Information
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Document No.
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Audit Title
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Client / Site
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Conducted on
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Prepared by
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Location
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Personnel
Program Highlights
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Immunization banner received in previous school year for 95-100% compliance
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Special program /nurse recognitions
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Special event/committee involvement.
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Participates in opportunities provided by community partners
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Dental Projects
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Project Saving Smiles
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UT School of Dentistry
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Vision Partnership(s)
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Kids vision for life
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UH School of Optometry
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Immunization outreach
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Referral to School based or mobile health care services
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Others
Estimated Program Acuity
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Number of students with an invasive procedure.
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Number of students with a documented chronic health condition requiring daily management during school hours.
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Number of students with a documented chronic health condition at risk for emergent care during school hours.
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Asthma
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Risk for anaphylaxis.
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Diabetes
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Seizure
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Other
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Number of nurses on campus full time
Medication Procedures
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There are at least 2 ways safe administration is addressed.
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Follow up corrective action will be completed by
- 1 day
- 10 school days
- 30 days
- 60 days
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Photo ID
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Student says his/her name.
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Student says name of medication and/or color of pill.
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If other, enter here
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Medication requests signed by the parent and physician for each medication on hand.
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Follow up corrective action will be completed by
- 1 day
- 10 school days
- 30 days
- 60 days
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A medication administration form is in designated binder, completed for each student and accurately reflects physician orders.
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Follow up corrected action will be completed by:
- 1 day
- 10 school days
- 30 days
- 60 days
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Self-carry medication administration orders are complete for each designated student.
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Follow up corrected action will be completed by:
- 1 day
- 10 school days
- 30 days
- 60 days
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Completed SHARS training.
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Follow up with corrected action will be completed by:
- 1 day
- 10 school days
- 30 days
- 60 days
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Principal Medication Designation form is complete and easily accessible
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Medication skills checklists complete for all designees (initial and return demonstrations documented).
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Drug information is included in the medication book.
Case Management of Students with Chronic Health Conditions
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IHP and Emergency Plan developed for each student.
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Follow up with corrected action will be completed by:
- 1 day
- 10 school days
- 30 days
- 60 days
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Medical Alert and Conditions screen in Chancery updated for all identified students.
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Follow up with corrected action will be completed by:
- 1 day
- 10 school days
- 30 days
- 60 days
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Training conducted and documented for use of emergency medication (I.e Diastat, asthma rescue meds, auto injector).
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Follow up with corrected action will be completed by:
- 1 day
- 10 school days
- 30 days
- 60 days
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Completed search in Chancery for students with medical alert/condition
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Follow up with corrected action will be completed by:
- 1 day
- 10 school days
- 30 days
- 60 days
Case Management of students with special healthcare needs/ invasive procedures
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Students enrolled who require invasive procedures
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Skip to last question in this section
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IHP completed and on file for each student.
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Follow up with corrected action will be completed by:
- 1 day
- 10 school days
- 30 days
- 60 days
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Emergency plan on file for each student including evacuation procedures.
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Follow up with corrected action will be completed by:
- 1 day
- 10 school days
- 30 days
- 60 days
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Orders for special procedure(s) are current, signed by parent and physician.
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Follow up with corrected action will be completed by:
- 1 day
- 10 school days
- 30 days
- 60 days
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Treatment consent form completed for each student including parent and physician signature.<br><br><br><br><br><br><br>
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Follow up with corrected action will be completed by:
- 1 day
- 10 school days
- 30 days
- 60 days
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Training conducted with Back-up Nurse.
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Follow up with corrected action will be completed by:
- 1 day
- 10 school days
- 30 days
- 60 days
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Name of back up school
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Office and designated staff informed of how and when to activate back up procedures in absence of nurse.
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Follow up with corrected action will be completed by:
- 1 day
- 10 school days
- 30 days
- 60 days
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Itinerant nurse request form available and easy to access.
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Follow up with corrected action will be completed by:
- 1 day
- 10 school days
- 30 days
- 60 days
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Knowledgeable of whether or not there are procedures at designated back-up school.
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Follow up with corrected action will be completed by:
- 1 day
- 10 school days
- 30 days
- 60 days
Anaphylaxis
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Anaphylaxis Awareness (Level 1) training completed and documented.
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Follow up with corrected action will be completed by:
- 1 day
- 10 school days
- 30 days
- 60 days
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Staff-specific training (Level 2) including use of auto-injector completed and documented.
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Follow up with corrected action will be completed by:
- 1 day
- 10 school days
- 30 days
- 60 days
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Epinephrine auto injectors are kept in an accessible cabinet during the school day.
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Follow up with corrected action will be completed by:
- 1 day
- 10 school days
- 30 days
- 60 days
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IHP completed and on file for each student, updated for current school year.
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Follow up with corrected action will be completed by:
- 1 day
- 10 school days
- 30 days
- 60 days
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Emergency plan on file for each student including transport of meds in case of evacuation
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Follow up with corrected action will be completed by:
- 1 day
- 10 school days
- 30 days
- 60 days
Diabetes Care
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Diabetes Management and Treatment Plan is current, signed by parent and physician.
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Follow up with corrected action will be completed by:
- 1 day
- 10 school days
- 30 days
- 60 days
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Staff-specific training completed and documented.
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Follow up with corrected action will be completed by:
- 1 day
- 10 school days
- 30 days
- 60 days
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UDCA Principal Designation Form is signed
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Follow up with corrected action will be completed by:
- 1 day
- 10 school days
- 30 days
- 60 days
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UDCA skills checklist has been completed (initial and return demonstrations documented).
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Follow up with corrected action will be completed by:
- 1 day
- 10 school days
- 30 days
- 60 days
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IHP completed and on file for each student, updated for current school year.
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Follow up with corrected action will be completed by:
- 1 day
- 10 school days
- 30 days
- 60 days
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Emergency plan on file for each student including procedures in case of evacuation.
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Follow up with corrected action will be completed by:
- 1 day
- 10 school days
- 30 days
- 60 days
Emergency Preparedness
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Emergency care forms are printed and available to be quickly taken during an evacuation.
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Follow up with corrected action will be completed by:
- 1 day
- 10 school days
- 30 days
- 60 days
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Evacuation plan in place for medications, special procedure supplies/equipment
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Follow up with corrected action will be completed by:
- 1 day
- 10 school days
- 30 days
- 60 days
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Emergency bag is intact, readily accessible.
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Follow up with corrected action will be completed by:
- 1 day
- 10 school days
- 30 days
- 60 days
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Crisis Team has been identified with at least persons trained in CPR.
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Follow up with corrected action will be completed by:
- 1 day
- 10 school days
- 30 days
- 60 days
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AED procedures current including checklist and unexpired pads and batteries.
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Follow up with corrected action will be completed by:
- 1 day
- 10 school days
- 30 days
- 60 days
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Location of AED
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Location
AED
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Wall mounted
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Submits 911 reports and follow up as required.
Substitutes
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Medication administration binder available.
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Follow up with corrected action will be completed by:
- 1 day
- 10 school days
- 30 days
- 60 days
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Current student health condition information is readily available.
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Follow up with corrected action will be completed by:
- 1 day
- 10 school days
- 30 days
- 60 days
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Emergency procedures and contacts for campus.
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Follow up with corrected action will be completed by:
- 1 day
- 10 school days
- 30 days
- 60 days
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Process for documentation clearly defined.
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Follow up with corrected action will be completed by:
- 1 day
- 10 school days
- 30 days
- 60 days
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Location of special procedures, emergency supplies, diabetes supplies clearly labeled.
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Follow up with corrected action will be completed by:
- 1 day
- 10 school days
- 30 days
- 60 days
Professional Accountabilty
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Years of experience in HISD
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Licensure renewal date
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Select date
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Continuing nursing education hours current.
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Vision/hearing re certification due before December.
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Knowledgeable of department goals.
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Follow up with corrected action will be completed by:
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Established individual goals for current school year.
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Follow up with corrected action will be completed by:
- 1 day
- 10 school days
- 30 days
- 60 days
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Completed ANTES training
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Follow up with corrected action will be completed by:
- 1 day
- 10 school days
- 30 days
- 60 days
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Self-assessment of skill level for invasive procedures
Clinic equipment and procedures
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Clinic environment neat with student appeal and easy access to supplies and materials.
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Follow up with corrected action will be completed by:
- 1 day
- 10 school days
- 30 days
- 60 days
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Audiometer annual calibration current
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Follow up with corrected action will be completed by:
- 1 day
- 10 school days
- 30 days
- 60 days
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Audiometer biological calibration current.
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Follow up with corrected action will be completed by:
- 1 day
- 10 school days
- 30 days
- 60 days
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Serial number
Audiometer
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Enter name of model
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Enter serial #
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Audiometer properly labeled.
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Follow up with corrected action will be completed by:
- 1 day
- 10 school days
- 30 days
- 60 days
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Age-appropriate vision screening tools.
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Follow up with corrected action will be completed by:
- 1 day
- 10 school days
- 30 days
- 60 days
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Utilizes Chancery and HEALTH HMS reports to document clinic activities.
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Follow up with corrected action will be completed by:
- 1 day
- 10 school days
- 30 days
- 60 days
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Reference books readily accessible
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Health Services Handbook
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Individualized Health plans
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Guidelines for Care of Student With Specialized Procedures
Communicable Disease Surveillance
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Student documentation reflects appropriate assessment of communicable disease risk.
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Follow up with corrected action will be completed by:
- 1 day
- 10 school days
- 30 days
- 60 days
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Utilizes influenza-like illness electronic submission as appropriate.
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Follow up with corrected action will be completed by:
- 1 day
- 10 school days
- 30 days
- 60 days
Comprehensive School Health Program
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Greater than 90% of students compliant for immunizations based on review of Chancery report and RN feedback.
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Process in place to monitor immunization compliance
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Follow up with corrected action will be completed by:
- 1 day
- 10 school days
- 30 days
- 60 days
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Screening programs complete
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Visual inspection of Hearing, Vision, and Spinal State report/s/planning is correct/complete /practical.
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Follow up with corrected action will be completed by:
- 1 day
- 10 school days
- 30 days
- 60 days
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Process in place to monitor screening referral and followup.
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Follow up with corrected action will be completed by:
- 1 day
- 10 school days
- 30 days
- 60 days
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Participates in student assessment and academic placement
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Utilizes Easy IEP
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Collects and analyzes health information
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Attends ARD, presenting pertinent health information
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Participates in 504 process, presenting pertinent health information
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Growth and Development education conducted according to health TEKS.
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Enter TEKS addressed and presentations offered.
Signatures
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Comments
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Program Specialist, Health and Medical Services
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Select date
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School Nurse
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Comments
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Select date