Arrowhead Union High School - Health Room Information

School Nurse	North Campus Health Room	South Campus Health Room
Melinda Belger, BSN, RN	Jolene Goodreau, Aide	Jen Pfeiffer, Aide
262-369-3630	262-369-3612 ext.4208	262-369-3611 ext.4108
belger@arrowheadschools.org	goodreau@arrowheadschools.org	pfeifferj@arrowheadschools.org

**** NEW Vaccination Requirements for incoming SENIORS****

The state of Wisconsin has recently updated the immunization requirements for school entry regarding the meningitis vaccination. These changes are effective immediately and will impact all students entering 12th grade. Please follow this link to see the Immunization Changes. Each student will need to provide proof of vaccination or have the waiver portion of the form filled out to meet state requirements. The form is available at Vaccination Form / Waiver If you are unsure if your student is up to date, please contact your student's physician.

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Welcome to Arrowhead!

Arrowhead High School has a health room at each campus that is staffed by a health room aide or the school nurse. The health room is open during the school day to help your student. Here are a few health room reminders:

If your student has a fever (100.4 or greater), please keep them home for 24 hours from the time the fever breaks without the use of fever reducing medications.

If your student is vomiting, please keep them home for 24 hours from the last episode.

Students are NOT allowed to carry any over-the-counter or prescription medications at AHS. All medications are to be provided to the health room and will be dispensed after the medication and proper forms are completed. (See below for forms.) For "as needed" medications, please limit the quantity to 50 or under. Exception: Individualized health plans that are signed by a student's physician for asthma inhalers, EPI-Pens, and insulin. Medication forms and Individualized Health Plans can be printed at the links provided below.

If your student will be gone for a medical appointment or procedure, please bring a medical note from your physician to exempt their absence.

If your student needs to be picked up from school for an illness, we request that pick up be made within 30 minutes.

If your student needs to be excluded from gym class or a sport due to a medical issue, please supply a medical excuse from your student's physician. Any time a medical excuse is provided, it is the responsibility of the parent/guardian to provide a medical letter clearing student for activity. Without a clearance letter, your student will not be able to participate in gym class or sports, which does include all summer gym classes.

Forms required for all freshman and new students:

Immunization Record – Required by the State of Wisconsin - State statute ss.252.04 and 120.12. (16). Please fill out completely or attach a copy of the student's immunizations from their physician's office and sign. The State of Wisconsin has added two immunizations that are required before freshman and senior year.
- TdaP (tetanus, diphtheria and acellular pertussis) vaccine. The only exception is if the student received a tetanus containing vaccine (e.g. Td vaccine) within 5 years of entering the 9th and 12th grade. That student is considered compliant and a TdaP booster dose is not required.
- Varicella (chickenpox) vaccine: A second dose will be required for students entering 12th grade or documentation of the year they had chickenpox disease

Physicals
- Physicals are no longer required for students unless they are participating in sports.
- However, all new students should submit a HISTORY AND PHYSICAL FORM signed by the parent or guardian. If your child has an anaphylactic allergy, seizure disorder, asthma or diabetes please have your student's physician fill out the according health plan below.
- If your child will participate in sports, a green WIAA physical card will be required. Take the form (the green physical card) to the doctor for signature. Forms will be distributed and collected through the Arrowhead Activities Office.

Health Room Consent Form - This form (provided below) is required for students to receive school supplied over-the-counter medications. Three medications are stocked in the health room: acetaminophen (Tylenol), ibuprofen (Advil), and diphenhydramine hydrochloride (generic Benadryl). All other medications must be brought and stored in the health room.

Individual Health Plan Requirement:

Allergic Reactions - Any student who has an EPI-PEN is REQUIRED to complete an Allergic Reaction Health Plan signed by a parent/guardian and their physician. These forms are valid for the duration of your student's enrollment at AHS. The parent is responsible for alerting health room staff of any changes. Please complete both of the documents listed below:
- Allergic Reaction Health Plan - To be filled out by both parent and student's physician.
- Allergy Contract - To be filled out by the parent and student.

Asthma - Students with asthma must have a completed Asthma Individual Health Plan. Parents fill out the top section and a physician must sign the bottom section. Any student carrying an inhaler is REQUIRED to have a health plan on file. This form is valid for the duration of your student's enrollment at AHS. The parent is responsible for alerting health room staff of any changes.

Seizure Disorder - Students with a seizure disorder must have a completed Seizure Disorder Health Plan completed at the beginning of each school year. If an emergency medication is needed for your student, please have your student's physician fill out the prescription order on the form. The emergency medication needs to be provided to the health room at the start of each school year.

Diabetes: Students are required to have their own diabetic supplies at all times. They are encouraged to store extra supplies and snacks in the health room. Below are the documents all diabetics are REQUIRED to have completed at the beginning of each school year.
- Emergency Action Plan (EAP)– Parents to fill out
- Diabetic Medical Management Order (DMMO) - Parents and MD to complete. Physicians can also use their own forms. CHW uses a form called Diabetic Individual Health Plan. Students are allowed to self-administer & self-dose insulin outside of the health room at Arrowhead only when their physician has documented that the student can self-administer and self-dose insulin on the Diabetic Medical Management Order.
- Self Administration Consent– Must be signed by parents and students.

Health Room Forms:

Allergic Reaction Health Plan

Any student who has an EPI-PEN must have a completed Allergic Reaction Health Plan. Student's physician must sign the form and indicate that they are allowed to self-carry their EPI-PEN.

Allergy Contract

Must accompany the Allergic Reaction Health Plan.

Asthma Health Plan

If your student has asthma, please complete this form. It allows your student to self carry their inhaler once signed by a physician. It is good while enrolled at AHS.

Diabetic- Self Administration Consent

Require for all diabetic students who will be self administering insulin. This must accompany a physician's DMMO that states that the student is independent in diabetic cares.

Diabetic - Emergency Action Plan (EAP)

Emergency plan for diabetic students.

Diabetic - Medical Management Orders

G-Tube Physician Orders

If your student requires tube feedings, please have your physician fill out this form. Please also call the nurse to discuss.

Headache Health Plan

For headaches / migraines that require additional intervention from the health room other than an over-the-counter medication.

Health Room Consent Form

General consent for ALL students to allow the health room to administer basic first aid comfort measures, and/or school supplied acetaminophen (Tylenol), ibuprofen (Advil) and diphenhydramine (Benadryl). This form is valid the duration of your student's enrollment.

History & Physical

Immunization Record

Over-the-Counter Medication

Consent to administer over-the-counter medications supplied by family. When bringing in medications please limit the quantity to 50 tablets or less.

Prescription Medication Consent

Required only if prescription medication will be administered at AHS. This form must be completed by the parents and signed by the prescribing physician every year that daily medications will be administered at AHS. This form is also necessary for administration of temporary prescriptions such as antibiotics, pain medications, etc.

Seizure Health Plan

For student's with a seizure disorder, please have this form filled out by your physician at the start of each school year.

Epinephrine:

1) The school nurse, licensed athletic trainers, health room personnel or staff trained in the administration of epinephrine auto-injector will administer the epinephrine auto-injector to students as ordered by a physician following the Allergy Health Plan.

2) If the school nurse, licensed athletic trainers, health room personnel, or staff trained in the administration of epinephrine auto-injector in good faith believes a student or person over 66 pounds without an Allergy Health plan is experiencing anaphylaxis, the school nurse, licensed athletic trainers, health room personnel or staff trained in the administration of epinephrine auto-injector may administer the stock 0.3mg epinephrine auto-injector. The person who administered the stock epinephrine auto-injector will call 911 immediately at administration.

3) Arrowhead High School will keep a stock 0.3mg epinephrine auto-injector in the health room and athletic training room for severe allergic reactions.

4) Arrowhead High School will keep a stock 0.3mg epinephrine auto-injector in three AED cabinets (South Campus by Door D and North Campus by Doors 1 and 15) and at the Mullett Ice Center.

Approved by Arrowhead High School's Medical Advisor

Narcan:

1. Arrowhead High School staff must complete the Opiate Overdose Prevention and Narcan Administration Training and provide certificate of completion to Arrowhead High School prior to administering Narcan (naloxone) or carrying their own supply of Narcan (naloxone) at school.

2. The school nurse, licensed athletic trainers, health room personnel, or trained Arrowhead High School staff may administer 4mg of Narcan (naloxone) nasal spray to a student of person who they believe in good faith is undergoing an opioid related drug overdose. This medication will be administered following manufacturers' directions and training. If the person does not respond by waking up to voice or touch and breathing normal, a second dose may be administered in two to three minutes in the other nostril.

3. Ther person who administers the Narcan (naloxone) nasal spray must call 911 prior to administration or immediately after administration of the medication.

4. Arrowhead High School will keep a stock 4mg Narcan (naloxone) nasal spray in three AED cabinets (South Campus by Door D and North Campus by Doors 1 and 15) and at the Mullett Ice Center.

Approved by the Arrowhead High School's Medical Advisor