Health care plan forms must be submitted annually. Please print and return to the front Health care plan forms must be submitted annually. Please print and return to the front office or to your school nurse. All health care plans require a parent and health care provider signature.

Allergies

Utah state law requires all students who carry and/or administer their own Epinephrine Autoinjector must submit an Allergy & Anaphylaxis – Emergency Action Plan. Forms are to be completed and signed by the parents and the health care provider each school year and brought to the school front office. All Epi-pens must be labeled with the student’s name.

• Utah Allergy/Anaphylaxis Healthcare Plan

Asthma

Asthma: Parents who request their student to carry and/or administer their own asthma inhalers must complete and submit an Asthma Medication Authorization & Self-Administration form per Utah state law. Forms need to be signed by the parents and the health care provider each school year, and then brought to the school front office. All inhalers must be labeled with the student’s name.

• Asthma Action Plan, Medication Authorization and Self-Administration    

Diabetes

• Diabetes Emergency Action Plan (State Form)
• Utah Diabetes Individualized Healthcare Plan
• Diabetes Medication/Management Orders (DMMO, State Form)

Seizures

• Seizure IHP/ECP
• Seizure Medication Management Order (SMMO)

Medication

Medications: Students in grades pre-K thru 8th grade cannot carry over the counter or prescription medication on their person. Students in grades 9-12 may carry 1-day supply of non-prescription medication for personal use only, which must be in original container. All Prescription and OTC medications administered at school must have a district Medication Permission form signed by parent and prescribing doctor with accurate medication name and dose. Medication and form must be brought to front office by parent

• Authorization for Student Medication

Other Health Concerns: If your student has a health concern that may impact his or her learning, please notify your school nurse to see if a school health plan is appropriate.

Screenings

Vision Screenings

Vision Screening: Each year JSD will conduct vision screenings for grades pre-K, K, 1, 3, 5, 7, special education students, new students and referrals. State approved distance charts and camera screening methods are used to screen your child. School screenings are coordinated by the school nurse who may use trained parent volunteers and school staff to assist, or may request State approved vision screening assistance from the Lions Sight Foundation, Friends For Sight, or the Utah Division of Services for the Blind and Visually Impaired. The results of the vision screening may be shared with other educators and healthcare professionals to provide appropriate services. If your student does not pass the screening, a letter will be sent in the mail. Please inform your child’s teacher with a written note if you do not want your student vision screened. Results of vision screenings for grades PK – 3rd grade will be sent to the Utah Division of the Blind and Visually Impaired. This information includes the student and parent demographics and screening results.

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Scoliosis Screenings

Scoliosis Screening: In the UDOH 1/9/2017, Utah School Spinal Screening Guidelines, “the Utah Department of Health recommends against routine school scoliosis screening in Utah.” The JSD School Health Service Department will provide parents information on how to screen their students for scoliosis yearly for students in grades 5th – 8th. You may contact your school nurse or medical provider if you have any questions or concerns.

• Scoliosis Guidelines

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