Medication administration details (dose, route, etc.) Returned to class/Sent home status Objective observations noted Parent/Guardian contact information documented Student's verbal description documented Follow-up plan documented Individual Health Care Plan referenced Staff notified appropriately Parent /Guardian notification documented Chief complaint recorded Vital signs when appropriate Parent/Guardian Name documented Collaboration with other team members including name and title documented Time student arrived/departed clinic documented Immunization Review Interventions provided clearly documented Student's response to treatment Clear clinic discharge instructions provided Time of student arrival/departure Previous health history referenced Procedure details/findings documented Allergies Noted Assessment findings documented Emergency Contact attempt and # of times Medication administration details (dose, route, etc.) Returned to class/Sent home status Objective observations noted Parent/Guardian contact information documented Student's verbal description documented Follow-up plan documented Individual Health Care Plan referenced Staff notified appropriately Parent /Guardian notification documented Chief complaint recorded Vital signs when appropriate Parent/Guardian Name documented Collaboration with other team members including name and title documented Time student arrived/departed clinic documented Immunization Review Interventions provided clearly documented Student's response to treatment Clear clinic discharge instructions provided Time of student arrival/departure Previous health history referenced Procedure details/findings documented Allergies Noted Assessment findings documented Emergency Contact attempt and # of times
(Print)
Medication
administration
details (dose, route, etc.)
Returned to class/Sent home status
Objective
observations
noted
Parent/Guardian
contact
information
documented
Student's
verbal
description
documented
Follow-up
plan
documented
Individual
Health Care
Plan
referenced
Staff notified appropriately
Parent /Guardian notification documented
Chief
complaint
recorded
Vital signs
when
appropriate
Parent/Guardian Name documented
Collaboration
with other
team members
including name
and title documented
Time student arrived/departed clinic documented
Immunization Review
Interventions
provided clearly documented
Student's
response
to
treatment
Clear
clinic discharge instructions provided
Time of student
arrival/departure
Previous
health
history
referenced
Procedure details/findings documented
Allergies Noted
Assessment
findings documented
Emergency Contact attempt and # of times
