Health Services

Documentation indicating that the child has received the required immunizations must be provided. Please review the minimum required immunizations listed on the Virginia Department of Health (VDH) School and Daycare Minimum Immunization Requirements website for complete details.

A child whose immunizations are incomplete may be admitted conditionally, as specified in the Code of Virginia § 22.1-271.2.B, provided the parent or guardian has documentation at the time of enrollment indicating that the child has received at least one dose of the required immunizations and has a written schedule for completing the remaining doses within 90 calendar days of enrollment. Upon failure of the parent to complete such within the extended time, the parent may receive written notice of the date the school intends to exclude the child due to incomplete enrollment requirements. The 90-day grace period does not apply to the Tdap requirement because Tdap is a single dose vaccine, not a series.

In accordance with § 22.1-271.2(C), no certificate of immunization shall be required for a student’s school admission if (i) the student or his parent submits an affidavit to the admitting official stating that the administration of immunizing agents conflicts with the student's religious tenets or practices; or (ii) the school has written certification from a licensed physician, licensed nurse practitioner, or a local health department that one or more of the required immunizations may be detrimental to the student's health, indicating the specific nature and probable duration of the medical condition or circumstance that contraindicates immunization.

The only two forms of exemptions in VA are religious and medical. Religious Exemptions DO NOT transfer from state to state. Students transferring from another state need to Certificate of Religious Exemptions (CRE-1) form.

Children of military families without documentation of immunizations should be immediately enrolled and shall have up to 30 days from the date of enrollment to obtain any immunizations required by the receiving state. (§ 22.1-360)

On July 1, 2009, Virginia entered into the Interstate Compact on Educational Opportunity for Military Children (§ 22.1-360 of the Code). This compact facilitates the timely enrollment of children of military families and ensures that they are not placed at a disadvantage due to difficulty in the transfer of education records from the previous school district(s) or variations in entrance requirements. According to the compact, children of military families, without documentation of immunizations, should be immediately enrolled and shall have up to 30 days from the date of enrollment to obtain any immunization(s) required by the receiving state. The compact does not waive the physical examination requirement for these children.

The standard grade levels screened for Hearing and Vision are Kindergarten, 3rd, 7th, 10th, and new students entering a Virginia school for the first time as established in § 22.1-273 of the Code of Virginia. Exception is made if the student has the relevant screenings as part of the comprehensive physical examination. The parents or guardians may also object on religious grounds and the student shows no obvious evidence of any defect or disease of the eyes or ears. Whenever a student is found to have any defect of hearing or vision the school shall forthwith notify the parent or guardian, in writing, of such defect or disease. These screenings are designed only to identify students who may need further assessment and evaluation. It is not for the purpose of diagnosis

These screenings are scheduled within the first 60 days of school start. Once done, this may be completed at any time within the current school year.

Each school division may set a policy, assigning the personnel responsible for completion of vision screening. Classroom teachers, physical education teachers, school nurses, or parent volunteers given the responsibility for vision screening should receive instruction in the proper techniques to be used. In addition, personnel should understand that vision screening is designed only to identify students who may need further assessment and evaluation. It is not for the purpose of diagnosis.

As recommended by the Virginia Board of Education, the York County School Division provides educational material for parents to identify the children who have abnormal curvature of the spine (scoliosis). According to current medical information, 7 to 10 of every 100 children may develop scoliosis; 1 to 3 of that group will require treatment. Scoliosis most commonly occurs in children 9-14 years of age. If the condition is detected early and appropriately treated, progressive spine deformity can be prevented. Scoliosis generally occurs in otherwise healthy children during the growth years, 10-15.  Progressive curves occur more frequently in girls than in boys.  Scoliosis tends to run in families and if scoliosis is diagnosed, other siblings should be evaluated. 

Students may have the following items in their book bag for personal use. Snacks, water bottles, peppermints or throat lozenges, cough drops, anti-microbial wipes, chap-stick, hand sanitizer, sunscreen, lotion, contact lens solution, change of clothing, personal hygiene products are allowed and parents are encouraged to replenish as needed.

Only non-medicated cough drops such as Ludens, Halls, etc. may be carried by a student with a parent's written request and the understanding that the responsibility of consumption of the cough drops belongs to the parent and child, not the teacher, nurse, or school. Cough drops can be a choking hazard and the safety of our students is our top priority. Carrying cough drops is a privilege, which can be revoked if the child demonstrates any irresponsible behavior with them or shares them with classmates. If there is a problem or misuse of any of these items, permissions can be revoked.

If a student has an accident or becomes ill during the school day, clinic staff will assess their condition and provide appropriate care. The parents will be contacted immediately if they need to go home or need further treatment. If your child states they were injured and you have not been contacted do not become alarmed right away. Please contact the nurse and find out your student’s situation. The child may not have told anyone of the injury, visited the clinic, showed signs or symptoms of injury at that time and/or they never returned as directed if they needed. In case of emergencies, clinic staff will provide care until the student can be transported to a hospital. It is important that clinic staff be made aware of current telephone numbers, emergency contacts, changes in health status and student medications, and that emergency contacts live locally.

Students with infectious or contagious conditions may be sent home until treatment is initiated. The Virginia Department of Health’s guidelines are followed by the school nurse regarding all communicable diseases.

• Your child will be sent home, and/or asked to remain at home, if any of the following symptoms are present:
• Fever of 100.0 degrees Fahrenheit or more
• Vomiting due to illness
• Repeated diarrhea
• Inflamed or draining eyes/ears
• Skin eruptions/draining sores
• Severe headache
• Sore throat/Upper Respiratory Infection - red throat, swollen glands, persistent dry or productive cough, and green or yellow nasal discharge
• Uncontrollable persistent cough
• Wheezing that continues to increase 1 hour after medication is taken
• Undiagnosed rash or skin infection
• Undiagnosed red eye and/or drainage from eye(s). Pinkeye is very contagious. Student must be on antibiotic medication 24 hours before returning to school
• Injury making it hazardous to be in school
• Earache or dental pain lasting more than 12 hours
• Student is too weak or fatigued to take part in routine daily school activities

24 Hour Rule-If your student has been sent home with any of those contagious symptoms, they may return to school when he/she has been symptom free for at least 24 hours without the use of medication, to include over-the-counter fever-reducing medications.

Every school will have medical designees inside their buildings, assigned by administration. These designees will have CPR/First Aid/AEDs/Emergency medication training such as Epi-Pens and Albuterol/Diabetes and Seizure care in addition to other routine medication administration and other chronic conditions specifics. Currently schools are not mandated in the Commonwealth of Virginia to have nurses in each school building; but YCSD has been prioritizing our students’ health needs for more than 20+ years and provides a full-time Registered Nurse in each clinic.

All public school systems in Virginia are required to have epinephrine/albuterol and opioid reversal agents available in each school for the emergency treatment of conditions such as anaphylaxis, opioid overdose and severe asthmatic-like events. Each school will be required to have at least two (2) employees trained in the administration of these emergency medications and will follow the guidelines on their administration and/or use as set forth by the Virginia Department of Education.

If a student is involved in an altercation or other situation, where they may have been injured by another person the nurse will almost always assess the injured to make sure there is not a need for emergency services. If needed EMS or appropriate nursing interventions will be instituted and you will be contacted without delay. While your student is assessed by the nurse, administration is actively conducting an investigation. If the student is stable, or does not need emergency nursing interventions then you will receive a call from administration after the investigation has concluded. You will be informed of the situation and the particulars of the incident and extent of your student’s involvement. After speaking with administration, should you have any questions about your student’s health status please do not hesitate to contact the nurse for further information.

York County School Division recognizes that a healthy child is an active learner, however if a concussion or brain injury is suspected this can negatively affect all aspects of wellness including academic fitness. Procedures and protocols are designed to guide school and designated members of the Concussion Management Team within each YCSD school building. These are intended for concussions that occur both within YSCD extracurricular activities/sports and those incurred outside of these activities.

Many people are vested in a student’s education, especially when a health condition affects his or her ability to learn. For the student to receive the best care, all of the team members must communicate effectively both amongst themselves and with the family. This cohesive team makes up an effective Concussion Management Team (CMT). Those involved can be grouped into four categories:

• Student and Family
• Academic Team: Teachers, Guidance Counselors, School Psychologists, Administrators
• Medical Team: Athletic Trainer, School Nurse, Physician
• Athletic Team: Athletic Director, Coaches, Physical Education Teachers

The basic academic concussion management process begins with identifying the injury and notifying the Concussion Management Leader (CML) of the injury, so the process can begin. When the student returns to school, a needs assessment must be performed to determine the student’s medical and academic problems. Once the needs are established, a plan with accommodations can be created and disseminated to team members. Any physician notes and guidelines can be used to help create the basic framework of the plan.

There could be an injury or illness which may cause your child to possibly miss or need accommodations in their PE class temporarily. A parent note is only acceptable for up to 3 PE classes that they may miss or need an alternative assignment for. Beyond that a note from a medical provider is needed as that may mean a more permanent solution to the student’s participation may need to be implemented. Please note, if a student’s PE class is modified then the same restrictions will apply to recess, sports and any intramural activity period involving the school.

Please be sure to fill out and return the "Health Update" form in the beginning of the school year. They are distributed through your child’s homeroom classes on the first day of school. This allows us to be aware of any new health concerns or changes with your child. Throughout the school year, if a new health concern/condition arises or contact information changes, please call the clinic to update or submit another revised form.

Any device or equipment that is required to be used, worn or monitored for the health of any student should be brought to the school with required documentation. This documentation should include the name of the prescriber (with contact information) and can be accepted from qualified and credentialed professionals, who have no personal relationship with the student, and whose credentials match the disability being evaluated (i.e., a medical condition documented by a physician, a psychological condition documented by a psychologist, etc.). A plan of care and/or guidance from the medical professional must also be submitted before accommodations for any temporary or chronic disabilities can be made. The documentation should include the following: Reason for use, duration (length) of use (with dates) and ability to use stairs, activity restrictions (such as PE or recess) or any special instructions. The parent/guardian must also provide the Medical Device/Equipment needed, to include items such as crutches, braces, wheelchair, cane, or walker. For example, the parent/guardian of students that require the use of a mobility assistive device in school; should provide the device, documentation and plan of care to the school nurse. This guidance assures the school can reasonably provide a safe environment for this student.

A student with a long-term disability does not require additional documentation each school year unless there is a change in the use of their medical equipment/device. The school nurse will review the documentation and develop and implement a plan to accommodate the student during the school day to include field trips.

Medications- As soon as you know of a field trip and your student will need extra consideration for medical reasons please do not hesitate to contact the nurse. All regularly scheduled medications and emergency medications will be packed to accompany the student on a field trip. Over the counter remedies cannot be sent.

Designees- If your student has a chronic illness and you are not able to attend the trip please contact your nurse immediately. Staff trained in emergency medications need to be assigned.

The York County School Division recognizes that it may be necessary for your child to receive medication during the school day. Administration of all medication will be recorded and retained in the student’s health record. The student’s right to privacy regarding medication administration must be respected and all health information related to student’s medication /medical condition must be maintained as confidential. Proper hygienic practices are to be employed. If a student lacks ability or understanding or is not complying with physician’s orders, the parent/physician will be notified and the situation will be reevaluated. For the health and safety of all students, the school nurse will strictly enforce the following in regards to medication:

• All prescription and over-the-counter medication (including, Tylenol, Advil, cold and cough preparations) must be administered by the school nurse (or designated trained school employee) in the school clinic.
• Students are not allowed to be in possession of any oral medication during the school day.
• All medication must be in the original, unopened bottle. Prescription medication must be in the original container with the child’s name, medication, dosage, time and amount to be given. Non-prescription medication must be in the original unopened container with the child’s name on the container.
• The clinic cannot accept phone or verbal permission for medication administration.
• All medication permission forms must be updated every school year.

A parent/guardian must transport medication to school.  Medication cannot be sent with the student. A parent/guardian must pick up any unused medication by the end of the school year. Any medication not picked up will be destroyed.

The Medication Admission Form must be completed before medication can be administered. This includes a health provider’s signature for all prescriptions and OTC medication that deviates from the printed instructions on the container.

Asthma Medication – The Asthma Health Care Action Plan & Authorization for Medication must be completed and on file in the clinic before a student can carry and self-administer asthma medication. All public school systems in Virginia are required to have stock Albuterol in each school for the treatment of severe asthmatic symptoms.

Epinephrine – The Emergency Allergy Form must be completed and on file in the clinic before a student can carry and self-administer epinephrine.  All public school systems in Virginia are required to have stock epinephrine available in each school for the treatment of anaphylaxis.

Seizure Rescue Medication – Only secondary school students with a seizure management and action plan completed with written permission and on file in the clinic may self-possess their rescue medication. Each school year these factors will be reviewed based on safety and responsibility of the student, and may be limited or expanded by appropriate school personnel, student’s parents and related physician discussions and approvals.

Possession and/or self-administration of these approved medications must be consistent with the purposes of the Virginia School Health Guidelines and the polices of York County School Division.

Alternative or Natural Remedies, Herbs, Vitamins, Homeopathic Medicines – School personnel will not administer any product that could be considered a drug, including natural remedies, herbs, vitamins, dietary supplements, homeopathic medicines, or medications from other countries without a written order from a health care provider authorized to prescribe in Virginia. The following conditions must also be met in addition to written doctor orders and authorization:

• Identification of the condition for which the product is being used                                
• Written request from the parent/guardian                                                                                                              
• Verification that the product and requested dosage are safe for the student (age, body weight & condition)
• Reasonable information about the therapeutic and possible effects and interactions

Although herbal products are sold over-the-counter, they are not fully regulated nor are there standardized dosing guidelines, particularly for the safe use in children. Homeopathic remedies are not required by the FDA to be tested for safety and effectiveness. School personnel and school nurses will not administer to children any substance whose safety is not established and does not meet the above conditions.

Students with special health care needs require guidance to school nurses, teachers, and other staff regarding the medical care of the students within the school setting. The Guidelines are based on current nursing and medical protocols for the care of children with special health care needs.

Parents or guardians have the primary responsibility for providing appropriate health care for their children. Whenever possible, parents are encouraged to work with their health care provider to administer medications and specialized health care procedures before or after school.

When procedures and medications need to be administered during school hours, the parents or guardians, health care provider, student (if appropriate), and school nurse should develop a plan to outline what needs to be done during the school day. Parents or guardians also need to provide the school with comprehensive medical information, medications, medical equipment, and medical supplies to help school staff care for their child.

With appropriate care, including medical management and strategies to reduce environmental asthma triggers, students with asthma can control their symptoms so that the condition does not interfere with their educational activities.

Schools are one setting in which many asthma control services can be provided. For example, school nurses can help students use their medications correctly and can refer students to medical care. Other school personnel have roles in ensuring that students receive emergency care when needed. School staff can also take steps to improve the school environment so that students, as well as faculty and staff, are not exposed to harmful substances that can trigger their asthma symptoms.

If a student needs to keep an inhaler or rescue inhaler in the clinic, parents are advised to have their pediatrician fill out the Asthma Action Plan Form. In addition, parents must fill out a Medication Authorization Form when the medication is brought into the clinic. If a student is mature enough your pediatrician may indicate that your child may self-carry their inhaler on their person. Please be advised however, it is always a good choice to have a backup inhaler located in the clinic.

There is a lack of expert consensus and guidance on whether a nebulizer treatment constitutes an aerosol generating procedure, especially when in relation to possible communicable respiratory illness. It is uncertain if these types of managements generate aerosols and are infectious and may contribute to transmission of respiratory infections. Given this uncertainty, YCSD school’s use metered dose inhalers with spacers over nebulizer treatments.

Recognizing that students with a history of seizures attend public school, every effort is made to accommodate the student in the school setting. YCSD health service providers follow the Seizure Management Guidelines as set forth by the Virginia Department of Education.

Managing a seizure in the school setting consists of protecting the student, observing the student, and administering medical assistance when needed. A Seizure Action Plan should be used with students being treated for a seizure disorder and contains vital information, which may assist if a seizure occurs during the school day.

Students with sickle cell disease may miss class time or be absent for doctor visits or hospital stays. These students need special consideration regarding missed instruction, assignments, and testing. Chronic fatigue or pain can make it appear that students aren't motivated to learn. School staff that are aware and know your student well can help you make their experiences in school more positive.

Kids and teens with sickle cell disease may not be able to play contact sports or participate in strenuous exercise — it is as individual as each student. In the absence of restrictions, encourage them to participate in moderate physical exercise and other school activities. It is important for the student to carry a bottle of water at all times and take frequent bathroom breaks. They may need breaks from instruction and activities when necessary; and avoid outdoor activities when it's very hot or very cold.

School personnel and caregivers play an important role in a student’s health and academic success. For students living with a chronic health condition like sickle cell disease, communication between parents and school officials is essential in supporting positive academic outcomes.

Collaboration and cooperation are key elements in planning and implementing successful diabetes management at school. As is true for students with other chronic diseases, students with diabetes are more likely to succeed at school when the student’s school healthcare team work together.

• Elementary students, depending on the duration of diabetes and level of maturity, may be able to perform their own blood glucose checks, but usually will require supervision. Older elementary students are generally beginning to self-administer insulin with supervision and understand the effect of insulin, physical activity, and nutrition on blood glucose levels. Unless the child has hypoglycemia unawareness, he or she should usually be able to let an adult know when experiencing low blood glucose.
• Middle and high school students are usually able to self-manage their diabetes depending on the duration of diabetes and level of maturity but will always need help when experiencing severe hypoglycemia. Independence in older youth should generally be encouraged to enable the student to engage in his or her decisions about his or her own care.

Parents are responsible for providing the school with all the supplies and equipment necessary to implement the Diabetes Medical Management Plan (DMMP) and related educational plans. Parents will need to meet with the school nurse, teacher(s), and necessary school personnel before the student with diabetes attends school to discuss the needs of the student and the school schedule.

Arrangements should be made in advance with students who self-carry and self-manage, so that they keep their diabetic supply kit in a dedicated place where it can be found in an emergency when the individual with diabetes may be unable to take care of him/herself. However, because diabetic supplies can be life-saving, back up supplies should also be kept in the clinic to reduce what the student must carry and to serve as an emergency backup. Extra supplies, provided by the parent/guardian, should be housed in the health or main office in the event the student’s personal supply is lost or cannot be located in an emergency.

While Virginia law permits students with diabetes to self-carry and manage their medical needs, it should be noted that when the student carries and self-administers medications or performs self-care tasks independently, there is an implied expectation that he or she will carry out self-care in a responsible, safe, and mature manner. It is expected that the student will keep medications in a secure, dedicated location known to the student and the school nurse or other trained staff member will facilitate assistance in the event of an emergency. Parents, students, and the school nurse should determine documentation of self-care and appropriate staff intervention.

The United States Dept. of Agriculture (Reg. 7 CFR Part 15b) requires substitutions or modifications in school meals for children with medical conditions or food allergies that may result in severe, life-threatening (anaphylactic) reactions. These substitutions need to be supported by a statement signed by a recognized medical authority (licensed physician, nurse practitioner, physician assistant). The statement must identify the medical or other special dietary condition which restricts the child's diet, the food or foods to be omitted, and the food or choice of foods to be substituted. For your student’s health and safety, the school needs the following items returned to the school’s clinic as soon as possible.

• Dietary needs/Substitutions (e.g., food intolerance)                                 
• Severe Food Allergy: contain specific instructions for the school staff in the event that an allergic reaction occurs while at school
• Emergency Medications: Epinephrine Kits or Benadryl are to be kept in the clinic (If applicable-your child suffers from a food allergy that causes possible life-threatening symptoms (i.e., shortness of breath or wheezing, hives, etc.) parents must provide all medication used to treat these symptoms

Food allergies, once considered rare, are now believed to affect 2.5 million American children.  Foods that most often cause allergic reactions include milk, peanuts, eggs, tree nuts (walnuts, pecans, almonds, etc.), wheat, fish, shellfish, and soy. These foods cause at least 30,000 emergency rooms visits annually and an estimated 150 deaths.

These statistics along with a dramatic rise in medical conditions such as childhood diabetes and obesity have caused a reevaluation of school policy concerning classroom treats. As of school year 2009-2010 we no longer permit food snacks to celebrate birthdays etc. in the classroom or cafeteria without prior approval from school administration and classroom notification. We do not want this viewed as "taking the fun out of school" but rather that the safety of our children is our #1 priority. Food brought in for particular academic-related classroom celebrations or concluding a unit of study will still be encouraged. These will be planned by the teacher in conjunction with their room parent while considering individual dietary restrictions of the class members.

Several safety factors were considered in our decision. Ingredient lists can be difficult to read as they often use confusing synonyms. For example, milk can be listed as casein, lactalbumin, hydrolysates, lacoglobulin, or whey and eggs can be listed as albumin, globulin, livetin, lysozyme, or ovalbumin. This can be an unfair burden on anyone attempting to make a safe food selection. Cross contamination between an allergy-containing and an allergy-free food can occur simply by using a shared utensil.  Manufactured treats are often prepared on the same assembly line that made peanut or chocolate treats last week, and this too is a potential threat to someone with a food allergy. Please support us in this policy to avoid these potential life-threatening reactions and keep our students safe and healthy.

Outdoor and indoor allergies such as seasonal allergies, tree pollen allergy, grass allergy, ragweed pollen allergy, insects or insect venom and indoor allergies such as classroom pets (furry animals, birds), mold, dust or dust mites, chemicals, nickel in jewelry, and other irritants are known allergens. Latex can also be an allergen for students and staff. Natural rubber latex can be present in school supplies, rubber bands, mouse pads, goggles, balloons, sports equipment and other materials. People with latex allergy may also experience an allergic reaction to certain fruits and vegetables, such as bananas, kiwi and avocados. This happens because proteins in natural rubber latex are similar to those found in cross-reactive fruits and vegetables. Students with these allergies can use the same forms, with the allergen clearly stated instead of a food item.