COMMUNICABLE DISEASE - ILLNESS

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Communicable disease prevention, surveillance, notification, and reporting are important roles provided by the school health team. In addition to documenting care of ill or injured students according to district procedures, it is important to share your observations and recommendations for follow up with the student's parent or guardian. Information may include:

• A description of the illness which includes date, time and details of the complaint.
• Recommendations for follow up.
• School health services contact information.

These "sample" forms on this page may be customized for use by districts consistent with NYSED, local district policy, and their Medical Director's policies and guidance, to inform parents and guardians of health issues noted.

Health Office Daily Visit 

Sample Student Daily Visit Form- This sample form was created to aid in tracking the number of student visits to the health office. It is available in landscape and portrait and is customizable. (1/2018)

General Illness Notifications

Notification of Student Illness Form - Fillable form to communicate student's visit to the health office due to illness

Notification to Parent/Guardian of Student Illness - Customizable MS Word Document

Classmate Illness Alert

When to Keep Child home Instructions to Parents/Guardians- Provides a custimizable sample letter to share district guidelines. (9/2017) 

Specific Illness Letters

Chicken Pox - Letter to Parents/Guardians

• NYS Department of Health Fact Sheet on Chicken Pox

Conjunctivitis - Letter to Parents/Guardians

• CDC Fact Sheet Pink Eye (Conjunctivitis)

Fifth Disease - Letter to Parents/Guardians

• NYSDOH Fact Sheet on Fifth Disease

GI Illness - Letter to Parents/Guardians

Hand Foot Mouth Disease (Coxsackie Virus) - Letter to Parents/Guardians

• NYSDOH Fact Sheet on Hand Food Mouth Disease (Coxsackie Virus)

Head Injury - Letter to Parents/Guardians

• Sample letter to parents listing symptoms of concussions (9/2017)

Head Lice - Letter to Parents/Guardians

• NYSCSH Head Lice Alert Letter For Parents/Guardians Emphasizing Prevention (1/2018)
• NYSDOH Fact Sheet on Pediculosis (Lice)
• CDC Treatment Guidelines

Impetigo - Letter to Parents/Guardians

• NYSDOH Fact Sheet on Impetigo

Pinworm Infection - Letter to Parents/Guardians

• NYS Department of Health Fact Sheet on Pinworm Infection

Pneumonia - Letter to Parents/Guardians

• NYS Department of Health Fact Sheet on Pneumococcal Disease

Ringworm - Letter to Parents/Guardians

• NYS Department of Health Fact Sheet on Ringworm

Scabies - Letter to Parents/Guardians

• NYS Department of Health Fact Sheet on Scabies

Shingles - Letter to Parents/Guardians

• NYS Department of Health Fact Sheet on Shingles

Strep Throat - Letter to parents/guardians

• NYSDOH Fact Sheet on Streptococcal Infections
• Death by Strep: One Family's Tragic Loss Although this is a rare complication, school nurses should be aware of this devastating tragedy.

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INJURIES

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The following forms are "sample" forms which may be customized and used by districts based on their Medical Director's Guidance and BOE policies

Notifications of Injury: Abrasions, Cuts or Puncture Wounds  This form may be used to notify parent/guardian of injuries related to abrasions, cuts or puncture wounds which may require follow-up.  Symptoms of potential infection and recommendations for follow-up are provided.   

Notification to Parent/Guardian of Student Injury - Customizable MS Word Document.  This form provides a checklist which may be used by the school nurse to indicate to the parent/guardian the reason for student visit, first aid provided, and method by which the parent/guardian was notified.  This form should be approved by your school medical director.