[School-nurse] School-nurse Digest, Vol 4, Issue 7

[Paula Smith (ADE)]

Connie,
Where are the guidelines that are mentioned at the bottom of your form?
Are they separate or is it referring to the paragraph above the list of
names on the team? Paula

Healthy children are healthy learners!
 
Paula Smith, MNSc., RNP
State School Nurse Consultant
Arkansas Department of Education
Coordinated School Health
2020 West 3rd St., Suite 320
Little Rock, AR 72205
office (501) 683-3600
fax (501) 683-3611
paula.smith at arkansas.gov
 
 Visit our website:
http://www.arkansascsh.org
 
-----Original Message-----
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[mailto:school-nurse-bounces at lists.arkansascsh.org] On Behalf Of
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Sent: Thursday, September 27, 2007 11:54 AM
To: school-nurse at lists.arkansascsh.org
Subject: School-nurse Digest, Vol 4, Issue 7

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Arkansas Coordinated School Health School Nurse listserv. 
Digest of today's messages:

Today's Topics:

   1. HIPAA form (Paula Smith (ADE))
   2. Hippa form (Connie Woods)


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Message: 1
Date: Thu, 27 Sep 2007 11:07:06 -0500
From: "Paula Smith \(ADE\)" <Paula.Smith at arkansas.gov>
Subject: [School-nurse] HIPAA form
To: <school-nurse at lists.arkansascsh.org>
Message-ID:
	<747B8FABF2CC8343B60112BB7BD53EAF0A2F3898 at EVS02.sas.arkgov.net>
Content-Type: text/plain; charset="us-ascii"

Thanks. Here is another one sent from Kathleen Bowen at Pyron. 

 

Release of Student Medical Information

 

 

The purpose of this form is to provide acknowledgement of the parental /
guardians authorization to the school caregivers to share information
with pertinent school staff that the parent and/or nurse deem necessary
for the care of ____________________________  a student at
____________________________ school.  

 

I, ____________________________, the legal parent / guardian of the
above named student give my permission for the designated care givers of
my child to share medical care information with pertinent school staff.
This information shall be disclosed on a need to know basis only
pertaining to the care of my child at school, field trips, activities,
and other designated school functions.

Pertinent staff includes but is not limited to the following: 

 

Teacher (s) ___                 School Secretaries ___
Custodians ___

Principal ___                       Cafeteria Manager ___
Transportation ___

Other ___________________________________________________

 

Signature: _________________________________

 

Printed Name: ______________________________

 

Date: ___/___/___

 

Nurse: __________________________________

 

Other: ___________________________________ 

 

 

 

++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++
+++++++++++++++++++++++

 

 

Verbal Acknowledgement of Release of Student Medical Information Consent
for release of student medical information was received on  __/__/__ by
phone / in person from  _________________ (parent / guardian) was
received by _________

Healthy children are healthy learners!

 

Paula Smith, MNSc., RNP

State School Nurse Consultant

Arkansas Department of Education

Coordinated School Health

2020 West 3rd St., Suite 320

Little Rock, AR 72205

office (501) 683-3600

fax (501) 683-3611

paula.smith at arkansas.gov

 

Visit our website:

http://www.arkansascsh.org

 

 

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Message: 2
Date: Thu, 27 Sep 2007 11:58:43 -0500
From: "Connie Woods" <cwoods at wmsd.net>
Subject: [School-nurse] Hippa form
To: <school-nurse at lists.arkansascsh.org>
Message-ID: <46FB9AF3020000D1000012A1 at griver.grsc.k12.ar.us>
Content-Type: text/plain; charset="us-ascii"

Paula
West Memphis School District places this attachment in our student
handbook for our protective health information.  We have a very high
success rate with this method, since all the students get a handbook and
there are several forms in the handbook that have to be turned into the
principals.
connie woods

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End of School-nurse Digest, Vol 4, Issue 7
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