Medication Forms

Medication Checklist

End of Year Procedure:

• Leave medication paperwork in the teal binder until August. Summer nurses may need to refer to these.

• Medication paperwork must be kept for 10 years. These should be uploaded and attached to the SNAP EHR and should not be shredded if this is not done. Do this after summer programs have ended.

• Old paper medication paperwork from years before school year 2024/2025 when we were not attaching medication documentation can be screeded after 10 years.

This must be completed during the staff development day before school starts.

Certificates are due by September 4th.

Email certificate to Darcey Barnard.

Complete audited version (free) ~1 hour.

An Introduction to Medication Administration and Delegation in MA Schools

Complete by September 4th.

After filing a 51a, please put note in Powerschool.

Nursing Assistant Annual Training

Complete this form for credit.

Complete by September 4, 2026.

Postural Documentation Instructions

Medication Delegation Forms

Medication Delegation Certificate 8/2027

Health Training Certificate 8/2027

Travel Mileage Worksheet

Each staff member must keep a log of travel from one school to another during the workday. These will be submitted to Accounts Payable after nursing administration reviews them at the end of the school year.

One drill must be anaphylaxis and one drill must be a behavioral health drill in collaboration with the school clinician.

Send copy of drill worksheet to Darcey Barnard by due dates.

Admissions Process:

All students entering the system will have the medical consent and health records uploaded into Enrollment.

It is your responsibility to run a report from PowerSchool of new students each week and retrieve their medical information from Enrollment.

The medical consent and health record should be attached in SNAP when entering initial health information.

Within System Transfer:

To ensure confidentiality, nurses will send original medical records of students transferring to another Lynn school directly to the nurse assigned to the new school in a sealed envelope labeled confidential (all school nurses have been supplied with a confidential stamp or stickers). If all health record information is attached to the SNAP EHR then this is not necessary.

Out of District Transfer:

Health records can be requested through the LPS website here. Original health records should be placed in a manila envelope, labeled “confidential” and given to the school’s office clerk to keep with the student’s cumulative record. If all health record information is attached to the SNAP EHR then this is not necessary.

Discharges:

Health records of students leaving the Lynn School System should be given to the clerk in charge to be added to the cumulative folder. If all health record information is attached to the SNAP EHR then this is not necessary.

In School Procedures:

Student medical records should not be viewed by any school personnel unless it is necessary to know information that will assist in providing direct services. All medical records should be kept in a locked file cabinet. If the building school nurse is unavailable and it is a necessary to know information to provide direct services, staff should contact nursing administration. Anyone viewing the paper or electronic health record must complete the student access log which is attached to each paper health record.

Standing MD Orders (will add once ready)

• Request for Disposables

• Request for Emergency Supplies

• Request for Equipment and Office Supplies

  
  

Send to Darcey Barnard by the 1st of each month to receive in a timely manner.

SY 2026/2027

• Nurses on a one-year plan or year one of a two-year plan must complete this by November 1st.

Strengths for SLG and PPG: This must be individualized and written by you for each assessment.

High-Priority Areas for SLG: Frequent health office utilization is a high-priority area because students who visit the nurse's office on more than 10% of school days often experience reduced instructional time and may

have underlying health, behavioral, or social-emotional needs that impact learning. By identifying these students and implementing targeted interventions, the school nurse can improve student health outcomes, increase time spent in the classroom, promote self-management skills, and ensure efficient use of health office resources. This work directly supports student achievement, attendance, and overall school well-being.

Student Learning Goal: By June 2027, I will decrease nurse office visits by 10% among students who currently visit the

health office on more than 10% of enrolled school days, as measured by health office visit data, through implementation of individualized care plans, targeted health education, staff collaboration, and family outreach. (i.e. 40 days into school, student has 5 or more nurse visits)

High-Priority Area for PPG: Following medication administration policies is a high-priority responsibility because it ensures student safety, reduces the risk of medication errors, protects student health, and maintains compliance with legal, professional, and district requirements. Accurate medication administration is a core nursing function that supports students' ability to remain healthy, safe, and ready to learn.

Professional Practice Goal: For SY 2026/2027, I will maintain 100% compliance with district policy JLCD-Administering Medicines to Students and MA regulation 105 CMR 210.000 by ensuring all medications are administered, documented, stored, and delegated according to established procedures, as measured through monthly chart audits, medication administration records (MARs), and administrative reviews.

Check "Team" if using the proposed goals. Check "individual" if using your own goal.

SY 2026/2027:

• Nurses on a one-year plan and year one of a two-year plan must complete the Educator Action Plan by November 15th.

Copy and paste exactly as written in this template if using nursing administration's proposed goals.

If you wrote your own goals, develop a clear, comprehensive action plan.

Refer to the educator action plan to complete your goals and when posting evidence later in the school year. 

• Those on 1-year plan must post evidence at least twice during the school year. Educator evidence is due by January 15th and May 1st.

• Those on 2-year plan must post evidence at least once during the school year. Educator evidence is due by May 1st. 

• Educator must post evidence towards Student Learning Goal, Professional Practice Goal and 6 Priority Standards. Your evidence is used to write your evaluation!  Here is an exemplary sample.

• Information should be organized as shown in the attached example. Please note that the goals in this sample are not your current goal!

• Please highlight your accomplishments. Evidence is not just about your goals. Every school has unique needs so tell us how you are improving health and wellness at your school under the priority standards.

• Please do not use student information in your evidence. You can cross names out or describe evidence in the evidence box.

Priority Standards:
I-A-3 Plan Development
I-B-1 Variety of Assessment Methods
II-B-1 Safe Learning Environment
II-C-1 Respects Differences
III-C-1 Two-Way Communication
IV-F-2 Professional Responsibility

There should be 4-5 goals outlined.

This should be done when licensure is obtained and on each 5-year renewal. Notify your supervising evaluator when complete so it can be approved/signed. This is your professional responsibility.

On renewal, you share your PD activity log or PD transcript with your supervising evaluator ensuring it relates to the IPDP goals.

SAMPLE IPDP

All School Nurses in Massachusetts must be certified by MA Department of Elementary and Secondary Education (DESE). This should be done as soon as possible after hire.

School Nurse (Levels: All)

Provisional License.

1. Valid license to practice as a Registered Nurse in Massachusetts.

2. A bachelor's or master's degree in nursing.

3. Passing score on the Communication and Literacy Skills test.

4. Completion of training within the orientation program for delivery of school health services as defined by the Department of Public Health and identified by the Department as found here:  

   ► Mandated Trainings | BUSM CME.                            

  Foundations of School Nursing Practice                             

Medication Administration in a School Setting: School

Nursing Practice in MA.

Initial License.

1. Valid license to practice as a Registered Nurse in Massachusetts.

2. A bachelor's or master's degree in nursing.

3. A minimum of two full years of employment as a Registered Nurse in a child health, community health, or other relevant clinical nursing setting.

4. Completion of an orientation program based on the requirements for delivery of school health services as defined by the Department of Public Health as found here: 

   ► Mandated Trainings | BUSM CME.                        Foundations of School Nursing Practice   

   Medication Administration in a School Setting: School Nursing Practice in MA.                

   School Health Screening Training*                                        SBIRT in Schools*                                                                     

   *Needed to screen

   
   

5. Passing score on the Communication and Literacy Skills test Massachusetts Tests for Educator Licensure (MTEL) (nesinc.com).

Professional License.

1. Possession and maintenance of a valid license to practice as a Registered Nurse in Massachusetts.

2. Possession of an Initial School Nurse All Levels license.

3. Three years of employment as a school nurse.

4. Completion of one of the following:

   1. Achievement and maintenance of certification or licensure by a nationally recognized professional nursing association as a school nurse, community health nurse, or a pediatric/family/school nurse practitioner as found here: Examination – NBCSN.

   2. A master's degree program that may include credits earned in a master's degree program for the Initial license in community health, health education, nursing, or public health.

Log into PowerSchool to see your evaluation plan/timelines, post forms, review evaluation documents, and sign up for LPS professional development.

SY 26/27: This is a new platform for evaluations and professional development.

A copy of the school's staff training list should also be placed in your paper MBHERP and in the red binder located with each AED station.

TRAINING FORMS AND CERTIFICATES:

• Epinephrine Competency Skills Checklist

• Narcan Competency Skills Checklist

• Staff Form for Delegation of Non-Emergency and Emergency Rescue Medications

• Stop the Bleed Certificate

• Seizure Certificate of Completion

• Health & Wellness Training Certificate of Completion

This highlights the specialty and professional expectations for school nursing.

Mentor Checklist updated 7/2026

Staff can view weekly payroll, benefit information, certifications, and tax documents here.

Staff can update home address, phone number and emergency contact information too.

All days must be entered as soon as possible to ensure accurate payroll!

Personal days cannot be used before or after a vacation or holiday. These requests will be denied.

Postural Opt Out Parent Notice 

Postural Documentation Instructions

Send for those students you need to refer after screening. This can be generated in SNAP:

Postural Referral Form  

Height/Weight Parent Notification

Spring Physical Exam Request

KG Health Information Request Forms

KG Screening Nurse Worksheet

Preschool Health Spring Notice for KG

 Guidelines for Keeping Your Child Home Letter

Standards of Conduct

Continuing Education

Actions of Complaints

MA Law About Student Records

DESE FAQs on Student Record Regulations

Lice Fact Sheets

Notice to Parents

AED & Emergency Equipment Inventory

•    School Health Services Webpage

•    Schools

•    Departments

•    Staff Resources 

Facebook Page

Here you will find all the information needed to complete the required district and health trainings on Canvas. Modules 1, 2, & 3 are due by 9/30/26.

MD Standing Orders:

EpiPen

EpiPen JR

Narcan

Tylenol

Ibuprofen

Calamine

Hand Sanitizer

Your principal is your primary evaluator. Either Jackie or Deb is your supervising evaluator. See above assignment list.

BMI Percentile Categories

Postural Opt-Out Parent Notification Letter

Postural Referral Letter

Postural Unable to Test Letter

An all-call message will be sent through ParentSquare the first week of school and before any vision and hearing screening is done to notify parents. Best practice would be for the school to send the dates once confirmed in a second message to parents.

Hearing Referral Letter and Second Notices

Vision Referral Letter and Second Notices

In September the nursing assistants will be coming to the schools to perform kindergarten vision screenings.

Classroom without cafeteria 

Posters:

Food Allergy Aware Poster

Peanut & Nut Aware Table

Peanut & Nut Aware Classroom

If you want a poster laminated, please email Darcey the poster with #quantity. 

• This code should only be used for doctors' notes excusing absences

NE-Nurse Excused

• To be used when the nurse has determined that a student is to remain home from school (See nurse for additional questions if needed)

  
  

January 23, 2026

Please note:

• Prioritize the survey grades (PK, KG, 7 & 12) for obtaining up to date immunizations:

  • Enter all immunizations into SNAP & attach proof

  • Sync SNAP with MIIS

  • Send parent notices

  • Contact providers

  • Collaborate with the SBHC if appropriate

  • Exclusion is the last option. Discuss with your Supervisor and Principal.

• A link to the Preschool Survey will be sent to the School Nurse at some point in September. If you do not receive a link, email immassessmentunit@mass.gov

• All other grades must be entered in MIIS

Full Instructions:

The annual Childcare/Preschool, Kindergarten, Grade 7, Grade 12, and College Immunization Surveys administered by the Massachusetts Department of Public Health (MDPH) are now open as of TBD. All surveys must be submitted by TBD.

The following information highlights important details about this year's survey:

1. Schools that submit surveys with 10+ students and measles, mumps, and rubella (MMR) rates of less than 90% will automatically receive a "Low MMR Rate" email in addition to the survey submission confirmation email.

2. As in previous years, there is no Influenza Survey being conducted.

Updated instructions, worksheets, as well as other school immunization information — including current requirements — are available on the MDPH website through the buttons below:

MDPH School Immunization Information

MDPH School Immunization Survey Materials

REMINDER: Enforcement of requirements is determined at the local level. Schools are encouraged to balance the dual public health benefits of high vaccination coverage and school attendance.

For Kindergartens, Grade 7, and Grade 12, the School Immunization Survey is available only through the Massachusetts Immunization Information System (MIIS). You must be registered with the MIIS to submit the School Immunization Survey or to search student vaccination records. If you are not registered with the MIIS, please begin the process as soon as possible by following the steps below:

• If someone in your school/school district is registered with the MIIS as an access administrator for your institution, they have the ability to invite new users to register. Instructions for adding users can be found in the mini guide below. If you are unsure who your access administrator is or if they are no longer employed, please reach out to the MIIS Help Desk.

• If this is the first time your school is registering with the MIIS, please access the MIIS Resource Center to start the registration process. Click on the purple "Registration" button to go to the "Registration Page" and then click "Begin Registration." Follow the prompts to create a profile for your school and complete the required registration paperwork.

• If you are completing the School Immunization Survey for a childcare/preschool or college, a separate email containing an access link to the survey will be sent. Please note that each link is unique and should NOT be shared across multiple sites. For K-12 schools with an associated childcare/preschool, the survey link can also be accessed through the MIIS when beginning a survey.

REMINDER: Shared MIIS access across users is prohibited.

MIIS "Add Users" Mini Guide

MIIS Resource Center

If you have any other questions about registration with the MIIS, please contact the MIIS Help Desk at MIISHelpDesk@mass.gov or 617-983-4335.

If you need to reset your password, you must contact the Virtual Gateway Helpdesk for a reset. They may be reached at (800) 421-0938. Neither the MIIS Help Desk nor the Data Assessment Unit can assist with password-related issues/resets.

Click the button below to log into the MIIS and begin the School Immunization Survey:

Click here to log into the MIIS

For any questions about the School Immunization Survey, please contact the Immunization Division - Data Assessment Unit at ImmAssessmentUnit@mass.gov.

Thank you for taking the time to complete the annual School Immunization Survey! Your effort and cooperation are greatly appreciated.

SEL will lead SBIRT

SBIRT Information and Forms

SBIRT LEADS 26/27

• Reason
• To
• Location

Evaluations are moving from Teachpoint to PowerSchool SIS. Update coming soon!

Proof of Completion

Complete by September 4th.

Assigned Evaluator List

You can also find stats for the last 3 years here.

Vision and Hearing Provider Lists (these are also available in SNAP when generating a letter)

How to Request Translation Services (last update 3/2025)

School Codes

Run a list in Powerschool

Additional Languages FAQs About Bed Bugs

EPA Bed Bugs in Schools/Guidance for School Nurses

MA DPH Bed Bug Protocol

Treatment and Control Measures

Keiry Pimentel

Patient Advocate-Program Coordinator

kpimentel@forsyth.org

Kathy Eklund

Senior Director of Occupational Health and Safety

Patient and Research Participant Safety Advocate

KEklund@forsyth.org

Office: 617-892-8216  

Cell: 617-851-2920

• Snow Emergency that is determined during the previous school day: LPS (Lynn Public Schools) external communication will be sent to inform families and care takers of the decision to close school for the next day. Communication to local media (television, website, and social media) will be made. 

• Snow Emergency determined before or after school hours: District level snow emergency tree will be activated to begin communication to Principals and department heads. District level communication will go out to all staff, families, and care takers. Communication to local media (television, website, and social media) will be made. 

1-hour delay/2-hour delay:   

• In unusual weather or other safety situations, LPS may delay the opening of the school day. Doing so will allow for the safe arrival to school campuses while protecting the school day. The district may elect to delay school by one or two hours. Delays would only have an impact on the opening of the school; dismissal time will not be impacted (dismissals will occur as normal). When delays are announced, the opening of school will occur one hour or two hours later than normal according to the attached schedule.   

• To support schools on the days that we need to have a delayed opening, Principals will have staff member(s) to assist on these days to supervise students who may arrive at school early. Please note that families and care givers should be sending their children to school at the designated delayed start time as there is limited supervision for students who arrive early. 

Early Dismissal: 

• We try to avoid early dismissal, however there may be circumstances where an early dismissal may need to be considered. Every effort will be made to communicate early dismissal decisions the night before to allow for parents to plan for the early student pickup. This communication will be shared via School Messenger and to the local media (television, website, and social media) 

  
  

Non-Urgent: 781-581-4400

Website

MA Behavioral Health Helpline: 1-833-773-2445

Website

When medication is administered, the eight rights of medication administration must be followed.

1. Right student: Use two identifiers to ensure it is the right student (even if you see them every day!). Confirm the right student each time with the medication bottle (e.g., never pre-pour medications).

2. Right medication: Be aware of any allergies a student may have to the medication. The School Nurse is responsible for verifying that the medication being administered to a student is correct. If there are questions, the School Nurse should check a reliable pill identifier resource to confirm medications. Nurses should not accept or administer any medication that has been prepared

by someone else (e.g., food prepared by parent/guardian containing a medication).

3. Right dose: Confirm appropriateness of the dose for the individual student using a current drug reference.

4. Right route: Confirm that the student can take or receive the medication by the ordered route.

5. Right time: Confirm both when the last dose was given and the safe window of administration.

6. Right documentation: Chart the site of an injection or any laboratory value or vital sign that needed to be assessed before giving the drug. Chart the medication administration as close as possible to the actual administration.

7. Right reason: Revisit the reasons for long-term medication use.

Note: Even if you just keep giving the same medication and dose every day for years, you are still responsible to review and confirm the prescription with a prescriber on a regular

basis (at a minimum annually).

8. Right response: Be sure to document observations of the student and any other nursing interventions that are applicable.

Note: You need to document the response to any medications given, including over-the-counter medications (i.e., if ibuprofen was administered for menstrual cramps, the School Nurse must document a response to the intervention – an appropriate response may be, “Returned to class; no further complaints voiced.”)

Managing Life-Threatening Allergies in Schools (MA DESE 2016)

Free sports, camp, or pre-participation school physical vouchers are available. We have some in the nursing office, just ask us!

9/15/2023

9/22/2023

9/29/2023

10/6/2023

10/20/2023

10/27/2023

11/3/2023

11/17/2023

11/22/2023

12/1/2023

12/8/2023

12/22/2023

1/5/2024

1/12/2024

1/19/2024

1/26/024

2/9/2024

2/16/2024

3/1/2024

3/8/2024

3/22/2024

4/5/2024

4/12/2024

5/3/2024

5/17/2024

5/24/2024

5/31/2024

6/7/2024

6/18/2024

For those with an account, you can access all memos in this folder:

Weekly Memos 2023-2024

Delegation Form

End of Year Status Report (will update when available)

Due June 4th

Please note that questions 12 and 13 are different this year than in previous years!

This year they are differentiating between the number of students with a certain diagnosis and the number of students with that diagnosis that have a special health care need.

For example:

A student has ADHD but does not take meds in school and does not have a 504 or IEP related to their ADHD. This student has an ADHD diagnosis but does not have a special health care need related to their ADHD. This student does not require an individualized health care plan related to ADHD.

A student has an ADHD diagnosis and takes Adderall in school daily. This student has an ADHD diagnosis and a special health care need related to their ADHD diagnosis. This student must have an individualized health care plan for their ADHD.

A student had a febrile seizure 5 years ago. Does not take any seizure medication and does not have an emergency medication. This is past medical history and would not be counted as a seizure disorder and would not be considered a special health care need.

A student has a seizure disorder documented by a medical provider. The student has been well controlled on meds at home and has not had a seizure in over a year. The student has an order for Valtoco and a 911 right off. Although the student is well controlled, they would be counted as having a seizure disorder and a special health care need. They would require an individualized health care plan as well as an emergency action plan.

A parent checks that their student has asthma on the emergency form. When you call to follow up, they say the student does not need an inhaler, and you have not received medical documentation stating the student has asthma. This is not medically documented and would not be counted as a student with asthma and would not be a special health care need.

As a general rule, if a student requires a medication for a condition, has a 504/IEP related to a condition, and/or requires an emergency action plan they have a special health care need and require an individualized health care plan for the related diagnosis.

When entering conditions/alerts please enter the date you are entering the alert in the date column. This is often skipped and is then hard to track if the alert is still relevant. For example: s/p surgery non weight bearing on crutches for 6 weeks. Whether this was entered last week or last year matters. Or seizure disorder with last seizure in August. August of what year matters, it helps us gauge how well the seizures are controlled.

The report also wants to know how we gathered our information is it parent reported, noted in medical provider documentation, or self-reported by student. This should be documented in the notes section as it makes a difference if it is noted on an e-form and then never confirmed by another source.

All Languages

See your stats on analgesic administrations here.

How to Print Labels for Pre-Reg.

Nursescan Copier Name and Location

If you scan medication or health forms to this folder, please move to your computer then rename. Nursing administration will delete files the day after they are scanned.

9/6/2024

9/13/2024

9/20/2024

10/4/2024

10/11/2024

10/18/2024

10/25/2024

11/1/2024

11/8/2024

11/15/2024

11/22/2024

12/6/2024

12/13/2024

1/3/2025

1/17/2025

1/31/2025

2/7/2025

2/28/2025

3/14/2025

4/17/2025

5/9/2025

5/30/2025

6/18/2025

Link to Canva Version

ESS is transitioning to a new platform Employee Access. In the meantime, if you would like to take the training use this link.

• Select “Retake Training” on the left bottom of the page

• Select “Full Training” then “Retake Training”

• It should bring you to the pre-assessment

• If that does not work, please sign out and sign back in and try the steps again.

Make sure you download and save your certificate! You will need to upload them to the new platform to prove completion.

Link to flyers

Additional Languages

Email our clerk, Darcey if you would like more of these printed on cardstock. Specify which ones you want printed and how many.

We have requested additional translations and will post when ready!

Link to flyer

Email our clerk, Darcey if you would like more of these printed on cardstock. Specify which ones you want printed and how many.

School Health staff ARE Healthcare Providers!

Alternatively, you can use the 10 B's guidance document developed by Alison Leiby!

Let Darcey know if you would like this copied and laminated.

See Spanish version in Canva. Other translations are here.

Parent Request Letters

A medical note from the provider is needed for all medical exemptions.

A parent note is needed for all religious exemptions.

Fire and Smoke Map

Healthy Air Network

Sunshine Fund Members

Sign up for virtual office hours with Deb and Jackie. Please indicate availability and a Microsoft Teams meeting link will be emailed to you.

Prefer in person help?

Reach out to arrange an in-person meeting after school.

Updated 7/10/2026

This involves developing plans, collaborating with parents, informing and educating staff on these plans.

Individualized Health Care Plans (IHCP) are nursing plans for the school day and school sponsored activities. This includes a nursing diagnosis, interventions, goals and outcomes. This should be reviewed and updated periodically throughout the school year or if the student's status changes. A covering nurse needs this information.

• IHCP should be created for any student with a medical condition that may require nursing care/treatment (e.g., asthma, diabetes, seizures, life-threatening allergies, catheterization, tube feeding, etc.) during the school day or school sponsored activity. 

• This plan may be referenced in an IEP or 504 plan.

Emergency Action Plans/Emergency Care Plans (EAPs/ECPs) are plans that you create and share with relevant school staff working with the student with the medical condition. They need to know how to respond in the event of a medical emergency.

• EAP/ECP should be created for any student that requires an emergency medication or has a condition that could be life-threatening if not recognized and treated promptly. (e.g., diabetes, VP shunt, bleeding disorder, sickle cell anemia, life-threatening allergy, seizure disorder, etc.).

• Relevant staff must be trained in a student's EAP and receive a copy.

• School nurse will document that student's EAP was shared, reviewed, and list those staff members.

Evacuation Plans are necessary for students or staff with limited mobility who may not be able to leave a building without a plan in place during an emergency such as a fire. Here is the English template and Spanish template.

Medication Administration Plans (MAP) with Parent Consent are required for any medication administered or needed for school including daily prescriptions, PRNs, or over-the-counter medications.

• This is required per the LPS Medication Administration Policy.

• SY 24/25, we combined the MAP and the parent consent which is also required to decrease repetitive information and forms that needed to be signed by the guardian.

  
  

Important Points:

• Some students may need an IHCP, EAP, Evacuation, and Medication Administration Plan. 

• Review plans annually and as needed when changes occur such as a significant health event or updated MD orders.

• Create plans in SNAP whenever possible.  This will make reviews and yearly updates much easier for you! Refer to this for instructions: SNAP How to Document .docx (sharepoint.com)

• Every nurse's office has the reference "Individualized Health Care Plans for School Nurses."  Use this to assist you to create plans, find nursing diagnosis for conditions, interventions, etc. This is particularly useful for conditions not seen frequently in the school setting.

• If a paper plan is created, keep in white binder with medical 504 plans. For paper plans, you must check IHCP in SNAP on conditions/alert tab and attach it.

• Train staff on need-to-know information including the EAP, Evacuation Plan, and IHCP accommodations.

• Copies of EAPs should be provided to relevant school staff and kept in the white care plan book unless created in SNAP. 

• For your protection, once you share an EAP and train a relevant staff member, document details in SNAP.

• Discuss food allergies with kitchen staff. Inform them which students have life-threatening allergies.  

• Discuss allergy plan for cafeteria/classrooms (e.g., nut aware classroom/ peanut butter table). 

• Send home classroom nut allergy letter if needed.

• Post allergy aware or do not share food signs in key locations such as classroom, cafeteria table, etc.

• Document with the date on the IHCP when a student meets a goal.

  
  

Choose #2 then #1

Option #2

All lines: 781-592-8796

Welcome Center Webpage

Nurse will document training on the staff training list and put certificate in the blue staff training binder.

The nurse will provide staff a training review and informational update at least annually then document this review.

• UAP Memory Jogger

Policy JLCD-Administering Medications to Students

Approved by Lynn School Committee on 9/25/2025

Handbook for Candidates

Every nurse office has been given this reference. Please notify nursing administration if missing.

Memo 9/12/2025

Memo 9/26/2025

Memo 10/17/2025

Memo 12/5/2025

Memo 1/9/2026

Memo 2/6/2026

Memo 3/6/2026

Memo 4/2/2026

Memo 5/1/2026

Memo 6/5/2026

this allergy training.

Staff present a certificate of completion for the medication administration for the UAP training to the nurse. Nurses keep these in the blue staff training binder. Staff should take this quiz for life-threatening allergies and epinephrine. These results will go to your staff training lists when completed.

The school nurse training an unlicensed school staff member in student specific epinephrine administration per the LPS Medication Administration Policy and 105 CMR 210.00 will supplement the training with a skills review using the short video and instruction sheet.

How to Use an EpiPen Video

How to Use Epinephrine: Adrenaclick

How to Use Auvi-Q

How to Use Teva

How to Use Teva Instruction Sheet

How to Use Neffy

Resources and FAQs for Neffy

School nurse will document training on the staff training list and complete a Competency Skills Checklist.

The nurse will provide staff a training review and informational update at least twice a year then document this review. The training should include:

• procedures for risk reduction

• recognition of the symptoms of a severe allergic reaction

• the importance of following the medication administration plan

• proper use of the administration device

• requirements for proper storage and security, notification of appropriate persons following administration, and record keeping

Epilepsy Foundation

Post-Test

Seizure Logs

Nurse will update staff training list and keep copy of quiz results in blue staff training binder.

After viewing, complete this acknowledgement for credit.

School Sponsored Activities Checklist and Worksheets

School Sponsored Activities Training for School Staff

School Sponsored Activities Procedure

Resources:

• Flowchart

• Checklist for School Staff

• Do's and Don'ts

Forms:

• Permission Slip

• Field Trip Study Tour Pre Planning Form

• Medical Form for Overnight Trips

• Emergency Form for Non-LPS Students

Replaces:

Field Trip Procedure

Health and Safety Procedure for Athletics

MA DPH Report Form

You can review all requests here.

Use this link to request help.

Moving forward, unlicensed school staff in need of training will complete this medication delegation training. Certificates of completion will be kept in the blue staff training binder.

The school nurse delegating a student specific emergency rescue medication to an unlicensed school staff member per the LPS Medication Administration Policy and 105 CMR 210.00 will supplement the medication delegation training with a skills review using the short video and instruction sheet. Check with nursing administration to see if trainers are available.

If you need specific instruction sheets or training videos for emergency rescue medications not listed here, please notify Deb and Jackie.

How to Use Baqsimi

Instruction Sheet: Baqsimi

Video Instruction Baqsimi

Safety Information for Baqsimi

Instruction Sheet: Gvoke

Video Instruction: Gvoke

How to Use Nayzilam Nasal Spray

Instruction Sheet: Nayzilam

Video Instruction: Nayzilam

American Lung Association "How To" Page

Instruction Sheet: Metered Dose Inhaler

Video Instruction: Metered Dose Inhaler

Instruction Sheet: Metered Dose Inhaler with spacer/mask

Video Instruction: Metered Dose Inhaler with spacer/mask

Instruction Sheet: Metered Dose Inhaler with spacer

Video Instruction: Metered Dose Inhaler with spacer

How to Use Valtoco Spray

Instruction Sheet: Valtoco

Video Instruction: Valtoco 5mg and 10mg

Video Instruction: Valtoco 15mg and 20mg

Training will be documented on the staff training list and Staff Form for Delegation of Emergency Rescue Medication.

The nurse will provide staff a training review and informational update at least annually then document this review.

• UAP Memory Jogger

Staff will review this training and complete the post-test:

Responding to an Opioid Overdose.mp4

Narcan Post-Test

The nurse will supplement this training with the following and review skills with staff member:

Harm Reduction

CDC How to Use Naloxone Nasal Spray

NARCAN® Nasal Spray

Nurse will document training on the staff training list and complete this Emergency Rescue Opioid Antagonist Competency Skills Checklist. This will be filed in the blue staff training binder. Please note that Narcan is not a student specific training.

LPS Food Allergy Policy EFAB

LPS Wellness Policy ADF

LPS Food Accommodation Request Information and Forms

GI Illness Symptom Checklist

GI Illness Child Care & K-12 School Cluster Reporting Form

Prevention:

• Handwashing

• Do not share food among students and staff

• Transportation Plan for Nurse Bus

  
  

Referral Steps for School Nurses:

1. Identify any student who did not pass their school vision screening and needs follow-up.

2. Contact the guardian and if they agree, ask them to sign this authorization allowing LCHC to contact them and schedule an appointment for their child.

3. Once the signed authorization form is collected, email:

• Jennyfer Lopez, Office Coordinator   📧 jlopez@lchcnet.org

• Luisa Gil, Practice Manager               📧 LGil@lchc.org

Include:

• The signed authorization form

• Vision screening referral form which includes the student's name and date of birth

• Guardian name and contact information

  
  

Follow-Up

• Once the student has the comprehensive vision exam, LCHC staff will email the completed referral form to Deb Tanzer, Jackie Westrin, and Darcey Barnard. Darcey will forward these to the corresponding school nurse.

• All referrals will also be stored in the LCHC Vision Form folder found in the nursescan drive for your review if needed.

Below are the options LCHC offers for those who are not insured:

• Patients are referred to the Enrollment Department to apply for insurance.

• Patients not eligible for health insurance can also apply for the Health Center’s Sliding Fee Discount Program.

• For patients who do not want to go thru the enrollment process and prefer to pay out‑of‑pocket, we give them a “cash” discount at check-in. (The routine exam would be $93 total, no materials included)

• As mentioned above, in certain circumstances we will see the patient and write off the exam fee.

For glasses, the clinic follows the same protocols listed above, with the exception that we just often utilize the Essilor program called Life Through Lenses, which can provide eyeglasses (frame and/or lenses) at no cost.

Vision Matters Flyer

Emergency forms will continue as a hybrid system for this school year. The emergency form was sent out in the spring electronically through PowerSchool Enrollment System.

Here is the paper version if needed:

Paper Emergency Form 2026-2027

Clerks will print the 2-page form from Enrollment.

• Give 2 pages to school nurse

• May keep page 1 in main office or give to other staff who may need a copy per the principal's discretion

Nurses can find athletic rosters here.

EAPs can be attached and will follow the student for any sport they sign up for. Nurses can attach directly or email to athletic staff to attach.

Nurses can find physical exams here too!

School Sponsored Activities Training for School Staff

All nursing assistants that are conducting health screenings must complete this course yearly.

Send certificate of completion to Darcey Barnard by September 4th to ensure readiness for screening.

• Health and Wellness Training (acknowledgement)

• Life-Threatening Allergies and Epinephrine Administration (post-test)

• Narcan Training (post-test)

• Seizure Precautions (post-test)

• Medication Delegation (certificate of completion or post-test if in Spanish)

• Stop the Bleed (English-staff email post-test result/Spanish-post-test)

Trainings are also posted here if staff are unable to access these in Canvas.

Final Forms One Pager

Approved activities for stipend hours

SEL De-escalation training

Signs of Suicidal Ideation