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