IMMUNIZATIONS, ROLE OF THE SCHOOL NURSE Purpose: The School Nurse oversees the immunization program in schools to ensure that students are up to date with their immunizations in compliance with Southern Nevada Health District (SNHD) guidelines. Additional Authority: NRS 439.550, Strict enforcement of chapter by local health officer; NRS 392.435-448, Immunization of pupils; NAC 392.105, Mumps, Hepatitis A, Hepatitis B, Varicella and Bordetella Pertussis; NAC 392.205, Required education and services; CCSD Regulation 5150: Health and Welfare: Students, CCSD Regulation 5151: Physical Examination, Immunization and Diagnostic Programs; Nevada Division of Public and Behavioral Health; McKinney-Vento Act; Southern Nevada Health District (SNHD); and, Centers for Disease Control and Prevention (CDC) Scope: School Nurses, Specialized Procedure Nurses, First Aid Safety Assistants (FASA), and other qualified, trained CCSD personnel Responsible Party: Director of Health Services Distribution: Health Services Coordinators, School Nurses, Specialized Procedure Nurses, First Aid Safety Assistants, qualified, trained Unlicensed Assistive Personnel; Health Services Department Secretarial Staff, Registrars and School Clerical Staff 1.0 Policy Statement POLICY 1.1 Immunization requirements for students are established by the Nevada Division of Public and Behavioral Health (DPBH). 1.1.1 The School Nurse keeps the school staff and FASA informed of any updates or changes to immunization requirements by the DPBH. 1.2 Children entering public and private schools in Nevada must have a record of valid doses of the required vaccine. 1.3 Immunization data is obtained during the enrollment process.
1.3.1 The parent/guardian must provide written proof that immunizations are up to date at the time the student is being enrolled. 1.3.2 Students may not be enrolled until proof of immunization compliance status is obtained. 1.3.3 Students, whose immunizations are in progress within appropriate timelines, may attend school. 1.4 Unless a student has a medical or religious exemption, they are required to be compliant and current with the required vaccines PRIOR to enrolling or attending school. Additional considerations would include: 1.4.1 Homeless students have a seven-day grace period to obtain immunization records, acquire immunizations or start immunization series. 1.4.2 Students of military families have a 30-day grace period in which to obtain immunization records, or initiate the required immunization series. 1.5 Parents/guardians may be referred to the Southern Nevada Health District with any questions or if clarification is needed. 1.6 The School Nurse works in coordination with office staff and the FASA to ensure a system to verify immunization compliance at the time of registration, record immunizations in Infinite Campus (IC), and track students who need follow up to ensure completion of a vaccination series.
1.6.1 The Health Office will generate Immunization Non-Compliance Reports throughout the school year, as directed by health services. (Refer to Health Office Immunization Procedures). 1.6.2 Each Health Office will maintain an Immunization Notebook per Health Services guidelines. 1.7 The state web-based system (Nevada WebIZ) may be utilized to check the student s immunization records prior to considering a student noncompliant. 1.7.1 The FASA may access WebIZ and assist the School Nurse with this process. 1.7.2 Copies of immunization records and titers will be maintained in the student s cumulative folder. 1.8 The School Nurse consults with the site administrator on school responsibilities with regard to immunization procedures. 1.9 The School Nurse will inform Health Services (Director or Coordinator) of any unusual outbreaks of vaccine preventable diseases which would require collaboration with the SNHD. 1.10 The School Nurse and FASA will use forms and procedures provided by Health Services or SNHD, including: 1.10.1 Immunization Reference Guide 1.10.2 Immunization non-compliance letters to parents (HS) 1.10.3 Written Statement Claiming Religious or Medical Exemption (HS) 1.10.4 SNHD Clinic Information
1.10.5 Immunization Notebook 1.10.6 Office Personnel/Registrar Immunization Procedures 1.10.7 Health Office Immunization Procedures 2.0 Procedures Immunization Exemption Procedure Essential Steps 1. Parent/guardian must provide dated and signed statement of a medical exemption from a LHCP and Medical Immunization Exemption form. Key Points/Precautions Utilize Medical Immunization Exemption form (HS) and obtained LHCP statement. Code M: Medical (with date) in IC if medical condition is permanent. Code M if medical condition is temporary, i.e. pregnancy, illness or surgery. School Nurse to review and enter an expiration date of medical exemption. 2. Parent/guardian opposed to immunization for religious beliefs must provide a dated and signed statement indicating that their religious beliefs prohibit immunizations. 3. A copy of the medical or religious exemption MUST be maintained permanently in the student s cumulative folder. 4. Student with an exemption either for medical or religious reasons are assigned an I in IC. 5. Parent/guardian of a student who has had chicken pox must provide a dated and signed LHCP statement verifying disease. 6. Parent/guardian of a student who has had any vaccine preventable disease Enter M (with date) for each vaccine(s) parent has indicated or if all, code M (with date) for all vaccines. Utilize Written Statement Claiming Religious Exemption from Vaccination form (HS). Code R: Religious in IC Enter R (with date) for each vaccine(s) parent has indicated or if all, code R (with date) for all vaccines. Make notation on form, Immunization Record-Do not remove. Health condition I code for immunization exemptions Document in electronic medical record as Special Problem. Document in IC as D: Had Disease (with date) for disease. SNHD verification of disease is acceptable. Document in IC as L: Lab Confirmed (with date) Lab confirmed titer.
or titer drawn must provide a dated and signed LHCP statement /Lab report verifying the disease or titer. School Nurse to confirm lab information and enter titer date. Immunization Non-Compliance Procedure Essential Steps 1. Review copies of immunization records received. 2. Generate the Generic Immunization Extract Report, from IC, as directed by Health Services. 3. Verify non-compliant immunizations before sending non-compliance letters. 4. Prepare an Immunization Non- Compliance Notice with site administrator signature. 5. Print IC and/or WebIZ immunization record and attach to the noncompliance letters to be sent home to parent/guardian. 6. Mail or send non-compliance letters home with students. 7. Maintain a tracking system in the Immunization Notebook for follow up and letters sent. 8. Follow up to ensure that the student receives the needed immunizations and returns to school in a timely manner. 9. School Nurse to follow procedures for Student Health Suspension with site administrator approval for students who continue to be noncompliant. Key Points/Precautions Check to verify if information was accurately entered into IC. Update information as needed. Reports will be generated during the months of September, November, January, March, May and July. Check student s cumulative folder and WebIZ to verify immunization information. Follow up with phone contact to parent as needed. Immunization Non-Compliance Notice (HS). Ensure all letters are signed by the site administrator. Letters may not be signed by the School Nurse or FASA. Place a copy of the notice in the Immunization Notebook. Provide Community Resource and/or Southern Nevada Health District Immunization Clinic information. FASA is responsible for maintaining the Immunization Notebook. Follow up should be completed within two weeks. Written proof of compliance is mandatory. Record immunizations received in IC and file updated immunization records in the cumulative folder. Student Health Suspension Notice (CCF) to be placed in the Immunization Notebook.
10. Generate Ad Hoc Tdap/MCV4 noncompliance report for current 6 th grade students beginning in January of each year. 11. Generate an updated Generic Immunization Extract Report in May. Middle Schools to also generate an updated Tdap/MCV4 non-compliance report for 6th grade. Middle School only. Generate Ad Hoc Tdap/MCV4 noncompliance January, March and May. Copy will be provided to registrar. 3.0 References, Sources, Bibliography 3.1 See Additional Authorities listed above. 4.0 Authorizations Health Services Director (Print) Signature Date