Series 5000: Students

5141 Student Health Services

School District Medical Advisor 

The Board of Education (Board) shall appoint a school district medical advisor and appropriate  medical support service personnel including nurses. 

The school district medical advisor, in cooperation with the Board and the board of health/health  department for the school district, shall: 

1. Plan and administer each school’s health program, 

2. Advise on the provision of school health services, 

3. Provide consultation on the school health environment, and 

4. Perform any other duties as agreed between the advisor and the appointing board of education. 

School health efforts shall be directed toward detection and prevention of health problems and to  emergency treatment, including the following student health services: 

1. Appraising the health status ofstudent and school personnel; 

2. Counseling students, parents, and others concerning the findings of health examination;

3. Encouraging correction of defects; 

4. Helping prevent and control disease;

5. Providing emergency care for student injury and sudden illness; 

6. Maintaining school health records. 

Health Records 

There shall be a health record for each student enrolled in the school district which will be  maintained in the school nurse’s room. For the purposes of confidentiality, records will be treated  in the same manner as the student's cumulative academic record. 

Student health records are covered by the Family Educational Rights and Privacy Act (FERPA) and  are exempt from the Health Insurance Portability Accountability Act (HIPAA) privacy rule.  However, it is recognized that obtaining medical information from health care providers will require  schools to have proper authorization and to inform parents that such information once released by  health care providers is no longer protected under HIPAA but is covered under FERPA.

Regular Health Assessments 

Prior to enrollment in kindergarten, each child shall have a health assessment by one of the  following medical personnel of the parents or guardians choosing to ascertain whether the student  has any physical disability or other health problem tending to prevent him or her from receiving the  full benefit of school work and to ascertain whether such school work should be modified in order  to prevent injury to the student or to secure for the student a suitable program of education: 

1. a legally qualified physician; 

2. an advanced practice registered nurse; 

3. a registered nurse; 

4. a physician's assistant; 

5. a school medical advisor; 

6. a legally qualified practitioner of medicine, an advanced practice registered nurse, or a physician assistant stationed at any military base. 

Such health assessment shall include: 

1. Physical examination which shall include hematocrit or hemoglobin tests, height, weight, and blood pressure; 

2. Updating of immunizations required under C.G.S. 10-204a as periodically amended;

3. Vision, hearing, postural, and gross dental screening; 

4. If required by the school district medical advisor, testing for tuberculosis and sickle cell anemia or Cooley’s Anemia; 

5. Any other information including a health history as the physician believes to be necessary and appropriate. 

Health assessments shall also be required in grades 6 or 7 and in grades 9 or 10 by a legally  qualified physician of each student’s parents or guardians own choosing, or by the school medical  advisor, or the advisor's designee, to ascertain whether a student has any physical disability or other  health problem. Such health assessments shall include: 

1. Physical examination which shall include hematocrit or hemoglobin tests, height, weight, and blood pressure; 

2. Updating of immunizations required under C.G.S. 10-204a and the Department of Public Health, Public Health Code, 10-204a-2a, 10-204-3a and 10-204a-4; 

3. Vision, hearing, postural, and gross dental screening;

4. If required by the school district medical advisor and the local health department, testing for tuberculosis and sickle cell anemia or Cooley's Anemia; 

5. Any other information including a health history as the physician believes to be necessary and appropriate. 

A child will not be allowed, as the case may be, to begin or continue in district schools unless health  assessments are performed as required. Students transferring into the district must provide evidence  of required Connecticut vaccinations, immunizations, and health assessments at enrollment and  prior to school attendance. 

Health assessments will be provided by the school medical advisor or the advisor's designee without  charge to all students whose parents or guardians meet the eligibility requirement of free and  reduced priced meals under the National School Lunch Program or for free milk under the special  milk program. 

The Board of Education shall annually designate a representative to receive reports of health  assessments and immunizations from health care providers. 

Health assessment results and recommendations signed by the examining physician or authorized  medical personnel shall be recorded on forms provided by the Connecticut State Board of Education  and kept on file in the school the student attends. Upon written authorization from the student's  parent or guardian, original cumulative health records shall be sent to the chief administrative  officer of the school district to which such student moves and a true copy of the student's cumulative  health records maintained with the student's academic records. The Superintendent of Schools, or  designee, shall notify parents of any health-related problems detected in health assessments and  shall make reasonable efforts to assure that further testing and treatment is provided, including  advice on obtaining such required testing or treatment. 

Students who are in violation of Board requirements for health assessments and immunizations will  be excluded from school after appropriate parental notice and warning. 

Vision Screening 

All students in grades K, 1, 3, 4, & 5 will be screened using a Snellen chart, or equivalent screening,  by the school nurse or school health aide. Additional vision screening will also be conducted in  response to appropriate requests from parents/guardians or professionals working with the student in  question. Results will be recorded in the student's health record on forms supplied by the  Connecticut State Board of Education, and the superintendent shall cause a written notice to be  given to the parent or guardian of each student found to have any defect of vision, with a brief  statement describing such defect. 

As necessary, special educational provisions shall be made for students with disabilities.

Hearing Screening 

All students will be screened for possible hearing impairments in grades K, 1, 3, 4, & 5. Additional  audiometric screening will be conducted in response to appropriate requests from parents/guardians  or professionals working with the student. Results will be recorded in the student's health record on  forms supplied by the Connecticut State Board of Education, and the Superintendent shall cause a  written notice to be given to the parent or guardian of each student found to have any defect of  hearing, with a brief statement describing such defect.

As necessary special educational provisions shall be made for students with disabilities. 

Postural Screening

School nurses will screen all female students in grades 5 and 7 and male students in grade 8 or 9 for  scoliosis or other postural problems. Additional postural screening will also be conducted in  response to appropriate requests from parents/guardians or professionals working with the student.  Results will be recorded in the student's health record on forms supplied by the Connecticut State  Board of Education, and the Superintendent shall cause a written notice to be given to the parent or  guardian of each student found to have any postural defect of problem, with a brief statement  describing such defect or disease. 

As necessary special educational provisions shall be made for students with disabilities.

Tuberculin Testing 

In addition to tuberculin testing, if required by the school district medical advisor, as part of regular  student health assessments, all new students, including preschool students, will be required to have  at least one test for tuberculosis prior to entry in district schools, if determined to be at risk for  exposure to TB. 

A test for tuberculosis should be performed if any of the following risk factors prevail: 

1. birth in a high risk country of the world (see list of countriesin Appendix) and do not have a record of a TST (tuberculin skin test) or IGRA (interferon-gamma release assay) performed in the United States; 

2. travel to a high risk country, staying at least a week with substantial contact with the indigenous population since the previously required examination; 

3. extensive contact with persons who have recently come to the United States since the previously required examination; 

4. contact with persons suspected to have tuberculosis, or 

5. lives with anyone who has been in a homeless shelter, jail or prison, uses illegal drugs or has an HIV infection.

The results of the risk assessment and testing, when done, should be recorded on the State of  Connecticut Health Assessment Record (HAR-3) or directly in the student’s Cumulative Health  Record (CHR-1) 

Immunizations/Vaccinations 

No student will be allowed to enroll in any program operated as part of the district schools without  adequate immunization against the following diseases: 

1. Measles 

2. Rubella 

3. Poliomyelitis 

4. Diphtheria 

5. Tetanus 

6. Pertussis 

7. Mumps 

8. Hemophilus influenza type B 

9. Any other vaccine required by Section 19a-7f of Connecticut General Statutes.

10. Hepatitis B 

11. Varicella (chickenpox) 

12. Hepatitis A 

13. Pneumococcal disease 

14. Influenza 

15. Meningococcal disease 

All students in grades K-12 are required to have received 2 doses of measles, mumps and rubella vaccine or serologic proof of immunity. Students entering kindergarten and seventh grade shall  show proof of having received 2 doses of varicella vaccine, laboratory confirmation of immunity, or  present a written statement signed by a physician, physician assistant or advanced practice  registered nurse indicating the individual has had varicella based on family or medical history.  (Varicella requirement effective August 1, 2011) 

All seventh grade students must show proof of 1 dose of meningococcal vaccine and 1 dose of Tdap  in addition to the completion of the primary DTP series. 

All students in grades K-12 are required to have 3 doses of Hepatitis B vaccine or serologic evidence of immunity.

Exemptions: 

Act P.A. 21-2 eliminates the religious exemption from immunization requirements for individuals attending (1) public and private schools, including higher education institutions, and (2) child care  centers and group and family day care homes. Under current law, individuals may opt out of  vaccination if they present a statement that immunization would be contrary to their religious beliefs  or, for minors, those of their parent or guardian. 

The Act grandfathers in individuals enrolled in grades kindergarten or higher who submitted a religious exemption prior to the bill’s passage (April 28, 2021). It continues to grandfather these  students if they transfer to another public or private school in the state (i.e., a primary or secondary  school). 

Under the Act, individuals with prior religious exemptions who are enrolled in pre-kindergarten or  other preschool programs generally must comply with immunization requirements by September 1,  2022, or within 14 days after transferring to a different public or private program, whichever is later. 

However, the Act allows these children to extend the timeframe within which they must comply with the immunization requirements if they present a written declaration from the child’s physician,  physician assistant (PA), or advanced practice registered nurse (APRN) that an alternative  immunization schedule is recommended. 

The Act also retains current law’s medical exemption from these immunization requirements for individuals who can document that the immunization is medically contraindicated. 

The medical exemption certificate must include: 

1. definitions of “contraindication” and “precaution”; 

2. a list of contraindications and precautions recognized by the CDC for each statutorily required immunization from which the provider may select on behalf of an individual; 

3. a section where the provider may record a contraindication or precaution not recognized by the CDC, but that in the provider’s discretion, results in the vaccination being medically contraindicated, including (a) an autoimmune disorder or family history of one, (b) family history of a reaction to a vaccine, (c) genetic predisposition to a vaccine reaction determined by genetic testing, and (d) a previous documented reaction correlated to a vaccine; 

4. a section where the provider may include a written explanation for the medical exemption;

5. a section requiring the provider’s signature; 

6. a requirement that the provider attach the individual’s most current immunization record; and

7. a synopsis of the grounds for any order of quarantine or isolation related to the exemption.

The school nurse will report to the local Director of Health any occurrence of State of Connecticut defined reportable communicable diseases. 

Health Assessments/Interscholastic Sports Programs 

Any student participating in an interscholastic sports program must have a health assessment, within the past thirteen months prior to the first training session for the sport or sports. After the initial  examination, repeat examinations are required every two years. Each participant in a sport program  must complete a health questionnaire before participating in each sport. 

Parents are expected to use the services of their private physician. If a student is unable to obtain a health assessment from his/her personal physician for financial or other reasons, an examination can be arranged with school medical advisor. Health assessment results shall be recorded on forms  provided by the Connecticut State Board of Education, signed by the examining physician, school  medical advisor or advisor's designee, filed in the student's health folder, and maintained up to date  by the school nurse. 

Coaches and physical education staff shall insure appropriate monitoring of an athlete's physical condition.

Student Medical Care at School 

School personnel are responsible for the immediate care necessary for a student whose sickness or injury occurs on the school premises during school hours or in school-sponsored and supervised  activities. 

Schools shall maintain files of emergency information cards for each student. If a child's injury requires immediate care, the parent or guardian will be called by telephone by the nurse, the  building principal, or other personnel designated by the principal, and advised of the student's  condition. When immediate medical or dental attention is indicated, and when parents or guardians  cannot be reached, the student will be transported to the nearest hospital unless otherwise indicated  on the student's Emergency Information card. In this event, the family physician/dentist and school  district medical advisor will be notified of school district actions. 

(cf. 5125.11 - Health/Medical Records HIPAA) 

(cf. 5142 - Student Safety) 

(cf. 5141.3 - Health Assessments & Immunizations) 

(cf. 5141.4 - Child Abuse and Neglect) 

(cf. 5141.5 - Suicide Prevention) 

(cf. 6142.1 - Family Life and Sex Education) 

(cf. 6145.2 - Interscholastic/Intramural Athletics) 

(cf. 6171 - Special Education) 

Legal Reference:

Connecticut General Statutes 

10-203 Sanitation. 

10-204a Required immunizations, as amended by PA 15-174 & PA 15-242. 

10-204c Immunity from liability 

10-205 Appointment of school medical advisors. 

10-206 Health assessments, as amended by PA 07-58 and PA 11-179. 

10-206a Free health assessments. 

10-207 Duties of medical advisers, as amended by P.A. 12-198. 

10-208 Exemption from examination or treatment.

10-208a Physical activity ofstudent restricted; boardsto honor notice. 

10-209 Records not to be public. (as amended by P.A. 03-211) 

10-210 Notice of disease to be given parent or guardian. 

10-212 School nurses and nurse practitioners. 

10-212a Administration of medicines by school personnel. 

10-213 Dental hygienists. 

10-214 Vision, audiometric and postural screening: When required; notification of parents re defects; record of results. (As amended by PA 96- 229 An Act Concerning Scoliosis Screening) 

10-214a Eye protective devices. 

10-214b Compliance report by local or regional board of education. 

10-217a Health services for children in private nonprofit schools. Payments from the state, townsin which children reside and private nonprofitschools. 

Department of Public Health, Public Health Code – 10-204a-2a, 10-204a-3a  and 10-204a-4. 

Federal Family Educational Rights and Privacy Act of 1974 (section 438 of  the General Education Provisions Act, as amended, added by section 513 of P.L. 93-568, codified at 20 U.S.C. 1232g). 

42 U.S.C. 1320d-1320d-8, P.L. 104-191, Health Insurance Portability and  Accountability Act of 1996 (HIPAA) 

Policy adopted: June 13, 2022 THOMASTON PUBLIC SCHOOLS  Thomaston, Connecticut