• HEALTH FORMS 2022-2023

    Laguna Elementary School / Laguna Middle School
  • Immunization Procedure/Requirements for Incoming Students

  • All New Mexico schools are required to comply with the NM Department of Health Statutes and Immunization laws. Therefore, parents/guardians are required to provide the school with an updated immunization record of their child during the time of school registration. Records may be obtained from students’ providing IHS hospital or private doctor including those shots received in Head Start.

    Students not up to date with immunizations place themselves and others at risk for acquiring serious, otherwise preventable diseases. The school health assistant will review immunization records and notify parents/guardians of children who are not up to date. Failure to provide the school with updated required immunizations will result in the student not being allowed to attend school. The students will be sent home from school until he/she receives the required immunization(s) for school enrollment. A referral to social services for neglect may be initiated.

    The following are required immunizations for school enrollment.

  • Diptheria/Tetanus/Pertussis (DPT/DTaP/Td)

    • O ne dose required on/after 4th birthday. Four doses are sufficient if last dose given on/after 4th birthday, but five doses are preferred for optimal protection.
    • One dose Tdap required for entry into 7th grade. HPV vaccination is also strongly recommended f or the prevention of cancer.
  • Polio (OPV/IPV)

    • Students in K - 9th grades final dose required on or after 4th birthday. Three doses sufficient if CDC’s catch up schedule used AND last dose was given on/after 4th birthday with at least 6 months between the las t two doses
  • Measles/Mumps/Rubella (MMR)

    • Minimum age for valid 1st dose is 12 mos. Live vaccines (MMR, Varicella) must be given on the same day; if not, they must be administered a min. of 28 days apart.
  • Hepatitis (HepA/HepB)

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    • Hepatitis A (HepA) - Please be aware that 2 doses will be required for Kindergarten entry .
    • Hepatitis B ( He p B ) - Two doses adult Recombivax HB is also valid if administered at ages 11 - 15 and if dose 2 received no sooner than 16 weeks after dose 1.
  • Chicken Pox (Varicella)

    • Min. age for 1st dose is 12 mos. Dose 2 should ideally be given at age ≥4, see note below. Live vaccines (MMR, Varicella) must be given on same day; if not, they must be administered a min. of 28 days apart. For K - 4th graders, receipt of vaccine, titer or laboratory - confirmed diagnosis is required as proof of prior disease.
  • Meningococcal Men (ACWY)

    • 1 dose required at age 11 - 12 for 7th grade entry; booster dose recommended at age 16 - 18. Men ACWY strongly recommended for ages 13 - 18.
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  • Consent for Administration of non-Prescription Medications/First Aid/Sick Care

    Laguna Elementary / Middle School 2022-2023
  • I/We, the undersigned parent(s)/guardian(s), hereby give consent to the LDoE Schools to offer/provide my/our child the following non-prescription medication(s) (brand or generic) as needed, by the school staff for minor complaints to enable student to function in the classroom. When it is deemed medically necessary, student will be sent home from the nurses’ office. Parent/guardian will be notified immediately.

  • The following procedures will be followed in accordance with LDoE Handbook Policies and Procedures.

    • Referrals will be made as necessary to the appropriate ACL offices for further evaluation or follow up.
    • The school will have your child transported by ambulance to ACL Hospital in case of extreme emergency such as profuse bleeding, broken bones, breathing stoppage, etc.
    • School personnel CANNOT administer OTC or other medications to children without a signed permission form. School personnel can administer prescription medicatio n only if the medication is provided in its original container with clear written directions. Parents are responsible to complete the Medication Administration Form provided in the registration packet.
    • In minor incidents, the school will contact the paren t/guardian(s) first and then the emergency contacts . If no one on the list can be contacted, your child will be returned to class or kept in the nurse’s office until his/her regular bus run.

    NOTE: Please be sure to notify office of updated contact information.

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  • Consent of Parent/Guardian for School Health Services

    Laguna Elementary / Middle School 2022-2023
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  • I hereby give consent to the Laguna Elementary/Middle School to provide school health services to my child by the designated staff while he/she is in attendance at school, as needed and available. School Health Services consists primarily of:

    • First Aide for injuries
    • Sick Care
    • Follow - up care of illnesses or injuries
    • Crisis intervention and mental health
    • Suspected child abuse/neglect
    • Reproductive health counseling (as needed)
    • General health counseling
    • Immunization tracking & reporting
    • Physical examination record and health questionnaire review
    • Health Care Plans for students with medically diagnosed health problem
    • Facilitate administering prescribed and non - prescribed medication (as per policy & procedure)
    • Screening for head lice (as needed)
    • Referrals to the ACL offices (as necessary, or specialty clinics for further evaluation of health problems or screening failures)
    • Inst ruction in health issues such as health promotion/disease prevention, diabetes, asthma, basic dental care, drug, tobacco and alcohol prevention
    • EMS/Ambulance services fo r urgent/emergency care and/or transportation to a local health care faci lity for emergency medical care
    • Weight, height, blood pressure screening as necessary

    Note: Parents/guardians will be notified of any referrals made regarding their children. Parents/guardians must update telephone numbers as soon as changes occur.

  • Please provide the names of two adult relatives or friends who will assure the responsibility of your child in case of illness or accident if you cannot, or until you can, be reached. Please notify these persons for this arrangement.

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  • IHS - Consent of Parent or Legal Guardian or Other Person* who has primary responsibility for the care of the child

    * Person is defined as one who in the absence of the parent or legal guardian provides a home for the child such as next of kin.
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    1. Health care including medical examinations, routine laboratory studies, x-ray procedures, and skin tests.
    2. Dental care including dental examinations, preventive use of fluorides and necessary emergency dental care.
    3. Mental health services including evaluation and treatment as necessary.
    4. Emergency health care for accidents or illness.
    5. Transportation of the child to and/or from another health facility for these services.
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  • FLUORIDE VARNISH

    Procedure: Fluoride varnish is applied directly onto the teeth.

    Benefits: Fluoride Varnish coats the outside of the tooth and makes it resistant to a cavity.

    Risks: Used in the proper amount, fluoride varnish is safe and effective.

     

    DENTAL SEALANTS

    Procedure: A Plastic coating is applied on the chewing surface of the back teeth.

    Benefits: Sealants help prevent cavity-causing germs from getting stuck in the deep groves in the back teeth.

    Risks: There are no known commonly occurring adverse effects or hazards associated with dental sealants.

  • IHS -School Screening, Fluoride Varnish, Dental Sealant Consent

    Indian Health Service Dental Program will be offering free dental screenings, fluoride varnish and sealants at your child's school.
  • Preventive Services provided by Indian Health Service at your Child's school DO NOT replace a regular dental checkup. We will send a notice home with your child of all retreatment they received in school.

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  • Parental Permission

    I give permission to have a screening, fluoride varnish and dental sealants placed:
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  • Note: all procedures rendered at these visits are billable to Medicaid and third-party insurance as authorized in the Indian Health Care Improvement Act.

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