Resources - A collection of forms, attachments and
other resources
from each section of the manual
INTRODUCTION
I. COORDINATED SCHOOL HEALTH
PROGRAM
- Model of Coordinated School Health
- Supervisory School Nurse Evaluation - by Medical Supervisor
- Professional School Nurse Performance Evaluation - by Medical Supervisor

- Associate School Nurse Performance Evaluation - by Medical Supervisor
- School Nurse Performance Evaluation - by Non-Medical Administrator
- School Nurse Performance Evaluation - by Non-Medical Site Administrators
- School Licensed Practical Nurse Performance Evaluation

- School Licensed Practical Nurse Application

- School Health Assistant Performance Evaluation

- School Health Assistant Application

- School Nurse Licensure Application

II.
NM STATUTES, ADMINISTRATIVE CODES, POLICIES AND REGULATIONS
RELATING TO SCHOOL HEALTH
- General Screen and SAT Review
- Recommended Steps for SAT
- Flowchart for SAT
- PED Health Services Checklist
- School District Policy Confidential Information
- Student Health Record

- Sick Child Memo – English

- Sick Child Memo – Spanish

- Injured Child Memo – English

- Injured Child Memo – Spanish

- Vision Screening Standards

- Vision Screening & Referral Form

- Confidential Services for Minors in New Mexico
- Public Health Authority for School Health Offices
- Adverse Events Reporting

- Commonly Used Abbreviations and Symbols for School Nursing

III. SCREENING, ASSESSMENT, AND SPECIAL EDUCATION PROTOCOLS AND GUIDELINES
- Familiar Sounds Audiogram
- Blood Pressure Percentiles
- Release of Medical Information

- Parental Permission to Obtain Information - English

- Parental Permission to Obtain Information - Spanish

- Referral Form - General

- Vision Referral Form and Letter

- Standards for Vision Screening in New Mexico Schools

- Vision Care Participating Network Providers

- Save our Children's Sight Voucher

- Save our Children's Sight - Nurse's Letter

- Save Our Children’s Sight Fund – Superintendent’s Letter

- Student Health Assessment

- Initial Student Health History

- Special Education Nurse Screening Summary Form

- New Mexico Medical Oversight Committee BMI Position Statement

- School Sports Physical Form

- Hearing Screening

IV. STUDENTS WITH SPECIAL NEEDS
- Asthma Action Plan

- Asthma Action Plan - Spanish

- Asthma Management: Initial Assessment
- Stepwise Approach for Managing Asthma
- Your Peak Flow Meter
- Strategies for Addressing Asthma
- School Nurse Asthma Assessment Tool

- Managing Asthma in New Mexico Schools

- National Institute Asthma Action Plan

- Asthma and Physical Activity in School

- Diabetes Medical Management Plan

- Guidelines for Hypoglycemia
- Diabetes Emergency Response Plan

- Carbohydrate Counting Worksheet

- Seizure Report Flow Log

- Seizure Activity Log
- Request for Homebound Instruction

- Confidential Nursing Report Special Education Students
 
- Helping the Student with Diabetes Succeed: A Guide for School Personnel
- Level 1 Training - Powerpoint

- Level 2 Training - Powerpoint

- Level 3 Training - Powerpoint

V. INDIVIDUALIZED HEALTH CARE PLANS
- Approved Nursing Diagnoses
- Individualized Healthcare Plan (IHP)
- Asthma Action Plan

- ADHD Health Care Plan

- Severe Allergies Health Care Plan

- Asthma Health Care Plan

- Diabetes Health Care Plan

- Diabetes Emergency Plan

- Seizure Disorder Health Care Plan

VI. MEDICATIONS IN THE SCHOOL
- Integrative Therapies Consultant Call List

- Medication Incident Report

- Medication Log

- Individual Multiple Medication Log

- Medication and/or Nursing Procedure Authorization - English

- Medication and/or Nursing Procedure Authorization - Spanish

- Physician Order and Medication Authorization Form - English

- Physician Order and Medication Authorization Form - Spanish

- Student Medications at School Memo - English and Spanish

VII. PROCEDURE GUIDELINES
- Colostomy Care Skills Checklist

- Ileostomy Care Skills Checklist

- Urostomy Care Skills Checklist

- Suctioning - Nasal and Oral Technique Skills Checklist

- Suctioning - Sterile Technique Skills Checklist

- Gastrostomy Feeding Button - Slow Drip/Continuous Method Skills Checklist

- Gastrostomy Button - Bolus Feeding Method Skills Checklist

- Nasogastric Tube Feeding - Slow Drip/Continuous Method Skills Checklist

- Nasogastric Tube Feeding - Bolus Method

- Female Catheterization

- Male Catheterization

- Ventilator Machine and Circuit Skills Checklist

- Ventilator Troubleshooting Alarms Skills Checklist

- Summary of Skills Training and Recommendations

- Authorization to Administer Specialized Health Service

- Authorization to Administer Specialized Health Service Student Log

VIII. EMERGENCY SERVICES/FIRST AID
IX. IMMUNIZATIONS
X. COMMUNICABLE DISEASE CONTROL
XII. SCHOOL
WELLNESS POLICY
-
State Administrative Code for Wellness Policy 
-
Wellness Policy Rule Documents 
-
Competitive Food Sales 
-
PED Standards of Excellence 
- Alliance for a Healthier Generation

-
NM Action for Healthy Kids Wellness Tool Kit
XIII. Dental Health
- Seal America Manual

- Guide to Serving Children with Special Health Care Needs

XIV. Mental Health
- Understanding Self-Harm

- Confidential Services for Minors in New Mexico

- 15 tips for talking to grieving kids in spansh

- About Grief

- Depression checklist for youth

- Ten things adults can do to help grieving children and teenagers

- Trauma facts for educators

XV. Standing Orders
- Standing Orders and Guidelines for the School Nurse to Treat and to Perform Laboratory Procedures

XVI. SCHOOL HEALTH SERVICES REPORT
PED Online Reporting Tool 
-
Report Definitions and Clarifications
-
School Health Services Complete Report Assist Tool 
-
Students with Medical Diagnoses Assist Tool 
-
Students Requiring Medically Complex Procedures Assist Tool

-
Students with Prescription Medications at School Assist Tool 
-
Daily Report Assist Tool for School Health Services Report
- 2011-2012 Annual School Health Services Summary Report Brochure

XVII. BLOODBORNE PATHOGENS
EXPOSURE & CONTROL
- Bloodborne Pathogens Exposure Training Control Outline

- Bloodborne Pathogens Exposure Exposure Control Plan

- Bloodborne Pathogens Training

- Bloodborne Pathogen Reference Guide

- Sample Bloodborne Pathogens Exposure Control Plan

XVIII. DELEGATION OF HEALTH SERVICES
- 16 NMAC 12.2.12(B) Standards of Nursing Practice (1-2-04)

- American Nurses Association and National Council of State Boards of Nursing:
Joint Statement on Delegation
- National Council of State Boards of Nursing Position: Delegation Documents

- National Association of State School Nurse Consultants Position:
Delegation of School Health Services

- National Association of School Nurses Position: Delegation

- Manual: Delegation of Care: Overview for the Registered Nurse
Practicing in the School Setting
- NCSBN Delegation Decision-making Tree

- NSCBN Delegation Decision Making-Grid
- Delegation Tree - Nurse Delegation to Nursing Assistive Personnel

- Decision Tree - Accepting Assignment to Supervise Unlicensed Assistive
Personnel
- Delegation Decision-making Grid


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