (Student Health Screening Record,
(PCS Form 2-407-A and B), the student’s school physical, nursing care plans and the
Florida Certificate of Immunization (DH Form 680, Parts A,B,C.) Note that in some instances
students will have a separate professional treatment health record which contains sensitive
and confidential health services information which, in accordance with F.S. and permission
of the parent/guardian or student and may not be automatically forwarded in the cumulative
health folder.
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STATE REQUIREMENTS (continued)
IMMUNIZATION REQUIREMENTS
INITIAL ENTRANT
1. A Florida Certificate of Immunization (DH Form 680- Attachment XIII) or a Religious
Exemption Form/Immunization (DH Form 681- Attachment XI) are the only acceptable
immunization certifications for first-time entrants to a Pinellas County School, grades pre-K
through 12. An original or photocopy is acceptable, providing the information is complete
and legible, and it is certified. Certified copies printed from Florida shots are acceptable.
2. If a parent/guardian does not have documentation of a student’s immunizations (lost, in
transit, etc.), refer the parent to the Pinellas County Health Department for boosters and a
Temporary Medical Exemption (DH Form 680-Part B). Note: A Temporary Medical
Exemption without dates of immunizations is unacceptable.
3. The school may elect to call the student’s former school, physician, etc (at parent’s expense)
and verify vaccines administered and the dates. The vaccines and their dates should be
placed on school letterhead, signed by a school employee and given to the parent to take to
the Pinellas County Health Department for transfer onto the Florida Certificate of
Immunization. (DH-680)
4. Many students, especially those enrolled in pre-kindergarten programs, will have Temporary
Medical Exemptions (they are in the process of completing necessary immunizations but
cannot receive additional doses of vaccine because the appropriate time interval between
shots has not passed).
Two weeks to one month before the Temporary Exemption expires, the school should return
the form to the parent, because it contains previous immunization information that may be
needed by the physician to continue or complete the child’s immunizations. A photocopy of
the form should be retained by the school until the original is returned. If the updated form is
not returned by the expiration date, the child is out of compliance and should be excluded
from school until the parent/guardian produces the proper documentation. A tickler system
is recommended to assure follow-up of expirations of Temporary Medical Exemptions.
5. A permanent Medical Exemption (DH 680-PartC) will be used when the student is not fully
immunized (per Part A) but cannot receive vaccine(s) due to medical contraindications. The
vaccine(s) contraindicated should be listed and medical reasons for each exception should
be stated. The physician should also include the dates of doses and types of vaccines that
the child was able to receive. DH 680-Part C must be signed or stamped by a physician.
Any currently or previously-enrolled student, regardless of his/her length of enrollment in a
Pinellas County Public School, who does not have a valid Florida Certificate of Immunization
on file will be given 30 days to produce proper documentation. The student will then be
temporarily excluded from school until valid documentation is provided by the
parent/guardian.
6. A homeless student as defined in S.1003.01/39.0016 shall be given a temporary medical
exemption for 30 school days.
7. Requirements for currently enrolled students in Pinellas County can be viewed at:
http://www.doh.state.fl.us/DISEASE_CTRL/immune/schoolguide.pdf
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STATE REQUIREMENTS (continued)
IMMUNIZATION REQUIREMENTS (continued)
TRANSFER STUDENT (from another Florida School public or private)
1.
2.
A student transferring from another Florida public school or re-entering a Pinellas County Public
School must produce evidence of compliance with Florida immunization status at the time of his/her
initial enrollment. Proof must be presented within 30 days of registration. Schools may elect to call
the former Florida public school (at parent’s expense) to verify that a valid Florida Certificate of
Immunization is on file. If records have not been received within 30 days of registration, the student
will be temporarily excluded from school until the parent/guardian produces valid documentation.
 It is recommended that school personnel give duplicate copies of each student’s
immunization record to the parent/guardian when the student transfers to another school, whether
within Florida or another state. Department of Health strongly supports this recommendation as a
convenience to families and school personnel. If the family has a copy of the student’s
immunization record, they can ensure that their child will not be delayed in enrolling in a new
school due to a lack of certification.
A student transferring from any Florida private school must present a Florida Certificate of
Immunization (DH Form 680) or a Religious Exemption from Immunization (DH 681) prior to enrolling
in a Pinellas County Public School.
BIRTH CERTIFICATE REQUIREMENTS
If a parent/guardian is unable to produce evidence of birth for registration purposes, as stated in Florida
Statute 232.03, an affidavit of age, sworn by the parent and accompanied by a certificate of age signed
by a public health officer or physician based on a physical examination is acceptable.
STATE REQUIREMENTS FOR EDUCATIONAL FACILITIES
Health Room Equipment and Supplies:
Each district school board must make adequate physical facilities available for health services per
s. 381.0056 (7), F.S. Existing school buildings are expected to comply with the minimum requirements as
identified in the Department of Education's guidelines, State Requirements for Educational Facilities.
These guidelines have specifications for school clinics.
The school health room should:
 Be located away from noisy, congested areas and preferably near the administrative office
 Be of sufficient size and layout to permit use for first aid, physical examinations, health
conferences, and for student isolation or observation
 Have direct line-of-sight from the health room staff desk to the cot area
 Be equipped with minimum facilities such as sink for hand washing, locking medicine cabinet,
supply storage, and examining equipment
 Preferably have a toilet facility included in the health room or at the very least be located
adjacent to a toilet facility
 Be of sufficient size and equipped with privacy screening to permit examination of students
who are unclothed
 Be appropriately staffed during school hours to serve the needs of students
 Be equipped with a telephone extension, computer hook up, and internet access
 Be considered an essential facility. The health room is the focal point for operation of an
effective school health program and provides direct services to students. The lack of an
adequate health room will seriously hamper the delivery of school health services.
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STATE REQUIREMENTS continued)
STATE REQUIREMENTS FOR EDUCATIONAL FACILITIES(continued)
Health Room Equipment and Supplies (continued)
Chapter 64F-6.004, F.A.C. requires that the school principal or designated person shall be
responsible to assure first aid supplies, emergency equipment and facilities are maintained.
Minimal health room equipment is as follows:
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Bed or cot: the number of cots is based upon student population – 3/500 students,
4/500-1000 students, plus 1 additional cot for each 1000 students
A separate cot area for boys and girls is essential at the secondary level (curtains
can be used to separate these areas)
Desk, chair, and file cabinet
Computer with internet access for record keeping and accessing health information
First aid equipment (such as AED, CPR face shield, etc.)
Covered trash container, biohazard trash container, sharps disposal container
Accurate scale for measuring student weight, accurate measuring device for
determining student height
Wheel chair or stretcher for transporting ill or injured students
Vision screening device
Audiometer for conducting hearing screening (in cooperation with speech/language
pathologist)
Examining equipment such as exam table, gooseneck lamp, and stool are
recommended for school sites providing ARNP or physician services
Recommended health room supplies
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Disposable sheets/towels/paper rolls to cover head area of cot
Blanket (disposable or laundered after each student use)
Emesis basin, washbasin
Antibacterial liquid hand soap, approved spray disinfectant, room deodorizer
First aid kit for use on other parts of campus
First aid supplies including band-aids, gauze squares, elastic roller gauze, cotton
balls, cotton tipped applicators, tape
Gloves, non-latex (students may have latex allergy)
Paper cups, medicine cups, towels and tissues
Ice bag with disposable/washable cover
Basic protection attire for emergency use, such as gown, mask, goggles
Thermometers or other temperature assessing devices
Sphygmomanometer and stethoscope
Access to the student emergency file card
Appropriate reference materials such as a current drug handbook and Control of
Communicable Diseases book
The use of other clinic supplies is dependent upon local school district policies and
should be determined with the assistance of the School Health Advisory Committee
EMERGENCY HEALTH GUIDELINES
Emergency Guidelines
1. STANDARD UNIVERSAL PRECAUTIONS MUST BE USED IN THE ADMINISTRATION OF
ALL FIRST AID. For detailed instructions, refer to the Chapter on Communicable Disease
and Infection Control and Pinellas County Schools Blood borne Pathogens Exposure Control
Program. Provided through the Risk Management Department.
2. “Emergency Guidelines for Schools”, a comprehensive and easy to use guide to handling a
large variety of medical emergencies involving children, should be used by school personnel
and other health professionals working in the schools as the primary guide in administering
immediate care to those students who become ill or injured at school.
3. Chapter 64F-6.004, F.A.C. also requires that persons staffing the school health room and
two additional school staff members be currently certified in first aid and cardiopulmonary
resuscitation by a nationally recognized certifying agency (i.e. American Red Cross or
American Heart Association). A list of persons currently certified to provide first aid and
cardiopulmonary resuscitation is to be posted in the health room, school office, cafeteria,
gymnasium, home economics classrooms, industrial arts classrooms, and any other areas
that pose an increased risk potential for injuries.
4. CPR courses must be updated every two (2) years, depending upon the course provided.
First aid courses must be updated every three (3) years.
5. All school personnel should be familiar with basic first aid and the principles of standard
precautions. First aid supplies should be kept in easily accessible locations known to all.
6. Current emergency data for all students provided by the parent/guardian on the Student
Clinic Card should be kept in an easily accessible file at each school.
7. Emergency medical services telephone number, 911, should be prominently placed on all
phones.
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EMERGENCY HEALTH GUIDELINES(continued)
EMERGENCY PREPAREDNESS
1.
Identify all persons trained in CPR and First Aid. Post the names and room numbers of
trained personnel throughout the school (e.g. administration, labs, P.E., cafeteria, shop, all
classrooms, health rooms, Emergency Guidelines for Schools etc.)
2.
Make locations of first aid emergency equipment known to all staff members.
3.
It is helpful to designate a “caller”. The “caller” places the call to 911 and attempts to
contact the parent/guardian, the parent’s designee, and/or student’s physician.
4.
5.
When calling for EMS: Dial 911 carefully.
 State: “We have an emergency involving (number of) students”
 State: type of injury.
 Give: name of school, address, phone number, location (e.g., gym, football field,
etc.)
When calling a parent:
State who is calling
Be reassuring.
If student must be transported to an emergency facility prior to the arrival of the
parent/guardian, confirm where student will be taken.
 Ask parent/guardian to go there.
 Remain calm.
 Give parent/guardian adequate, accurate information, but don’t cause another
emergency.
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6.
Send personnel to the school entrance to direct EMS to the location of the emergency.
7.
Keep Student Clinic Cards updated and in good order. It is recommended that new cards
be completed yearly on each student.
8.
If parent/guardian cannot be reached prior to transporting the student to the hospital, take
a copy of the Student Clinic Card and emergency contact information.
9. Maintain adequate supplies for CPR and first aid.
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INJURY / ILLNESS ASSESSMENT GUIDELINES
INTRODUCTION
The intent of this chapter is to provide a convenient guide for non-emergency and emergency
situations. It is not intended as a guide for the diagnosis or treatment of health problems of the
school-age child.
Emergency health needs arise from injury, sudden illness, or the progression of a minor
discomfort or symptom. It is important for school personnel to respond quickly, to provide first
aid and to minimize further injury and /or insult to the student while he/she is within the school
environment. While teachers and administrators are routinely responsible for dealing with these
situations, they should consult with the school nurse whenever the need arises.
First aid and emergency care should save lives, prevent further injury, alleviate pain, and ensure
safe transfer of the student to parents and/or ill student when parents or persons designated by
parents cannot be reached. The information presented in this chapter is intended for use as a
guide in meeting health needs and is not a substitute for prudent thinking and common sense
response to health situations.
INJURY / ILLNESS ASSESSMENT GUIDELINES
An area should be maintained for the assessment and isolation of illness or injured students.
The area should be situated so that students may be supervised by an adult at all times.
Adequate privacy for conferences with students and parents/guardians should be provided.
1. The classroom teacher has primary responsibility for early detection of sudden illness and
referral of the sick student to health room personnel or the principal. Refer problems to the
school nurse using the appropriate student referral form. See Student Referral, (PCS Form
2-2335)
2. Staff should follow guidelines outlined in “Emergency Guidelines for Schools”, which is
available on line. The emergency guidelines are meant to serve as basic “what to do in an
emergency” information for school staff without medical/nursing training when the school
nurse is not available. It is strongly recommended that staff who are in a position to provide
first aid to students complete an approved first aid and CPR course. Staff should take time
to familiarize themselves with the format and review the “How to Use the Guidelines” section
prior to an emergency situation.
3. Standard blood and body fluid precautions must be used in the administration of all first aid.
(For detailed information, refer to the Chapter on Communicable Diseases and Infection
Control and Pinellas County Schools Blood Borne Pathogens Exposure Control Plan
provided through Risk Management Department.)
4. When students come to the health room seeking relief for minor discomforts:
 Tactfully question the student regarding the nature of the complaint.
 Listen carefully to the student’s complaint, and accurately record the information given
on the Clinic Card.
 Proper evaluation of illness may be difficult at times. Many students who have no
organic disease will be sent to the health room “feeling bad.” Example: Many
stomachaches are caused by failure to eat breakfast or failure to allow adequate time in
the bathroom for bowel movements.
 Observe for visible signs of illness. (See Chapter on Communicable Diseases and
Infection Control.)
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INJURY / ILLNESS ASSESSMENT GUIDELINES (continued)
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Check vital signs, and if deviations from normal are detected, the parent/guardian should
be notified.
 If vital signs are normal, the student should be allowed to rest for a short period. If the
student still does not feel well enough to return to class, the parent/guardian should be
notified. A little personal attention for minor complaints is frequently sufficient to help the
student return to his/her classroom.
 The student with a minor complaint should be encouraged to remain in school unless it
would compromise the health of other students. The student who frequently visits the
health room should be referred to the school nurse.
Information of a private or personal nature may be divulged in the course of caring for a
student. It is imperative that such information be kept in confidence. An exception is
reporting that information to appropriate staff only if this is relative to the student’s wellbeing.
Students who present with a complaint of menstrual cramps should be given information on
“Menstrual Pain” to take home for review with their parent/guardian. Menstrual pain results
in a significant number of school absences and missed classes, and students should be
encouraged to seek treatment.
Students who are very ill or who have suffered a serious injury should be accompanied by
an adult to the health room or office. In some cases of injury, the student should not be
moved until emergency assistance arrives.
Parent/guardian should be contacted immediately when it is determined the student is too ill
to remain in school. It should be made clear to parent/guardian that the school health room
is not to be used as a long-term holding area for ill or injured students. Parent/guardian
should be given facts, not a diagnosis:
- “Your child has an elevated temperature of 101 and a rash,” not, “Your child has the
measles.”
- “Your child states that he is nauseated and he appears pale and listless,” not, “Your
child has the flu.”
For any wound, the student’s immunization record should be reviewed for the date of the
last tetanus toxoid (DTaP, Td, and/or Tdap) administration. Notify the family of this date and
advise them to consult their family physician or the Department of Health to determine the
necessity for administration of tetanus booster. Send home a “Wound Care” information
sheet, if appropriate.
A student with a suspected communicable disease should be isolated from other students
until the parent/guardian arrives. Make every effort to protect the privacy of the student in
cases where illness or infestations may be embarrassing.
No student is permitted to leave the school before the parent/guardian is consulted except
when a major emergency necessitates immediate transfer to the hospital or physician’s
office.
All incidents involving a head injury should be carefully documented. The parent/guardian
should be notified immediately by telephone and in writing via a Notice of First Aid for Bump
or Blow to the Head of the incident, since head injury symptoms may not be obvious at once
and parents/guardian must be made aware of the possibility of signs and symptoms
developing later.
When a major emergency necessitates immediate transfer to the hospital or physician’s
office.
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INJURY / ILLNESS ASSESSMENT GUIDELINES (continued)
Immediate Evaluation and Referral to Treatment Facility Needed (Call 911):
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Acute airway obstruction, choking
Cardiac or respiratory arrest
Near-drowning
Massive external hemorrhage and
internal hemorrhage
Internal poisoning
Anaphylaxis
Neck or back injury
Chemical burns of the eye
Heat stroke
Penetrating/crushing chest wounds
Vomiting large quantities of blood
Crushing chest pain
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Dislocations and (possible) fractures
Extended period of unconsciousness
Major burns
Respiratory distress
Unresolving tachycardia-rapid heart
rate
Drug overdose
Head injury with lose of
consciousness
Penetrating eye injuries
Seizures, cause unknown
Medical Consultation Desirable within an Hour:
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Laceration (with severe bleeding controlled)
Bites and stings (animal, insect and snake) without anaphylaxis
Burns and blisters
Accidental loss of a tooth
Acute emotional state
Possible reaction to drugs
High fever (above 103)
Asthma/wheezing
Non-penetrating eye injury
Attention by a Trained Staff Person with School Nurse/Parent Consultation Needed:
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Convulsions in known epileptic
Insulin reaction in diabetic
Abdominal pain
Fever (100-103)
Sprains
Minor Injuries/Illnesses can be Handled by a Trained Staff Person Following
Standardized Procedures:
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Abrasions
Minor burns
Nose bleeds
Mild headaches
Menstrual cramps
CLINIC RECORDS
When students are sent to the office or health room unaccompanied, it is helpful to have the sending
teacher complete a brief Clinic Referral Form. This form can be used by personnel in the health room or
office to communicate the disposition of the student to the person initiating the referral.
1. Each school should maintain a file with Student Clinic Cards (PCS Form 11-1454) for every student to
be used as quick reference in case of an emergency.
a. The clinic card should be filled out at the beginning of each school year, kept up to date, and
made accessible to personnel responsible for the health room area.
b. Clinic cards should be reviewed annually by the school nurse.
c. Special health needs should be flagged on the card to identify the student with special health
problems.
d. Medications or specific procedures to be taken in case of an emergency should be recorded in
detail.
e. The reverse side of the Student Clinic Card has been designated to maintain a record of the
individual student’s visits to the health room. See list of approved abbreviations on next page to
use when documenting care of student. The full signature (first and last name) of staff person
should be printed and signed in signature verification area.
f. Those students who exhibit frequent or patterned health room visits should be referred to the
school nurse for further evaluation via nursing assessment.
g. Dated clinic cards should be stored at the school for a three-year period or sent to central
Records (Records Retirement) for disposition, providing the student had a new and current clinic
card on file.
3. Administration of medication is sometimes necessary during the school day to comply with the
physician’s prescription. Authorization is granted for school district personnel to administer medication
in 1006.062, Florida Statute.
4. Trained school personnel shall administer medication (s) only to those students who have an
Administration of Prescription Medication form and/or an Administration of Over-the-Counter
Medication form (WH 98333 and 98334) on file at the school.
a. The Administration of Medication form shall provide for either the physician’s and
parent’s/guardian’s signature for administration of over-the-counter medications or only the
parent’s/guardian’s signature for administration of prescription medications.
b. Student Medication cards should be transferred to the nurse’s confidential file if they become
inactive, until the end of the school year. At that time, the Nurse confidential file shall be sent
(along with other medical documents) to Central Records where they are stored for the required 7
years.
5. Students who require treatments or procedures during school hours (e.g. nebulizer, blood glucose
monitoring, catheterization, tube feedings, etc.) require an Authorization for In-School
Treatment/Procedure (PCS Form 2-2334), Authorization for Diabetes Management in School (PCS
form 2-2966) or g-tube feeding orders on file at the school. The form must be signed by the
parent/guardian, principal, physician, and school nurse and filed in the treatment log.
6. Students with chronic health conditions such as asthma, insulin dependent diabetes mellitus, seizure
disorders, severe food allergies etc. may require a Health Care Plan. Individualized health care plans
provide specific preventive measures and interventions for that student’s condition. Pinellas County
School Health Services and/or the Department of Health will initiate these care plans. Personnel are
available through both offices to answer any questions pertaining to them.
7. All incidents involving a head injury should be carefully documented. The parent/guardian should be
notified immediately by telephone and in writing via a Notice of First Aid for Bump or Blow to the Head
of the incident, since head injury symptoms may not be obvious at once and parents/guardian must
be made aware of the possibility of signs and symptoms developing later.
8. Refer to the Risk Management Department Procedure Guide for information regarding student
accidents.
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Approved School Health Abbreviations List 2011
B/A
BP
BS
CP
C/O
Band-Aid applied
Blood pressure
Blood sugar
Care plan
Complains of
Emergency Medical
Service
Emergency room
Follow up
Headache
Home visit
Left message
Nausea/Vomiting
Pulse
Pick/up
Rest room
Return to class
Stomachache
Shortness of breath
EMS
ER
F/U
H/A
HV
LM
N/V
P
P/U
RR
RTC
S/A
SOB
S/W
SW
T
TC
Soap and water
Social Worker
Temperature
Telephone call
@
At
↑
↓
R
L
Ø
Č
Up/increased/elevated
Down/decrease
Right
Left
No/None
With
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CLINIC MAINTENANCE AND WAREHOUSE SUPPLIES
1. The school should maintain a neat-well organized health room.
2. Work areas should be provided for health room personnel. Adequate privacy should be
provided for students.
3. Emergency medical services telephone number 911 should be prominently placed on all
4.
5.
6.
7.
phones.
A list of persons currently trained in CPR and First Aid and their location in the school.
The “Emergency Guidelines for Schools” should be highly visible in the health room.
Locations of emergency equipment and supplies should be prominently posted in the
health room.
Storage areas for supplies and medications should be kept under constant supervision
and locked when not in use.
Warehouse items should include:
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Antiseptic Liquid Soap
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Bandage 2” roll
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Band-Aid 1”x 3”

Band-Aid 2” x 3”

Biohazard labels

Cold compress- reusable

Cot paper white, 18”x 125”

Cotton balls, non-sterile

Cotton tip applicators

Digital thermometers- LCD Display and probe covers

Electronic thermometers and probe covers

Eye patches

Gauze sponges sterile 3”x 3”

Gloves, protective (latex and non-latex

Kleenex tissue

Mask/Eye shield

Medicine cups

Pedicu-sticks (for head lice inspection)

Personal protective equipment kit

Tape, adhesive ½”

Tape, adhesive 1”

Tongue blades

Tweezers
NOTE: Refer to Warehousing Services Catalog “First Aid”
8. Some medical supplies have an expiration date, after which the product’s effectiveness
may be compromised. It may be helpful to establish a regular schedule for checking first
aid supplies noting expiration date; breaks or tears in sterile packaging, and amount of
remaining supplies. All supplies past expiration date should be disposed.
9. It should be remembered that most minor injuries can be satisfactorily handled by
washing with regular soap and water and covering with a dry band aid. Use of all other
topical antiseptics should be discontinued.
11/11
Poisoning / Overdoses
POISONING – MEDICAL EMERGENCY- CALL 911
1. Call 911—Ask for Poison Control (or call Poison Control directly at 1-800-2221222) and follow instructions.
2. Save the label or container of the suspected substance for identification. If the student
vomits, save a sample of the vomited material for analysis. Wearing disposable gloves,
check student’s mouth and remove any remaining “poison.” If possible, ascertain age
and weight of student, what student swallowed, amount and when it was taken.
3. Watch breathing. If breathing stops, start RESCUE BREATHING.
4. Notify parent/guardian
5. Record action taken on a health room activity log, Student Clinic Card and Injury Report.
6. Place referral in nurse’s mailbox for follow-up, when appropriate.
OVERDOSE: DRUG OR ALCOHOL INTOXICATION
1. Call 911 as appropriate and notify parent/guardian.
2. Secure as much information as possible about drug, amount ingested, etc. Wearing
disposable gloves check student’s mouth and remove any remaining “poison.” If
possible, ascertain age and weight of student, what student swallowed, amount and
when it was taken.
3. Do not leave student alone. Be supportive, gentle, and tolerant.
4. Observe for SHOCK.
5. Watch breathing. If breathing stops, start RESCUE BREATHING.
6. Record action taken on a health room activity log, Student Clinic Card and Injury Report.
7. Place referral in nurse’s mailbox for follow-up, when appropriate.
11/11
Substances
Possible Effects
Procedures to Follow
for all Possible Overdoses
Stimulants; nicotine, Caffeine,
amphetamines, Cocaine, crack
Respiratory difficulty, fatigue,
For all possible overdoses:
increased, pulse rate and blood
pressure, increased, alertness,
1. Call 911
excitation, loss of appetite,
Insomnia. OD: irritability, agitation,
2. Notify parent or guardian.
increased body temperature,
hallucinations, convulsions,
3. Secure as much
possible death.
information as possible
about drug, amount
Depressants/Narcotics: alcohol,
Loss of coordination,
ingested etc.
sedatives, tranquilizers, opium,
sluggishness, slurred speech,
morphine, heroin, codeine,
disorientation, depression,
4. DO NOT LEAVE
barbiturates, meperidine
euphoria, drowsiness, respiratory
STUDENT ALONE
depression, constricted pupils,
sleep, nausea. OD; total loss of
5. Be supportive, gentle and
coordination, nausea,
tolerant. Watch breathing,
unconsciousness, cold clammy
if breathing stops, start
skin, dilated pupils, convulsions,
RESCUE BREATHING
coma, possible death
Cannabis: THC, marijuana,
Hashish
Relaxed inhibitions, euphoria,
increased appetite, distorted
perceptions, disoriented behavior.
OD: fatigue, paranoia, possible
psychosis
6.
If the student does vomit
send a sample of the vomit
and ingested material with
its container (if available)
to the hospital with the
student
Hallucinogens: PCP (angel dust), Illusions, hallucinations, distorted
LSD, mescaline, Peyote,
perception of time and distance.
psilocybin (mushrooms)
OD: Longer and more intense
“trips” or episodes, psychosis,
convulsions, possible death from
behavior.
7.
Do NOT follow an
antidote label on a
container: it may be
incorrect
Inhalants: aerosols, solvents,
nitrous oxide, Amyl nitrite, butyl
nitrite
Exhilaration, confusion, poor
coordination. OD: Heart failure,
unconsciousness, asphyxiation,
brain damage, possible death.
Designer drugs; XTC (ecstasy),
nexus
Uncontrolled tremors, drooling
impaired speech, paralysis, brain
damage, blurred vision, paranoia,
illusions, hallucinations, impaired
perception. OD: Possible death.
11/11
MANDATORY CHILD ABUSE REPORTING
FL Statute 39.201 requires teachers and other school personnel to report any “suspected
child abuse” to the abuse registry by calling 1-800-962-2872 (1-800-96-ABUSE) or sending a
fax transmittal form to 1-800-914-0004. Use “Abuse/ Neglect Report Form” (PCS form 21490)
1.
2.
3.
4.
Notify your building principal or designated administrator of the report.
You may wish to involve other Student Services personnel. They can interview the
student and assist you with the report process. However, because you are the person
who observed the marks and/or heard the child’s story, you must be present when the
report is made. If you suspect abuse, it is your legal obligation to report the suspected
abuse.
Be sure you have correct names of the child and D.O.B.; responsible adults; perpetrator,
if known; address and telephone numbers; and the nature of abuse written down before
you call. Always ask for the name and operator I.D. # of the person who takes your
report.
If you have any questions regarding indicators of abuse and neglect, refer to the last
page of the Child Abuse reporting Procedure brochure available from the school social
worker and discuss the case with your school social worker.
Telephone numbers you may need:
 Abuse Registry
 Fax Reporting
 Social Work Administration
 Local Law Enforcement
 Help-a-Child
 Pinellas County Sheriff’s Office
 C.P.I Division/Admin office
 C.P.I. Captain
5.
6.
7.
8.
9.
11/11
1-800-962-2873 (1-800-96-ABUSE)
1-800-914-0004
727-588-6431
544-3900
582-6200
582-3823
582-3825
After the Abuse Registry has received the report, complete the “Abuse and Neglect
Form,” - PCS 1490, at your school within 48 hours.
If the Abuse Registry does not accept the report because it is a criminal matter, ask them
to transfer you to the police department and make the report directly to law enforcement.
If the Registry operator tells you that the situation you describe is not a reportable
offense or that they cannot accept the report, discuss this with your school social worker,
guidance counselor or principal or call the Social Work Administrator at 588-6431.
If abuse recurs, report again, even if the first report was not accepted by the Abuse
Registry.
If you are aware that the DCF already has an open case, call the local case worker or
his/her supervisor. Additional information that you share about an open abuse case will
be helpful, and your name will not be shared by DCF with the family.
Physical and Behavioral Indicators of Child Abuse and Neglect
Physical Indicators
Behavioral Indicators
Physical Abuse
Unexplained Bruises and Welts:
 on face, lips, mouth
 on torso, back, buttocks, thigh
 on various states of healing
 clustered, forming regular
 patterns
 reflecting shape of article used
to inflict (electric cord, belt
buckle)
 on several different surface
areas
 regularly appear after absence:
weekend/vacation







Wary of adult contact
Apprehensive When Other
Children Cry
Behavioral extremes:
Aggressiveness & withdrawal
Frightened of Parents/guardian
Afraid to Go Home
Reports Injury by
Parents/Guardian
Unexplained Burns:
 cigar or cigarette burns
especially on soles, palms, back
or buttocks
 immersion burns (sock like,
glove like, doughnut-shaped on
buttocks or genitalia)
 patterned like electric burner,
iron, etc.
 rope burns or arms, legs, neck
or torso
Unexplained Fractures
 to skull, nose, facial structure
 in various stages of healing
 multiple spiral fractures
 to external genitalia
Unexplained Lacerations or
Abrasions:
 to mouth, lips, gums, eyes,
external genitalia
Physical Neglect




11/11
Consistent hunger, poor
hygiene, inappropriate dress
Consistent lack of supervision,
especially in dangerous
activities or long periods
Unattended physical problems
or medical needs
Abandonment






Begging, stealing food
Extended stays at school (early
arrival/ late departure)
Constant Fatigue, listlessness
or falling asleep in class
Alcohol or drug abuse
Delinquency (i.e.: thefts)
States: “there is no caretaker”
Physical Indicators
Sexual Abuse






Difficulty walking or sitting
Torn, stained or bloody underclothing
Pain or itching in genital area
Bruise or bleeding in external
genitalia, vaginal or anal areas
Venereal disease - especially in
pre-teens
Pregnancy
Behavioral Indicators







Emotional
Maltreatment


Speech Disorders
Lags in Physical Development
Failure to thrive
Unwilling to change for Gym or
participate in Physical
Education class
Withdrawal, fantasy or infantile
behavior
Bizarre, sophisticated or unusual
sexual behavior or knowledge
Poor peer relationships
Delinquent or Runaway
Reports Sexual Assault by
Caretaker
Habit Disorders (Sucking, Biting,
Rocking, etc.)
 Conduct Disorders (antisocial,
destructive, etc.)
 Neurotic Traits (sleep disorders,
inhibition of play)
 Psychoneurotic Reactions
(hysteria, obsession,
compulsion, phobias,
hypochondria)
Behavioral Extremes:

Compliant, passive

Aggressive, demanding

Overly Adaptive Behavior:

Inappropriately adult

Inappropriately infant
Developmental lags (mental,
emotional)
Attempted Suicide
11/11
MANDATORY ABUSE REPORTING (continued)
ALL OTHER REPORTS
Calls that are considered “not an abuse report” are as follows:
1. Complaints of harm perpetrated by someone other than a parent, adult household member
or other person responsible for the child’s welfare. Transfer the caller to law enforcement.
2. Disputes concerning custody of a child. Refer the caller to an attorney or clerk of the circuit
court.
3. Complaints of infants or children in automobiles who are not in legally-required restraining
devices. Refer the caller to law enforcement.
4. Requests for service. Refer the caller to a number in the telephone reference list or the
Hotline #211.
Examples of services requested:
Transportation
Food or Food Stamps
Housing
Day Care
Counseling
Employment or public assistance
Job Training or education
Help with utilities or rent
Homemaker services
5. Complaints of children running away from parents or legal custodians, persistently
disobeying reasonable and or lawful demands of parents or legal custodians, and being
beyond their control. Refer to school social worker.
6. Complaints that a child is not attending school. Refer the caller to the school social worker.
7. Complaints of children (depending on age of child) being denied access to the home
because of disciplinary reasons or ungovernable behaviors. Refer the caller to the school
social worker.
8.
Complaints concerning head lice with no medical adverse effects. Refer the caller to the
school nurse.
11/11
CLINIC VOLUNTEERS
1.
2.
School health volunteers, when properly trained and supervised, can make major
contributions to the delivery of school health services. School health volunteers function
under the direct supervision of the principal and school nurse and must receive
appropriate training to perform their duties.
Training for school health volunteers should mirror that of school health
paraprofessionals, with the exception of medication administration and medical
treatment procedure training. Volunteers are not permitted to access student records,
which would include health room records. Qualifications for volunteers should mirror that
of school health paraprofessionals as well, although CPR and First Aid certification
would be recommended rather than mandated, depending on the role of the volunteer.
RESPONSIBILITIES OF HEALTH ROOM VOLUNTEERS
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
11/11
School clinic volunteers giving care to students should be aware of their own abilities
and limitations in providing care.
Volunteers should work willingly with the school health coordinator and/or school health
nurse.
Volunteers should prepare a daily log of students visiting the clinic for the school nurse
or principal
Volunteer should alert designated school personnel concerning students that need to be
referred to the school nurse.
Volunteers should practice good hand washing techniques to prevent the spread of
possible infection from student to student.
Volunteers should receive in-service education regarding the proper way to handle body
fluids.
Volunteers should change paper sheets on clinic bed after being used by each student.
Volunteers may take student’s temperatures by mouth, under the arm, or using a
thermo-scan thermometer and record on Clinic Card and Health Services Log.
Volunteers should use thermometer sheaths or probe covers over thermometers.
Volunteers should report any elevated temperatures to designated school personnel or
principal.
Volunteers may apply ice, if indicated, after consulting with designated school personnel
or principal.
Volunteers should properly dispose of all soiled articles used by each student.
Volunteers should keep the clinic clean and orderly.
Volunteers DO NOT diagnose illness or disease.
Volunteers DO NOT dispense medications, only trained school personnel or
Registered Nurse (RN) Volunteer School Nurses (RN’s approved and participating
in PCHD/DOH School Nurse volunteer program).
Volunteers DO NOT recommend any medication.
Volunteers DO NOT give continued care to any specific injury.
Volunteers DO NOT contact parent/guardian, send students home, or excuse students
from class participation.
Volunteers DO NOT apply heat to any injuries received by students.
Volunteers DO NOT probe for splinters or foreign objects with needles or tweezers.
Volunteers DO NOT discuss students’ health outside the clinic setting.
CLINIC PROCEDURES
MEASUREMENT OF BODY TEMPERATURE
Purpose:
Evaluation of body temperature (fever) is one sign of an infectious disease. If a student
complains of any of the following symptoms (the list is neither comprehensive or
inclusive), the temperature can be one tool in the assessment process:
1. headache
2. watery eyes
3. nausea/stomachache
4. sore throat
5. vomiting
6. rash
7. chills
8. cough
9. runny nose
10. earache
The parent should always be notified under the following conditions:
1. If the temperature is above 100.0.
2. If the student has an obvious rash.
3. If the student experiences repeated episodes of vomiting or diarrhea.
4. If the student has a headache accompanied by fever, vomiting, or stiffness of
the neck.
Students with serious communicable diseases do not always have a fever. Many
students with temperature elevations above normal (below 100.8 in a normal
environmental setting, when quiet) may not have a communicable disease.
General Information and Recommendations
1. RECTAL TEMPERATURE SHOULD NEVER BE TAKEN.
2. GLASS THERMOMETERS ARE NOT RECOMMENDED FOR USE WITH
STUDENTS.
3. ORAL temperatures should be taken only on student who can be trusted to keep the
thermometer under their tongue with their mouth closed without biting on the
instrument.
4. Always use disposable plastic sheaths with digital thermometers and disposable
plastic tips with electronic and tympanic membrane sensor instruments.
5. The AXILLARY (under the arm), TYMPANIC, TEMPORAL or other non- invasive
route should always be used under the following conditions:
 If the student is four (4) to six (6) years of age or developmentally delayed.
 If the student has been vomiting recently.
 If the student has had a recent seizure.
 If the student is crying or is upset emotionally.
 If the student has eaten or drunk hot or cold foods or liquids within the last 10
minutes.
 If the student is unconscious or does not respond to his/her surroundings.
 If an electronic, digital, or plastic strip thermometer or a tympanic membrane
sensor (ear) instrument is used, instructions accompanying the thermometer
should be followed.
11/11
CLINIC PROCEDURES (continued)
Measurement of Body Temperature(continued)
Equipment
1.
2.
3.
4.
Thermometer
Disposable plastic sheaths or tips
Tissue, cotton balls
Alcohol
Procedure For Oral Temperature
1. Wash hands
2. Assemble equipment. Refer to operating manual for instructions on the use of the
thermometer
3. Explain procedure to student.
4. Insert thermometer into plastic sheath or tip.
5. Place the thermometer in the student’s mouth, far back under either side of the tongue.
6. Instruct the student to breathe through the nose and not to talk.
7. Make sure the student does not bite the thermometer.
8. Tell the student the thermometer must stay in place until it beeps.
9. Remove the thermometer. Remove the plastic sheath or tip and discard into lined
covered trash can.
10. Wash hands.
11. Document the reading on the Clinic Card.
12. Wipe thermometer down with alcohol on a cotton ball.
Procedure For Auxiliary Temperature
1. Wash hands.
2. Assemble equipment. Refer to operating manual for instructions on the use of the
thermometer.
3. Explain procedure to student.
4. Insert thermometer into plastic sheath or tip.
5. Place the thermometer under the student’s arm.
6. Hold the student’s arm firmly against his/her body.
7. Tell the student the thermometer must remain in place until it beeps.
8. Remove the thermometer. Remove the plastic sheath or tip and discard into lined,
covered trash can.
9. Wash hands.
10. Document the reading on Clinic Card.
11. Wipe the thermometer down with alcohol on a cotton ball.
11/11
CLINIC PROCEDURES (continued)
Measurement of Body Temperature (continued)
Procedure for Tympanic Thermometers
1. Wash hands
2. Assemble equipment. Refer to operating manual for instructions on the use of the
thermometer.
3. Explain procedure to student.
4. Make sure the student has been indoors for at least 10 minutes before taking
temperature.
5. Slide a probe cover over the probe (use a new probe cover for each measurement).
6. Pull the ear pinna back and up to straighten the ear canal’s natural curve and provide a
clear path to the tympanic membrane.
7. Place the probe in ear, aiming it toward the tympanic membrane. Insert the probe until it
seals the ear canal.
8. Press the activation button on the thermometer and wait the time specified by the
device’s manufacturer.
9. When you have a reading, remove the probe and dispose of the cover.
10. If reading seems too low, replace the probe cover and repeat the measurement.
11. Wash hands
12. Document reading on Clinic Card.
13. Wipe the thermometer down with alcohol on a cotton ball.
Procedure for Thermofocus (Temporal) Thermometer
1. Wash hands
2. Thermo-focus is a “non-contact” thermometer. The device enables the temperature of
students to be taken without touching the skin, simply by moving the thermometer close
to the forehead at the distance indicated by the device.
3. Press the “FACE” button to turn the thermometer on.
4. Flip open the protective cap.
5. Press and hold the “FACE” button to light the pointing lights.
6. Hold the thermometer perpendicular to the middle of the forehead until a single point of
light appears.
7. Release the “FACE” button and hold the thermometer steady until the aiming lights blink.
8. Read the value shown on the display. The thermometer goes onto standby after 30
seconds, displaying the surrounding air temperature.
9. Document temperature on Clinic Card.
10. Wipe the thermometer down with alcohol on a cotton ball or alcohol wipe.
11/11
CLINIC PROCEDURES (continued)
MEASUREMENT OF PULSE
DEFINITION: Direct measurement indicative of function of the cardiac system.
PREPARATION
1. Explain procedure to student using appropriate developmental approach.
2. Use watch (or clock) with second hand and stethoscope.
3. Wash hands.
PROCEDURE
1. Take pulse for one full minute.
2. Ausculate in the apical area of the heart with stethoscope or palpate the radial artery
with the pads of your index and middle fingers.
3. Assess for rate and rhythm. If the rhythm is irregular, describe it in detail.
4. Document pulse rate on Clinic Card
MEASURMENT OF RESPIRATIONS
DEFINITION: Direct measurement indicative of function of the respiratory system.
PREPARATION
1. Explain procedure to student using appropriate developmental approach.
2. Use watch (or clock) with second hand and stethoscope.
3. Wash hands.
PROCEDURE
1. Count respirations for one full minute (one respiration consists of an inspiration
and expiration.)
2. Observe chest rising and filling or osculate with stethoscope on chest and/or back.
3. Assess for rate, rhythm, and depth of respirations.
4. Note any abnormal breath sounds, such as wheezing.
5. Depth is described as shallow, moderate, or deep.
6. Document respiratory rate and any abnormal breath sounds on Clinic Card.
11/11
CLINIC PROCEDURES (continued)
MEASURING BLOOD PRESSURE
PURPOSE
Blood pressure (BP) measurement reflects two cardiac cycle stages. Systolic pressure
refers to the maximum pressure exerted on the arterial wall during systole (left ventricular
contraction). Diastolic pressure refers to the minimum pressure exerted on the arterial wall
during diastole (left ventricular relaxation).
PREPARATION
1. Explain the procedure to the student using appropriate developmental approach.
2. Make sure the student is relaxed and has not eaten or exercised in the past 30 minutes.
The student can sit, stand or lie down during the BP measurement. Remove all clothing
from his/her arm (avoid an arm with paralysis, injury, edema).
3. Assemble equipment:
a) Select the appropriate size cuff (air bladder should be at least 80% of the
circumference of arm).
b) Stethoscope
PROCEDURE
1. Palpate brachial artery along inner upper arm.
2. Wrap cuff smoothly and snugly, centering the bladder over the brachial artery. The lower
cuff edge should be one inch above the antecubital space. Tell the student not to talk.
3. Insert the stethoscope with the earpieces pointing forward. Apply the bell head lightly
with complete contact over the palpable brachial artery.
4. Inflate the cuff rapidly to 30 mmHg above the point where you no longer feel the radial
pulse.
5. Release the air so the pressure falls 2-3mmHg per second.
6. Listen for the onset of at least two consecutive beats. This is the systolic pressure. Note
the closest mark on the manometer. Always record BP measurements in even numbers.
7. Listen for a muffling sound with children or the cessation of sound with adults. This is
the diastolic pressure. Continue to listen for 10-20mmHg to confirm your reading.
Deflate the cuff rapidly and completely.
8. Wait one to two minutes before repeating on the same arm. If the measurement is
elevated, the American Heart Association recommends taking two more measurements
at one to two minute intervals. Refer the student for treatment if the average of the
second and third readings is elevated.
9. Record the pressure, position (sitting or standing), arm used, and action taken on Clinic
Card.
11/11
CLINIC PROCEDURES (continued)
APPLICATION OF ICE
PURPOSE
To reduce swelling, bruising, pain and/or bleeding. May be used for insect bites or stings,
muscle strain or sprain, tooth trauma fractures, burns and nose bleeds.
PREPARATION
1.
2.
3.
4.
5.
Explain procedure to student using appropriate developmental approach.
Wash hands and assemble equipment:
Ice bag (could use ice or dampened frozen sponge sealed in a Ziploc bag)
DO NOT USE ICE-FILLED LATEX GLOVES IF STUDENT IS ALLERGIC TO LATEX
Clean cover for ice bag, such as a paper towel. DO NOT place ice bag directly on skin.
PROCEDURE
1.
2.
3.
4.
5.
6.
7.
11/11
Put on gloves.
Cover the ice bag before applying
Leave on 20-30 minutes
Leave ice off for 15 minutes before reapplying
Dispose of ice bag.
Remove gloves and wash hands.
Document date, time, injury and student’s response on Clinic Card