LOS ANGELES UNIFIED SCHOOL DISTRICT Policy Bulletin

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1 TITLE: NUMBER: ISSUER: Child Health and Disability Prevention (CHDP) Program and Blood Lead Testing BUL Michelle King, Senior Deputy Superintendent School Operations, Office of the Superintendent Debra Duardo, Interim Executive Director Student Health and Human Services ROUTING ESC Superintendents Principals School Nurses School Administrative Assistants DATE: January 22, 2013 POLICY: MAJOR CHANGES: Students must present evidence of having received a specified health assessment examination 18 months prior to or within 90 days of enrollment to first grade. This Bulletin replaces BUL Child Health and Disability Prevention (CHDP) Program and Blood Lead Testing issued on October 23, The content has been revised to reflect current examination requirements, new reference contacts, and elimination of the exclusion policy and annual report. GUIDELINES: The following guidelines apply: Legislation establishing the Child Health and Disability Prevention (CHDP) Program was enacted in Basic to the program is the concept that many physical and mental disabilities can be prevented, or their impact lessened, with early recognition and treatment of defects. (See California Administrative Code, Title 17, Sections 6802 et. Seq. and Health and Safety Code, Part 1, Article 3, 4, Section 320 et seq.). The following assessment procedures were established by legislation for entry to first grade: Evaluation of health status consisting of a health, nutritional, and developmental history, physical examination, including height, weight, dental assessment, vision and hearing screening, blood pressure, urine test, anemia test, blood lead screening, mantoux skin test for tuberculosis screening and immunizations, as deemed necessary by the State of California, the Los Angeles County Department of Health Services and the clinician. This type of assessment must be done within 18 months prior to entry into the first grade or within 90 days after admission. In addition to the first grade physical mandate, other eligible students may receive medical treatment, physical examinations and immunizations as stated above. Other assessments appropriate to age and gender may be included. Student Health and Human Services Page 1 of 13 January 22, 2013

2 All health assessments and medical services are provided free of charge to all financially eligible students or those who have Medi-Cal. If the student is not eligible for medical services according to the above categories, the family must obtain medical services and/or the first grade entrance physical through other public/private providers. Eligibility for students without medical insurance is established from the State of California CHDP Eligibility Determination Table that is updated yearly by the State of California. After the school physical has been completed, the parent/guardian will receive a copy of the Confidential Screening/Billing Report - PM 160 (Attachment A), and the results discussed. Any child, upon completion of this examination who has an actual or suspected health condition that is not currently under care, will be referred for diagnostic and treatment services as indicated. If no regular source of care can be identified, the family may be referred to an appropriate public agency or to no less than three sources of care as listed by the CHDP Referral Provider Book. Requirements for School 1. Every public or private school, which has students enrolled in kindergarten and/or first grade shall, at the time of registration, inform parent/guardian of the provisions of the State CHDP Program. This can be done by providing the Los Angeles Unified School District CHDP Program Consent for Health Assessment, Examination and Eligibility Determination and Receipt/Release of Medical Information - Form (Attachment B) and a letter to parent/guardian (Attachment C). If LAUSD personnel performs the exam, the consent form must be retained in the student s health record. 2. Nutrition screening is a required component of a CHDP examination. 3. Each student must present evidence of having received a specified health assessment examination l8 months prior to or within 90 days of enrollment of first grade unless the parent/guardian has signed a Waiver of Health Examination for School Entry - PM 171B (Attachment D). If the parent is having difficulty obtaining the health screening, refer them to the school nurse for assistance. 4. All information and results of the health screening of each student is confidential and part of the student s health record. It cannot be released without the informed consent of the parent/guardian. Proof of Admission to First Grade 1. Proof of Health Examination Completion Parents/guardians must present written proof of a complete health assessment Student Health and Human Services Page 2 of 13 January 22, 2013

3 within 18 months prior to the first day of first grade or within 90 days after entry to first grade. (Date of entry into first grade may vary according to the current school calendar.) This proof may be presented on either: a. CHDP Assessment Confidential Screening/Billing Report Form PM 160 (Attachment A) b. State of California Report of Health Examination for School Entry - PM 171A (Attachment E) or equivalent 2. Waiver of Health Examination Parents/guardians who do not wish to provide evidence of an examination should sign a Waiver of Health Examination for School Entry PM 171B (Attachment D). 3. Students Who Repeat First Grade It is not necessary for a student that repeats the first grade to repeat their physical examination. A copy of the examination must be retained in the health record. 4. Students Who Repeat Kindergarten If a student is examined within six months of kindergarten entry or during the kindergarten year and has a CHDP report on file, and then repeats the kindergarten year, he/she need not repeat the health assessment. 5. Students Enrolled in Special Education Programs Many students enrolled in special education programs have extensive health records on file with the school. When there is no record of a complete health assessment within 18 months prior to first grade entry, parents/guardians should be encouraged and assisted in obtaining and submitting the report of health assessment to the school. If the parent/guardian refuses, a waiver should be obtained (Attachment D). In ungraded special education, data should be submitted on students who are age six on or before December 2 of the current school year as outlined above. 6. Schools with Ungraded Classes Students who will be age six on or before December 2 of the current year will be regarded as equivalent to students in first grade for CHDP Program purposes. Procedures for Obtaining Certification for School Entrance If the designated LAUSD school personnel are not available or the student is not financially eligible or the parent/guardian prefers their child s physical exam to be done by their provider or choose a public agency, the school/school nurse must refer Student Health and Human Services Page 3 of 13 January 22, 2013

4 the child to the appropriate public medical agency to obtain the required health screening. School personnel should never refer students to private medical agencies unless that is the student s current designated provider. If school personnel have questions regarding which public agencies to refer students, they can call either the Student Medical Services at (213) or District Nursing Services at (213) Guidelines for Blood Lead Testing In 1992, blood lead testing became a required component of the CHDP health assessment. The screening is offered to children under 72 months of age and those that are identified as high risk. The District has contracted with an outside laboratory for this testing. When the test is indicated, the CHDP School Physician or School Nurse Practitioner will complete a lab request for the family to take the child to the nearest contracted laboratory site. The Central Nursing CHDP Program will send the lead test result to the school or school clinic site to be recorded on the health record. The school nurse is responsible for notifying the parent or guardian about the blood lead results on those students with an elevated lead level of 10 ug/dl or higher. The parents must be counseled regarding possible sources of lead poisoning and nutritional guidelines to counter act elevated lead levels. The parent or guardian should be made aware that blood lead retests will be need to be repeated until there are two (2) consecutive blood lead valves under 15 mcg/dl measured 6 months apart. AUTHORITY: RELATED RESOURCES: This is a policy of California Administrative Code, Title 17, Sections 6802 et. Seq. and Health and Safety Code, Part 1, Article 3, 4, Section 320 et seq. and Child Health and Disability Prevention (CHDP) Program, California Department of Health Services, Children s Medical Services Branch, Child Health and Disability Prevention Program Los Angeles County Public Health Department, CHDP Program ASSISTANCE: For assistance or further information, please contact Student Medical Services at (213) or District Nursing Services at (213) Student Health and Human Services Page 4 of 13 January 22, 2013

5 Student Health and Human Services Page 5 of 13 January 22, 2013

6 LOS ANGELES UNIFIED SCHOOL DISTRICT Student Health and Human Services Attachment B CONSENT FOR HEALTH ASSESSMENT, ELIGIBILITY DETERMINATION AND RECEIPT/RELEASE OF MEDICAL INFORMATION FORM Child s full name Birth date School Grade Room No. Track I hereby give my consent for my child to have the physical examination, blood, urine, and Tuberculin tests and required immunizations through the school health screening program. I also authorize the receipt/release of the results of the screening to the Los Angeles Unified School District, California State Department of Health, the County of Los Angeles Department of Health Services Child Health and Disability Prevention Program and any Health Plan/providers in which my child is enrolled. Number of Persons in family Family Income Monthly PLEASE CHECK: Child is: Covered by Medi-Cal Yes Has already had school Yes No admission physical No examination? Member of Private Yes Date of last complete physical exam: Health Plan/HMO? No Name of health plan: Where was physical exam done? My child will have the Yes I wish my child to have Yes Physical exam done by No physical done at school. No a private doctor or prepaid health plan. Authorization: I consent to submission of claims to my insurance carrier(s) for fees for services provided to my child. I authorize the release of any medical information between LAUSD and my insurance carrier(s) as may be necessary to prepare a claim for services. I authorize my insurance carrier(s) to process medical claims submitted by LAUSD and to assign payment of benefits to LAUSD for these claims: Yes No X ( ) Signature of Parent or Guardian Home Phone ( ) Street Address Phone where you may be contacted during the day City Zip code Date File this form in the Health Card Student Health and Human Services Page 6 of 13 January 22, 2013

7 DISTRITO ESCOLAR UNIFICADO DE LOS ANGELES Oficina para la Salud Estudiantil y los Servicios Humanos Attachment B-1 FORMULARIO DE CONSENTIMIENTO PARA LA EVALUACIÓN DE LA SALUD, DETERMINACIÓN DE LA CLASIFICACIÓN Y RECIO O DIVULGACIÓN DEL FORMULARIO DE INFORAMACIÓN MEDICA Nombre y Apellido de niño(a) Fecha de nacimiento Escuela Grado Salón Ciclo lectivo Por la presente autorizo que mi hijo sea sometido a un examen médico, análisis de sangre, de orina y a que se le practique la prueba de la tubercolósis. También autorizo que se le den las vacunas requeridas a través del programa de evaluación inicial escolar. Además, autorizo el recibo o la divulgación de los resultados de la evaluación inicial a Distrito Escolar Unificado De Los Angeles, la Secretaría de Salud Pública del Estado de California, el Departamento de Salubridad del Condado de Los Angeles, el Programa de Salud Infantil y Prevención de Discapacidades y todo Plan de Salud al que el niño(a) pertenezca. Número de personas en la familia Ingreso familiar mensual Favor de indicar: El/la niño/a Recibe los servicios Sí Le han hecho a el/la niño/a Sí de Medi-Cal No un examen médico para el No ingreso a la escuela? Es el niño/a miembro de un Sí Fecha del último examen médico plan de salud u organización para No la administración de los servicios médicos (HMO) particular? Nombre del plan: Lugar donde se hizo el último examen médico: A mi hijo/a lo examinará un Sí Yo quiero que mi hijo/a sea Sí médico particular o un plan de No sometido a un examen médico No salud pago por anticipación. Autorización: Yo consiento a la sumisión de cobro a la compania/s de mi seguro medico por las cuotas por los servicios proveidos. Yo autorizo el compartir cualquier información medica entre mi/s seguros medico y LAUSD tan como sea necesario, para preparar el cobro por los servicios. Yo autorizo a mi seguro medico a procesar los cobros medicos sometidos por LAUSD y para asignar el beneficio de pago por estos cobros a LAUSD: Sí No X Firma del Padre/Madre o Tutor Teléfono de la casa Domicilio Teléfono donde puede ser localizado durante el día Ciudad Código Postal Fecha Student Health and Human Services Page 7 of 13 January 22, 2013

8 LOS ANGELES UNIFIED SCHOOL DISTRICT Student Health and Human Services Attachment C Use School Letterhead Date: Dear Parent/Guardian: California law requires children to have a physical examination within 18 months prior to or not later than three (3) months after entering first grade. The examination includes a health history, physical examination with vision and hearing screening, necessary immunizations, tuberculosis skin test, a test for anemia, a urine test and blood lead screening. Many physicians, group health plans and the County of Los Angeles CHDP Program offer these services. If you are covered by a private health plan you should have the examination done there. The Los Angeles Unified School District will provide this service to the families of those students who are eligible and unable to obtain this examination from their physician or clinic. Please complete the attached page to see if your family qualifies. For the exam at school, you must be present with your child. The results of the examination including any necessary referral assistance will be discussed with you. Please indicate your choice below with a check mark and return the form to the school nurse My child will have the physical examination done by a private doctor or health plan. I will provide the school with a copy of the findings. I wish to have my child examined at school and have completed the eligibility form. I do not wish my child examined for the CHDP Program and will sign the waiver form. Name of Child Room No. Sincerely, Principal Student Health and Human Services Page 8 of 13 January 22, 2013

9 DISTRITO ESCOLAR UNIFICADO DE LOS ANGELES Oficina para la Salud Estudiantil y los Servicios Humanos Attachment C-1 Fecha Estimados Padres o Tutores: La ley de California exige que los niños se hagan un examen físico dentro de los 18 meses previos a su ingreso al primer año lectivo o, a más tardar, dentro de los tres (3) meses siguientes al mismo. El examen comprende un historial de salud, examen físico con control de la visión y la audición, las inmunizaciones necesarias, una prueba de reacción a la tuberculosis, un examen para determinar si el niño pudiera tener anemia, un análisis de la orina y un control de plomo en la sangre. Muchos médicos, planes de salud y el Programa CHDP (Programa de Salud Infantil y Prevención de Discapacidades) del Condado de Los Angeles ofrecen estos servicios. Si su familia está cubierta por un plan privado de salud, debe coordinar para realizar dichos exámenes allí. El Distrito Escolar Unificado de Los Angeles les ofrecerá este servicio a las familias de aquellos estudiantes que reúnan los requisitos y cuyos médicos o clínicas no les proporcionen tales beneficios. Por favor, complete la página adjunta para determinar si su familia tiene derecho a este servicio. Para el examen en la escuela, tiene que estar presente con su hijo. Los resultados del examen, incluyendo cualquier tipo de derivación necesaria a un especialista, son temas que se tratarán directamente con usted. Por favor, indique su elección a continuación con una cruz, y entréguele el formulario a la enfermera de la escuela. 1. Mi hijo(a) se hará el examen físico a través de un doctor particular o un plan de salud privado. Le suministraré a la escuela una copia de los resultados. 2. Quisiera que mi hijo(a) fuera examinado(a) en la escuela, por lo que he completado el formulario para determinar si tenemos ese derecho. 3. No deseo que mi hijo(a) sea examinado(a) para el Programa CHDP, y firmaré el formulario de exoneración. Nombre y apellido del estudiante Salón Atentamente, Director(a) Student Health and Human Services Page 9 of 13 January 22, 2013

10 Attachment D Student Health and Human Services Page 10 of 13 January 22, 2013

11 Attachment D-1 Student Health and Human Services Page 11 of 13 January 22, 2013

12 Attachment E Student Health and Human Services Page 12 of 13 January 22, 2013

13 Attachment E-1 Student Health and Human Services Page 13 of 13 January 22, 2013

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