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HomeMy WebLinkAbout2024-048-E-Health Dept-Memorandum of Agreement between Orange County Health Department and Orange County Schools 2023-2024 school year4884-1724-9679, v. 1 MEMORANDUM OF AGREEMENT BETWEEN ORANGE COUNTY HEALTH DEPARTMENT AND ORANGE COUNTY SCHOOLS 2023-2024 SCHOOL YEAR This Memorandum of Agreement (MOA) between the Orange County Health Department (OCHD) and the Orange County Schools (OCS) has been written to provide understanding, give direction and establish specific responsibilities. It is reviewed by both parties, amended as necessary and renewed on an annual basis. The final version is submitted to the School Health Branch of the Division of Public Heal th within the NC Department of Health and Human Services. The OCHD and the OCS system work cooperatively to assure the delivery of high -quality nursing services for students of the OCS (Policy Number 6120, Student Health Services Policy). The OCHD Medical Director and/or designee will provide medical consultation and direction for policies and procedures used by the OCS-employed nurses. Medication standing orders/vaccination guidelines will be consistent with OCHD policies and procedures. (Appendix I) The policy and document references in this MOA can be found on the OCS website in the Board of Education; Board Policies section. In addition to being employees of the school system who perform duties assigned to them by OCS supervisory personnel, the OCS Superintendent, and/or the OCS Board of Education, including but not necessarily limited to the duties described herein, school nurses shall also be areas authorized by OCHD to support the work of the OCHD in the following areas as explained in more detail in this MOA: 1) Immunization provision (allowing nurses to administer immunizations per OCHD and OCS policies and protocols, consistent with this document) 2) North Carolina Immunization Registry (NCIR) access 3) Emergency operations (school nurses are included in OCS emergency preparedness planning, shelter staffing and other preparedness-related activities in conjunction with OCHD) 4) Communicable disease control (allowing school nurses to promote and implement guidance established by OCHD) OCS and OCHD designate the following nursing administrative liaison personnel to coordinate school health efforts: ● OCS Lead Nurse(s) – receive(s) administrative oversight from an OCS administrative designee ● OCHD School Nurse Liaison (Communicable Disease Nurse) and the Director of Nursing Both OCS and OCHD shall conduct ongoing evaluation of these cooperative efforts and collaborate on needed changes. The services provided by the nurses and other school health staff are in accord with the guidelines included in the most current editions of the following: ● North Carolina School Health Program Manual ● https://www.dph.ncdhhs.gov/wch/cy/schoolnurses/manual.htm ● OCHD Immunization Protocols ● OCHD Child Health Protocols ● OCHD Emergency Protocols ● American Public Health Association Control of Communicable Diseases Manual ● North Carolina General Communicable Disease Control’s North Carolina Communicable Disease Manual ● https://epi.dph.ncdhhs.gov/cd/lhds/manuals/cd/toc.html ● CDC Manual for the Surveillance of Vaccine Preventable Diseases https://www.cdc.gov/vaccines/pubs/surv-manual/index.html ● OCHD Primary Care Program Manual ● North Carolina Tuberculosis Policy Manual https://epi.dph.ncdhhs.gov/cd/lhds/manuals/tb/toc.html ● Orange County Schools, School Nursing Program: Policies and Procedure Manual ● OCS health-related board policies ● American Red Cross First Aid/CPR/AED Guidelines ● Children & Youth Assisted by Medical Technology in Educational Settings: Guidelines for Care ● School Emergencies Manual https://files.nc.gov/dpi/documents/resources/nc-emergency-guidelines.pdf ● Red Book - Report of the Committee of Infectious Diseases Barton and Schmitt, Instructions for Pediatric Patients DocuSign Envelope ID: CEF0A315-C0D6-4618-8F2A-729FFE153BB6 4884-1724-9679, v. 1 ● American Academy of Pediatrics Managing Infectious Disease in Child Care and Schools: A Quick Reference Guide ● American Academy of Pediatrics Managing Chronic Health Needs in Child Care and Schools: A Quick Reference Guide ● School Nursing: A comprehensive Text ● COVID-19 Operational Guidance for K-12 Schools and Early Care and Education Programs to Support Safe In-Person Learning | CDC OCS will maintain a current waiver for lab testing procedures performed by the school nurses/school staff according to federal CLIA (Clinical Laboratory Improvement Amendments of 1988) requirements. The OCS administrative designee will renew the certificate every 2 years. The school will provide an appropriately equipped private room (including a desk, telephone, refrigerator, computer with e-mail access and locking file cabinet) with adequate privacy for confidential counseling between students, parents, employees and nurses in compliance with medical confidentiality standards. The room shall also be equipped to ensure compliance with current OSHA standards assuring adjoining restroom facilities and handwashing facilities to minimize the likelihood of transmission of infectious diseases from sick students to others. Storage space for health-services equipment (i.e. vision testers, wheelchairs, etc.) is also required. For informational purposes only, at the time of execution of this MOA, the OCS Board of Education employs thirteen Registered Nurses, one LPN, and 2 School Health Technicians who serve the Orange County Schools. As to any such personnel throughout the term of this MOA: ● Lead nurse responsibilities will be assigned. These responsibilities will be either assigned to a full - time lead nurse or shared between 2 school nurses whose school- specific time will be .65 FTE/school with .35 FTE designated for lead nurse activities. The time allotted for lead nurse duties, if shared, will continue to be .7 FTE. Additional coordinative duties will be assigned to other school nurses as appropriate. ● On-site supervision of each nurse is provided by the respective school principal and/or other OCS administrative staff. ● Supervision of nursing practice will be provided by the lead nurse(s). Nursing licenses are verified upon employment and annually via the North Carolina Board of Nursing website by OCS Human Resources to ensure current licensure. Confidentiality agreements for all school nurses are obtained upon employment and updated annually with OCHD to allow exchange of health information as necessary. All school nurses must achieve and maintain minimum training standards. RNs serving as OCS school nurses must: ● Either have a bachelor’s degree in nursing (BSN) or in a related field that qualifies the nurse to sit for the National School Nurse Certification Exam OR ● Obtain the degree in an accepted field (as referenced above) within 3 years of employment if hired without a bachelor’s degree ● Obtain National School Nurse Certification within 3 years of employment with renewal every 5 years ● Maintain professional certification in First Aid/CPR/AED Nurses must be trained in all areas of responsibility that apply to the age of students served by their school(s) as outlined in this agreement. Bi-Annual/Annual trainings in Health and Safety must be maintained and include: ● HIPAA Privacy and Security (for NCIR access) ● Bloodborne Pathogen Training ● Restraint Training ● Prevent Blindness Vision Screening (every 2 years) ● Respiratory Protection Training and Fit Testing ● CPR/AED/First Aid Instructor training (initial and renewal every 2 years) Notwithstanding anything to the contrary herein, the following general terms govern this MOA:  OCS and OCHD shall each be solely responsible for the supervision, direction, evaluation, hiring, discipline, dismissal, payroll tax deductions, and other employment-related responsibilities for their own respective employees. Nothing in this MOA shall be construed to create an employment or agency relationship, joint venture, or partnership between OCS and OCHD.  The roles and responsibilities assigned to OCS staff other than school nurses are based on current OCS practice and are included in this MOA only as a point of reference. Nothing in this MOA prohibits OCS supervisory staff, the OCS Superintendent, or the OCS Board of Education from reassigning such duties to other staff.  The parties acknowledge and agree that, effective December 1, 2023, any “treatment” provided to any minor child by any “health care practitioner,” as those terms are defined in Part III of N.C. Session Law 2023 -49 (to DocuSign Envelope ID: CEF0A315-C0D6-4618-8F2A-729FFE153BB6 4884-1724-9679, v. 1 be codified at G.S. 90-21.10A and 90-21.10B) requires advance written or documented parental consent except as otherwise provided in Article 1A or by court order. The parties further acknowledge and agree that this parental consent requirement does not apply to the administration of medications prescribed by a doctor on behalf of the parents, the provision of emergency health care, or the performance of other first aid or lifesaving techniques performed by OCS-employed nurses or other school system personnel consistent with requirements of G.S. 115C-375.1 (as amended by Section 7.81(c) of the 2023 Appropriations Act).  Nothing in this MOA shall be construed to create any enforceable rights, benefits, or obligations on the part of any third party. SCHOOL HEALTH PROGRAM COMPONENTS/RESPONSIBILITIES ORANGE COUNTY SCHOOLS (OCS) PERSONNEL ORANGE COUNTY HEALTH DEPARTMENT (OCHD) PERSONNEL I. Administration/Joint Planning for School Health – Both the local health department and the local school system have specific responsibilities that are clearly defined as the result of joint planning and evaluation. Objective: To implement a comprehensive school health program in the Orange County Schools (OCS) OCS Administrative Personnel ● Serves as the administrator responsible for the school health services program OCHD Medical Director ● Serves as medical director for the school nursing program Lead Nurse/Designee ● Supervises and evaluates the nursing practice of school nurses ● Provides coordination of services and quality assurance monitoring of school health nursing program ● Oversees coordinative assignments to school nurses ● Serves as coordinator and primary contact to the OCHD during communicable disease events ● Develops, reviews and approves school health-related policies and protocols and also data collection policies and protocols. ● Completes inventory tasks and requests purchase of health- related supplies ● Assists the OCS Administrative Personnel as indicated (i.e., new nurse interviews, annual MOA review/revision, etc.) ● Coordinates services provided to the Pre-K and Head Start Programs ● Coordinates scheduling/assignments of UNC School of Nursing students ● Completes and submits the School Nurse End-of-Year Report to DHHS ● Completes annual nursing evaluation of school nurses ● Serves as liaison with OCS, OCHD and Emergency Medical Services (EMS) OCHD School Nurse Liaison (Communicable Disease Nurse) ● Serves as OCHD liaison for the School Health Nursing Program ● Participates in the School Health Advisory Committee, OCHD Nursing Director: ● Coordinates completion of annual Memorandum of Agreement ● Supervises the nursing practice of the lead nurse(s) responsible for supervision of the school nurses ● Participates or designates an OCHD representative to participate in interviews for school nurses School Nurse (additional coordinative assignments) ● Assists with the development of school health-related policies and protocols ● Coordinates Red Cross CPR/AED/First Aid training for faculty and staff (system-wide) ● Coordinates student & staff vaccine clinics ● Completes Immunization, K assessment and Prevent Blindness (vision screening) state reports ● Serves as liaison with the Head Start and Title I Pre K Programs School Nurse ● Establishes contact with the principal at respective school ● Works with the principal and other administrators to identify and work toward health-related goals ● Functions within guidelines outlined by the school nurse job description Principal ● Serves as on-site administrator for each school nurse ● Completes annual performance evaluation for on-site non- nursing duties SAFE SCHOOL ENVIRONMENT Objective: To promote a safe school environment. Principal (with SN or NP) ● Ensure that designated personnel receive training for Safe Schools, lockdowns, OSHA procedures ● Ensure that school safety and OSHA procedures are followed in the event of an accident or injury at school DocuSign Envelope ID: CEF0A315-C0D6-4618-8F2A-729FFE153BB6 4884-1724-9679, v. 1 ORANGE COUNTY SCHOOLS (OCS) PERSONNEL ORANGE COUNTY HEALTH DEPARTMENT (OCHD) PERSONNEL ● Maintain a system of accident reporting, including incident and OSHA reports ● Develop, recommend and implement procedures for illness and accident care that are consistent with the district policy ● Evaluate classrooms and school facilities for safety features and access by all students Registered Nurse (RN) and Nurse Practitioner (NP) ● Participate in the planning and implementation of safe schools teams ● Participate in Orange County disaster planning and response ● Review incident reports and provide input as indicated ● Implement infection control activities such as work practices (hand hygiene, no eating or drinking in certain areas, no re-capping of used needles, using sharps containers), appropriate use of PPE and cough etiquette. HEALTH PROMOTION Objective: To assist students and employees in achieving and maintaining a healthy lifestyle Registered Nurse (RN) and Nurse Practitioner (NP) ● Promote healthy school environment as specified in OCS policy 3541/6140/7245 Physical Activity and Health Eating ● Collaborate with PE teachers to provide intervention for students with elevated Body Mass Index ● Coordinate employee wellness programs that include health screening ● Implement the “Tobacco Free Schools” law (G.S. 115C-4078) and local board policy 5026, Smoking and Tobacco Products OCHD ● Coordinate health promotion activities of Healthy Carolinians of Orange County with OCS Healthy Schools Advisory Council II. Service Delivery A. Health Screenings Objective: To identify specific health problems which may be a deterrent to the child’s performance in school i. General Screening and Observation Teacher ● Observes for signs and symptoms of illness, injury or deviation from normal behavior which might need some type of health intervention (The teacher, who sees the student daily and knows how he/she looks and acts, will readily recognize when he/she is not well.) ● Refers student with suspected health problems directly to the nurse for evaluation and follow-up School Nurse ● Screens referrals, makes assessments, develops appropriate plans of care and provides necessary follow-up ii. Vision Screening Principal/Designee ● Assures a suitable location for screening to take place ● Assures cumulative folders health records are made available for screening and are re-filed once screening and documentation is complete Teacher/Teacher Assistant ● Provide a list of all special education students due for re- evaluation who will need screening for re-evaluation prior to the scheduled screening time for next year, new students to the system who need screening, grade levels scheduled for screening and others not included who have been identified as needing screening ● Coordinate with nurse to make students available for screening ● Assures parents are notified of upcoming screenings School Nurse ● Coordinates with the school administration and teachers to implement screening activities ● Screens students for acuity in grades 1,3,5,7 and new to the school system with the HOTV, Snellen, Goodlite or other appropriate vision test as scheduled during the school year ● Screen special education students or students referred for evaluation for far and near acuity with an appropriate test as listed above (including those students who will need screening for re-evaluations prior to the scheduled screening times for next DocuSign Envelope ID: CEF0A315-C0D6-4618-8F2A-729FFE153BB6 4884-1724-9679, v. 1 ORANGE COUNTY SCHOOLS (OCS) PERSONNEL ORANGE COUNTY HEALTH DEPARTMENT (OCHD) PERSONNEL year). Screening will occur in accordance with state recommendations. ● Screen male kindergarten students for color perception ● Rescreen students having positive results ● Notify parents of positive results ● Record test results on cumulative folder health record ● Refer all students with a positive screen for appropriate care and follow-up as needed ● Follow-up with parents to promote compliance with care recommendations ● Submits data to lead nurse(s)/designee for compilation of state mandated report iii. Dental Screening (optional) Principal/Designee ● Provides access to appropriate screening location ● Assures accessibility of health records for documentation of screening results and follow-up activities ● Assures accessibility of student/family contact data for follow-up purposes Dental Screening Staff (would vary annually based on availability) ● Screens selected students for dental needs or problems ● Completes follow-up for students with dental needs ● Documents screening results and follow- up activities on student health record in cumulative folder ● Provides a list of students referred to nurse ● Provides screening data (including # screened, # referred, # obtained care) to nurse ● Provide classroom instruction on dental health at the elementary level per school nurse request and staff availability School nurse ● Facilitates organization of screening at each school site ● Receives screening data ● Submits data to lead nurse(s)/designee for state-mandated report completion ● Collaborates with school social worker as needed for students in need of dental work 1. B. Health Assessment Objective: To identify health problems that may interfere with the child’s performance in school. i. Record Review and Referral Principal/Designee/Teacher ● Distributes student health and emergency forms at the beginning of the school year to all students, collect completed forms and make available to nurse ● Ensures return of student health and emergency forms from all students. School Nurse ● Reviews student health and emergency forms ● Initiates appropriate follow-up for identified health problems ● Provides information about students with chronic diseases and/or significant health problems to appropriate school personnel in consultation with parent ● Works with teachers to appropriately manage health concerns of students ● Conducts staff development activities on health concerns as needed ● Reviews Health Assessment Transmittal forms on all students entering NC public schools for the first time and initiates appropriate follow-up for identified health concerns ii. Kindergarten Registration OCS Administrative Staff/Principal DocuSign Envelope ID: CEF0A315-C0D6-4618-8F2A-729FFE153BB6 4884-1724-9679, v. 1 ORANGE COUNTY SCHOOLS (OCS) PERSONNEL ORANGE COUNTY HEALTH DEPARTMENT (OCHD) PERSONNEL ● Organizes and implements a kindergarten registration process School Office Staff ● Gives Health Assessment Transmittal form and other pertinent forms to parents/guardians prior to and at registration School Nurse ● Participates in kindergarten registration assessing the health and immunization status of incoming kindergarteners and initiate appropriate follow-up as needed C. Immunizations Objective: To assist schools in complying with North Carolina G.S. 130A -152 through 157 i. Record Review and Exclusion OCS Administrative Staff/Principal ● Assures that all students receive information on the influenza vaccine; meningococcal vaccine; and cervical cancer, cervical dysplasia, human papilloma virus (HPV) and the vaccines available to prevent them, to satisfy the requirements of 115C- 375.4 and 115C-47(51). School ● Informs parent/guardian of requirements ● Has parent/guardian read and sign immunization notice form at the time of registration ● Informs parents of consequences of having an incomplete immunization record after the 30th day following enrollment ● Maintains a list of incoming immunization records and gives to nurse to review ● School Nurse ● Uses NCIR to access immunization records of newly enrolled students and staff ● Requests immunization records as needed from parent/guardian or school previously attended ● Reviews immunization records of all newly enrolled children and rising 7th and rising 12th graders graders ● Attaches/encloses immunizations to permanent health record/folder in the cumulative folder ● Informs parent/guardian when the record is incomplete and the necessary requirements needed to meet N.C. Immunization Law ● Allow OCHD to inspect immunization records as required by law, including records of incomplete immunizations, medical and religious exemptions. ● Keeps principal advised of students not in compliance and of any special problems ● Prepares Immunization Report for submission to NC Immunization Branch ● Completes HIPAA Privacy and Security training for NCIR access ● Signs NCIR Confidentiality Agreement OCHD Staff ● Makes available immunization appointments within 1-3 business days of request ● Following successful completion of HIPAA Privacy and Security training and signing of NCIR Confidentiality Agreement, facilitates school nurses’ access to North Carolina Immunization Registry (NCIR) Principal/Designee ● Excludes any student from school who does not present documentation of immunizations that complies with G.S. 130A- 155 D. Public School Health Assessment Report Objective: To assist schools in complying with North Carolina G.S. 130A -440 and 130A-441. (NOTE: Children entering kindergarten for the first time must present an appropriately completed Health Assessment Transmittal Form (HATF) within the first 30 days of enrollment.) (Policy Number 4111, Kindergarten Health Assessment Policy) i. Record Review and Exclusion School ● Informs parent/guardian of requirements and have parent/guardian read and sign registration form acknowledging having been advised of requirement ● Informs parent/guardian of consequences of not completing HATF OCHD Staff ● Schedules appointments for Kindergarten Health Assessments ● Advises clinic manager if appointments slots are not available within the timeframe needed by the parent Principal OCHD Clinical Staff DocuSign Envelope ID: CEF0A315-C0D6-4618-8F2A-729FFE153BB6 4884-1724-9679, v. 1 ORANGE COUNTY SCHOOLS (OCS) PERSONNEL ORANGE COUNTY HEALTH DEPARTMENT (OCHD) PERSONNEL ● Excludes any student from school who does not present documentation of immunizations that complies with G.S. 130A- 440 ● Completes HATF accurately and completely School Nurse ● Reviews each cumulative folder/health folder for the presence of a completed HATF ● Informs parent/guardian when HATF is not present in cumulative folder/health folder or when mandatory components of the form are incompletely/incorrectly completed ● Keeps principal informed of students not in compliance ● Assists parents in obtaining kindergarten physicals as needed E. Health Assessment Transmittal Form (Grades K-12) Objective: To assist schools in complying with North Carolina G.S. 130A -440 (B). (NOTE: Children entering NC Public Schools for the first time must present an appropriately completed Health Assessment Transmittal Form within the first 30 days of enrollment.) School ● Informs parent/guardian of requirements and have parent/guardian read and sign registration form acknowledging having been advised of requirement ● Informs parent/guardian of consequences of not completing form OCHD Staff ● Schedules appointments for assessments ● Advises clinic manager if appointments slots are not available within the timeframe needed Principal ● Excludes any student from school who does not present a completed form in accord with G.S. 130A-440 (B). specifications OCHD Clinical Staff ● Completes form accurately and completely School Nurse ● Reviews each cumulative folder/health folder for the presence of a completed form ● Informs parent/guardian when form is not present in cumulative folder/health folder or when mandatory components of the form are incompletely/incorrectly completed ● Keeps principal informed of students not in compliance ● Assists parents in obtaining health assessments as needed F. Children with Special Health Care Needs Objective: To identify and coordinate management of health problems that may interfere with learning and comply with the State Board of Education Policy on “Special Health Care Services” (policy #GCS-G-006-.0402) i. Counseling and Consultation School ● Includes the nurse as a member of one or more of the following committees (504, SAT/STT, IEP team) where students may be identified and referred for nursing and other health care interventions ● Provides the nurse access to records of exceptional children when necessitated by a legitimate educational interest ● Services will be provided under Section 504 of Americans with Disabilities Act (ADA) School Nurse ● Serves as a member of either the 504, SAT/SST, or IEP committee(s) as appropriate. ● Provides counseling and consultation to parent/guardian and school personnel on health-related issues. ● Reviews the health records of exceptional children as indicated ● Assists in appropriate screening and referral for further evaluation as needed. ● Reviews and interprets findings with school personnel and discusses planned follow-up. ● Refers students to the EC/504 coordinators for evaluation if the nurse receives information regarding a potentially disabling medical condition ● Assists parent/guardian of children needing special health care in securing services. ● Develops an IHP (Individualized Health Plan)/EAP (Emergency Action Plan) for children with potentially life-threatening conditions, significant health problems as appropriate and any student needing a specialized medical procedure at school DocuSign Envelope ID: CEF0A315-C0D6-4618-8F2A-729FFE153BB6 4884-1724-9679, v. 1 ORANGE COUNTY SCHOOLS (OCS) PERSONNEL ORANGE COUNTY HEALTH DEPARTMENT (OCHD) PERSONNEL ● Guides school personnel in the implementation of the school system’s medication policy by: ▪ Providing training ▪ Supervising administration of medications ▪ Reviewing medication documentation for accuracy ▪ Documenting training in medication administration ● Provides and documents training, supervision and observation sessions for all specialized medical procedures and other procedures as indicated ii. Coordination of Care Principal ● Provides supplies and appropriately trained staff necessary to meet the health needs of students with special heath needs. ● Assures the availability of an area with adequate privacy for medical procedures to be performed on students with special health needs ● Assures agreement/consent among parents, nurse and medical providers for the delegation of specialized health care procedures to any unlicensed employee. Lead Nurse(s) ● Initiates a case management program for identified students through Professional Learning Community (PLC) groups School Nurse ● Serves on the committee specific to the school in which children are identified and referred for nursing and other health care interventions. ● Develops IHP/EAP in coordination with parents, medical provider, classroom teacher and others involved in the care of the student. ● Assesses unlicensed staff for potential to perform delegated health procedures. ● Trains eligible staff in aspects of student’s care and in any specialized medical procedures that may need to be performed during the school day. ● Monitors procedures being performed by unlicensed staff and documents quality of care at least annually. Retrains or assumes responsibility for performing specialized health procedures when unlicensed personnel’s performance is in question. Informs lead nurse immediately of problems. G. Management of Acute Health Problems Objective: To correct acute health problems that may interfere with a child’s performance in school i. Policy Development, Training and Nursing Care Plan Development a. Nuisance Diseases (such as lice, scabies, etc.) Principal ● Supports screening policies, referral and school re-entry criteria Teacher/Teacher’s Assistant ● Screens, refers and enforces criteria for re-entry according to school system guidelines ● Requests in-service on screening if needed School Nurse ● Instructs school personnel on the epidemiology and detection of nuisance diseases as requested and needed b. Emergency Administration of Epinephrine , Benadryl and Naloxone by Nurses Lead Nurse(s) ● Obtains annual medication authorizations for epinephrine, Benadryl and Naloxone from OCHD Medical Director. OCHD Medical Director ● Provides standing orders for Epinephrine, Benadryl, and Naloxone. ● Provide resources for procurement, training, and administration of Naloxone and other medications. School Nurse ● Administers Epinephrine and/or Benadryl to provide emergency medical aid to persons suffering from an anaphylactic reaction. DocuSign Envelope ID: CEF0A315-C0D6-4618-8F2A-729FFE153BB6 4884-1724-9679, v. 1 ORANGE COUNTY SCHOOLS (OCS) PERSONNEL ORANGE COUNTY HEALTH DEPARTMENT (OCHD) PERSONNEL ● Will maintain policy detailing naloxone procurement, storage, training, and administration ● Administers Naloxone to high school students to provide emergency medical aid to persons believed to be suffering from an opioid overdose. c. Medical and Dental Emergencies (Policy Number 4205: OCS First Aid and Emergency Care Policy) Principal ● Designates school staff to receive/maintain certification in First Aid/CPR/AED. ● Assures maintenance of emergency information on each student as provided by the parent. School Nurse ● Provides instruction in First Aid/CPR/AED to designated school staff/personnel at assigned school according to Red Cross requirements. ● Develops an EAP for those students with identified life- threatening medical conditions; shares with appropriate school staff (teacher, bus driver, etc.) ● Maintains a current copy of the student’s EAP in the Emergency Information Notebook accessible to school staff ● Provides in-service trainings for school staff as requested and as appropriate ● Assists parents/guardians in obtaining health care for students. School Nurse or Designated School Personnel ● Manages health-related emergencies ● Refers to parent/guardian/family/emergency facility as appropriate d. Emergency Equipment Proficiency Policy Number 6130 (Automated External Defibrillator) School System Administration ● Support maintenance and supply needs associated with AEDs at school sites as indicated OCHD Medical Director: Provides order for AED use by nurses Lead Nurse(s)/Designee ● Serves as liaison with OCS and Emergency Medical Services (EMS) ● Provides oversight to nurses as needed for battery/supply needs identified during monthly checks on units ● Coordinates follow-up activities after a use incident School Nurse ● Establishes proficiency with AEDs ● Provides training to designated staff annually H. Consultation Objective: To advise school personnel and students about school and child health. School Nurse ● Provides consultation and assistance in the area of health to school personnel according to the following priorities: ▪ Control of communicable disease ▪ Life endangering conditions ▪ Potentially handicapping conditions (including physical, psychological and socio-economic) ▪ Handling medical emergencies ▪ Environmental hazards ▪ Accident prevention ● Reviews students’ health concerns with teachers/staff on a “need-to-know” basis, in order to prevent/treat known medical conditions (including food-related conditions with cafeteria managers) ● Participates in faculty meetings to provide appropriate health information. ● Participates in health education sessions for parents ● Assists school personnel in planning health rooms and emergency supply kits DocuSign Envelope ID: CEF0A315-C0D6-4618-8F2A-729FFE153BB6 4884-1724-9679, v. 1 ORANGE COUNTY SCHOOLS (OCS) PERSONNEL ORANGE COUNTY HEALTH DEPARTMENT (OCHD) PERSONNEL ● Consults with OCHD, supplies information and acts as a resource regarding communicable disease management and follow-up ● Assists with and supports kindergarten registration ● Provides health counseling to students as individuals or groups upon request ● Reports to OCHD, occurrences that may pose a health risk (i.e., infectious disease, contamination, etc.). I. Referral and Follow-up Objective: To address health-related issues which may interfere with the student’s school performance School Staff ● Refers to nurse any child with a health issue or suspected health issue ● Notifies parent/guardian of suspected health issue as appropriate School Nurse ● Advises school personnel of appropriate health issues to refer to the nurse ● Notifies parent/guardian of any student identified as needing a referral. Assists parent/guardian in obtaining health care for the student. III. Administration of Medication Objective: To ensure that medication is administered safely at the school site. School Staff ▪ Follows medication guidelines as outlined in OCS Medication Policy (Number 6125) ▪ Completes initial training in medication administration and renew training annually OCHD Medical Director ● Provides authorization to administer vaccines and/or emergency medication to faculty/staff/students (Medications Authorized for Administration to Faculty/Staff/Students, Appendix I) ● Approves medication policies and procedures. School Nurse ● Reviews medication order for appropriateness: ● of dosage ● for condition ● for use in the school setting ● Notifies Lead Nurse/OCHD Medical Director of medication orders not meeting the above criteria ● Sets up documentation format to be used by school staff administering the medication ● Guides school staff in the implementation of the school system’s medication policy by: ▪ Providing and documenting medication training ▪ Supervising administration of medications ▪ Reviewing medication documentation for accuracy OCHD Medical Director ● Reviews and approves students’ medication orders for non-traditional or off-label uses for appropriateness of administration at the school site. IV. Health Education Objective: To support a comprehensive health education program to the school -aged child Lead Nurse/School Staff ● Consults with nurses who are requested to provide small group leadership and individual student health education on appropriateness of topic OCHD Staff ● Serves as a resource for school personnel in health education ● Provides, by teacher’s request, classroom instruction and small group leadership School Nurse ● Serves as a resource for school personnel in health education through assisting teachers in preparation and presentation of health education activities ● Provides small group leadership and individual student health education V. Communicable Disease Objective: To promote prevention and control of communicable diseases within the school system. (Policy Number 4230: Communicable Disease – Students and Policy Number 7262: Communicable Disease – Employees) i. Investigation and Control DocuSign Envelope ID: CEF0A315-C0D6-4618-8F2A-729FFE153BB6 4884-1724-9679, v. 1 ORANGE COUNTY SCHOOLS (OCS) PERSONNEL ORANGE COUNTY HEALTH DEPARTMENT (OCHD) PERSONNEL OCS Administrative Personnel ● Reports any unusual signs, symptoms or unusually high absentee rates of students and/or staff to the School Nurse immediately ● Makes available attendance records or other information needed for the investigation and/or follow-up of reportable communicable diseases to OCHD, in compliance with the privacy requirements of the Family Education Rights and Privacy Act (FERPA) and state law ● Jointly plans with OCHD for possible communicable disease occurrences ● Coordinates with OCHD for media-related events OCHD Nursing Administrative Liaison designee/OCHD Staff ● Leads investigation and/or follow-up of reportable communicable events ● Provides consultation for procedure development for communicable diseases in the schools ● Provides information to the media in conjunction with school administration regarding communicable events Lead Nurse(s)/Designee ● Assists OCHD staff in the investigation and follow-up of reportable communicable events ● Provides on-going coordination and follow-up to school administration and staff during communicable disease investigations and outbreaks ● Provides consultation to nurses, school staff, students and parents as indicated ● Assists in the development and implementation of procedures recommended or required by OCHD ● Serves as the primary point of contact with OCHD with regard to communicable disease control measures and any future delegations of authority from OCHD to OCS school nurses to issue quarantine or isolation orders on behalf of OCHD. OCHD Nursing Administrative Liaison designee/OCHD Staff ● Communicates with Lead Nurse(s)/Designee and directs school nurses’ follow-up activities during communicable disease investigations and outbreaks School Nurse ● Reports any unusual signs, symptoms or unusually high absentee rates of students and/or staff to the Lead Nurse(s)/Designee, school administration, and/or OCHD as indicated ● Assists Lead Nurse(s)/Designee and OCHD staff in the investigation and follow-up of reportable communicable events ● Provides appropriate follow-up to school administration and staff during communicable disease investigations and outbreaks ● Provides consultation to nurses, school staff, students and parents as indicated ● Implements appropriate control measures (including use of Personal Protective Equipment (PPE)) as indicated ● To the extent they are specifically authorized in writing to do so by OCHD in response to outbreaks of communicable diseases, issues quarantine or isolation orders to staff or students on behalf of OCHD. Principal ● Makes available student information (i.e. class lists, bus lists, etc.) as indicated ● Provides a confidential location with telephone access to OCHD/other OCS staff to use as needed ii. School Site Vaccine Administration (optional) Principal or Designee ● Assures a suitable location and necessary furniture/equipment for the provision of vaccinations. ● Assures distribution of immunization information and permission forms to parents/school personnel and assures collection of returned forms OCHD Liaison/OCHD Staff ● Provides Vaccine Information Statements (VIS) to schools. ● Provides vaccine, medical supplies and documentation supplies as needed. ● Assures data entry School Nurse ● Provides education, confirms parental consent and administers vaccines according to OCHD procedures and protocols and manufacturers’ guidelines. ● Completes and returns appropriate documentation to OCHD for data entry OCHD Nurse(s) ● Assists with immunization administration as needed ● Ensures maintenance of cold chain for all vaccines iii. OSHA Compliance Program DocuSign Envelope ID: CEF0A315-C0D6-4618-8F2A-729FFE153BB6 4884-1724-9679, v. 1 ORANGE COUNTY SCHOOLS (OCS) PERSONNEL ORANGE COUNTY HEALTH DEPARTMENT (OCHD) PERSONNEL Lead Nurse(s)/Designee ● Works with OCS administrative staff to ensure employees identified by OCS Exposure Control Plan as at-risk for blood- borne pathogens exposure receive Hepatitis B vaccine ● Consults with Medical Director as indicated OCHD Liaison’ ● Coordinates availability of OSHA-required vaccines for OCS staff through OCHD clinics and billing of OCS for required services OCHD Medical Director/Liaison ● Provides direction to Lead Nurse(s)/designee for OSHA-related issues VI. Environmental Health Objective: To assure that the physical facilities and food handling practices do not endanger the health of students, teachers and other school staff, or others using the premises. OCHD Environmental Health Specialist ● Inspects the cafeteria and food handling practices in each school according to State criteria ● Inspects the school building for appropriate construction of existing structures and general sanitation, with emphasis on restrooms and hand-washing supplies, according to State criteria. ● Be available for counseling in the event that there is suspected mold, that the school air quality is at risk or other related concerns. VII. Substance Abuse Prevention/Intervention Objective: To promote the reduction of substance use. School Staff ● Provides prevention /intervention education and counseling services to students as indicated ● Refers for additional services as indicated OCHD Staff ● Facilitates the implementation of prevention/intervention education activities at the middle and/or high school levels School Nurse ● Provides prevention /intervention education and counseling services to students as indicated ● Refers for additional services as indicated VIII. Adolescent Sexuality Objectives: ● To ensure medically accurate, comprehensive sexual and reproductive health information is promoted. ● To promote compliance with a chosen birth control method ● To provide nonjudgmental information on adolescent sexuality issues, including LGBTQI issues ● To enhance prevention, treatment and follow-up compliance for sexually transmitted diseases (STDs) in the adolescent population, ● To promote HPV vaccine for teens; ● To serve as a resource for information to aid in the promotion of healthy, responsible decisions regarding sexual heal th Family Planning N.C.G.S. 115C-81.30 and OCS Board Policy 1310 require written parental consent before the provision of information to students regarding where to obtain abortion services or contraceptives School Staff ● Refers students who may be in need of family planning counseling to the school nurse School Nurse ● Provides family planning counseling and education to referred students, only consistent with state law and local board policy. ● Refers for health care services as needed. ii. Sexually Transmitted Diseases (STDs) School Staff OCHD Staff ▪ Refers to School Nurse as indicated DocuSign Envelope ID: CEF0A315-C0D6-4618-8F2A-729FFE153BB6 4884-1724-9679, v. 1 ORANGE COUNTY SCHOOLS (OCS) PERSONNEL ORANGE COUNTY HEALTH DEPARTMENT (OCHD) PERSONNEL ● Refers students who may be in need of STD services to the nurse School Nurse Consistent with state law and local board policy regarding parental consent: ● Provides follow-up to students referred from OCHD clinics ● Counsels and refers students with a suspected STD IX. Maternal Health Objective: To provide support services to the pregnant and parenting teen mother and father. School Nurse ● Provides one-on-one counseling and education to pregnant and parenting teens ● Collaborates with school support staff to assure availability of needed educational and support services OCHD Staff ▪ Refers pregnant and parenting teens to School Nurse as indicated School Staff ● Identifies and refers to the nurse those teens in need of pregnancy/parenting counseling. X. Pre-K and Head Start Programs (for 3 and 4 year olds) Objective: Coordinate to identify and refer health problems that may interfere with the child’s readiness level for school entry Lead Nurse(s)/Designee ● Provides coordination for nursing services to students/staff in the above daycare-regulated programs. School Nurse ● Assists with immunization compliance with North Carolina General Statutes ● Coordinates and/or provides vision screenings for students and refers positives for evaluation ● Reviews health information and consults with staff/parents as necessary ● Develops EAPs/IHPs as indicated ● Oversees medication administration per OCS Medication Policy ● Provides CPR/AED/First Aid (required), Medication Administration (as indicated) and other trainings to staff XI. Extended Day / Summer Programs Orange County School Programs (Read to Achieve, Extended School Year for EC Population, High Schools’ Credit Recovery, Summer School) (not athletics and clubs) Objective: To coordinate management of health issues in OCS-managed programs Lead Nurse(s) ● Consult with school administration to ensure appropriate coverage ● Ensures that program staff are provided with training in medication administration, CPR/AED/First Aid, diabetic care and management ● Provides consultation to staff School Nurse(s) ● Provide medical information to program staff, upon request, on attendees ● Ensure access to PPE for first aid purposes Program Staff ● Advise parents of need to provide medication to program ● Collect health information on attendees ● Consult with Lead Nurse/School Nurse regarding medical needs of attendees Community Schools Programs (Afterschool and Summer Camps) Objective: To provide training and support regarding medical issues within FERPA guidelines Lead Nurse(s) DocuSign Envelope ID: CEF0A315-C0D6-4618-8F2A-729FFE153BB6 4884-1724-9679, v. 1 ORANGE COUNTY SCHOOLS (OCS) PERSONNEL ORANGE COUNTY HEALTH DEPARTMENT (OCHD) PERSONNEL ● Coordinates training in medication administration, CPR/AED/First Aid, diabetic care and management to program staff School Nurse(s) ● Share medical information with program staff per written parental consent Program Staff ● Obtain PPE and first aid supplies ● Collect health information on attendees including authorizations for medications and special procedures ● Obtain authorized medication and needed medical supplies from parents. XII. UNC Nursing Students Objective: To provide on-site Community Health experience for a bachelor’s or master’s-level nursing student. OCS Administrative Personnel ● Receives and maintains criminal background checks, OSHA training from UNC School of Nursing for all students ● Receives request for school nurse preceptor from UNC nursing instructor ● Coordinates placements of nursing students with Lead Nurse(s) Lead Nurse(s)/Designee ● Determines appropriateness of nurses interested in serving as preceptors to UNC students ● Coordinates placements of nursing students with OCS Administrative Personnel School Nurse ● Orients UNC student to facility-specific OCS Bloodborne Pathogen Control Plan within the first 2 weeks of assignment ● Orients UNC student to OCS nurse’s roles and responsibilities ● Instructs UNC student on appropriate nursing duties ● Supervises all nursing activities with students XIII. Emergency Response Objective: To assist the OCHD in response to emergency situations in the community that will impact OCS students and their families by assuring staffing of emergency shelters and other sites designated for emergency services in times of community crisis/disaster. i. Staffing In times of community crisis/disaster, the OCHD may be involved in or leading the public health response. During those times , demand for nurses may exceed capabilities of the OCHD staff and volunteer nurses. School nurses may be needed to supplement the roles and functions of the Health Department nursing staff. Emergency shelters are established when local emergency management officials have identified a disaster and determine there is a need for sheltering displaced individuals in predetermined shelter locations. If necessary and with the approval of the OCS Superintendent or Board of Education, OCHD nurses will staff shelters for 72 to 96 hours until the American Red Cross (ARC) Disaster Services can assume control and management of shelters. Since OCHD has limited nursing personnel to staff emergency shelters, OCS nurses will supplement the roles and functions of OCHD nurses during the first 72 to 96 hours until ARC can assume staffing and management OCS nurses will continue to assist with staffing if ARC is not able to provide sufficient staffing. Crisis or disaster responses may be indicated for unanticipated reasons. A wides pread communicable disease exposure necessitating urgent prophylaxis/treatment of large numbers of citizens or a biological, chemical or nuclear terrorist event are examples of such crises. Lead Nurse(s) ● Maintains a current roster of school nurses including contact information. ● Implements a call-in system among school nurses during potential emergencies. ● Arranges for the provision of school nurses to relieve OCHD nursing staff in shelters during disasters. ● Coordinates with OCS administrative personnel to provide for compensatory time for time worked ● Arranges for the provision of school nurses to assist in a crisis or disaster response. OCHD Staff ● Assigns nursing staff to shelters when they are declared open to the public. ● Assigns OCHD nurses as the primary shelter staff ● Assigns two nurses to each shelter. Initial assignment may be up to 72-96 hours depending upon prevailing conditions, with each nurse alternating duty every 12 hours. DocuSign Envelope ID: CEF0A315-C0D6-4618-8F2A-729FFE153BB6 4884-1724-9679, v. 1 ORANGE COUNTY SCHOOLS (OCS) PERSONNEL ORANGE COUNTY HEALTH DEPARTMENT (OCHD) PERSONNEL ● Maintains a current list of available nurses on file with OCHD with current licensure and CPR certification. ● Notifies the Nursing Director of any changes in availability of staff due to long-term illness, termination, etc. ● Assures school nurses attend shelter training and crisis/disaster training as arranged by OCHD, including ICS 100, ICS 200 and NIMS 700. ▪ As circumstances allow, pairs of OCHD nurses will be assigned on a rotating basis for 8-12 hour shifts until all available staff have been exhausted. ● Assigns nurses to respond to a widespread crisis or disaster utilizing OCHD nurses first. ● Arranges for training of staff regarding disaster shelter responsibilities and crisis/disaster response, including ICS 100, ICS 200 and NIMS 700. ii. Respiratory Protection School Nurse ● Follows OCHD Respiratory Protection Plan ● Nurses and other at-risk staff complete initial Medical Evaluation Questionnaire and thereafter as needed based on changes in medical condition ● Nurses and other at-risk staff complete Respiratory Protection Training via OCHD’s FlexTraining web-based training software ● Nurses and other at-risk staff coordinate N95 respirator fit testing with OCHD Preparedness Coordinator ● OCS maintains supply of N95 respirators based on N95 respirator to which nurses and other at-risk staff were fitted ● Will supply alternative respiratory protection devices, such as PAPR, in the event someone cannot be fit-tested to an N95 respirator. ● Participates in annual respiratory protection training and N95 fit testing OCHD Staff ● Provides current copy of OCHD Respiratory Protection Plan ● Provides medical evaluation questionnaire to be completed and returned ● Enrolls OCS nurses and other at-risk staff in respiratory protection training ● Performs N95 respirator fit-testing and supplies two (2) N95 respirators to each OCS staff fit-tested annually. XIV. Records and Reports Objective: To document health services as required by federal, state and local guidelines, and to maintain appropriate healt h information. School Nurse ● Maintains the Permanent Health Record folder (salmon-colored) in a secure location with restricted access in a manner consistent with the Family Educational Rights and Privacy Act (FERPA) ● Maintains in the Permanent Health Record folder documentation of ▪ The child’s health status at the time of school enrollment or transfer, including immunizations ▪ Health Assessment Transmittal Form ▪ Results of medical evaluations/nursing assessments. ▪ Teacher/nurse referrals for health care, as appropriate ▪ Referrals to providers of health care, as appropriate, ▪ Results of services rendered by referral source, and a plan for continuity of care, if indicated ▪ authorization form(s) for the administration of medications, signed by the physician and parent/guardian ▪ Documentation of parent/guardian health-related conferences or contacts, as appropriate ▪ Evidence of mutual planning for health care needs ● Maintain each student’s Permanent Health Record card/folder in a manner consistent with FERPA in the student’s cumulative file ● Maintains each student’s Permanent Health Record card/folder in the student’s cumulative file documentation of: ● Immunizations ● Screenings/referral results ● Emergency/urgent health conditions ● Other health information (non-sensitive), as necessary Following successful completion of HIPAA Privacy and Security training, provides view access to NCIR. Principal ● Ensures that the health record of all new and transfer students into the school shall be made available to the school nurse as soon as available DocuSign Envelope ID: CEF0A315-C0D6-4618-8F2A-729FFE153BB6 4884-1724-9679, v. 1 ORANGE COUNTY SCHOOLS (OCS) PERSONNEL ORANGE COUNTY HEALTH DEPARTMENT (OCHD) PERSONNEL ● Ensures confidentiality of health information XV. XV. Professional Development Objective: To assume responsibility for continuing education and professional development and to contribute to the professio nal growth of others. Principal ● Supports the School Nurse in obtaining continuing education credits required for re-licensure and national board certification renewal OCHD Nursing Administrative Liaison designee/OCHD Staff ● Coordinates and/or notifies school nurses of educational/workshop opportunities School Nurse ● Assumes responsibility for pursuing continuing education required for licensure and school nurse certification renewal ● Participates in continuing education programs to increase knowledge and enhance skills ● Implement recommendations for change resulting from evaluation and review Lead Nurse(s) ● Evaluate the practice of each school nurse annually XVI. Confidentiality Objective: To maintain the confidentiality of health and medical information for individual students Lead Nurse(s) ● Provides signed copies of “Orange County Health Department - Annual Confidentiality Statement” to OCHD Nursing Administrative Liaison Personnel for each OCS-employed school nurse OCHD Nursing Administrative Liaison designee ● Maintains original “Orange County Health Department - Annual Confidentiality Statement” signed by school nurses School Nurse ● Reviews and signs the OCHD “Orange County Health Department - Annual Confidentiality Statement” upon employment and annually (Appendix II) ● Takes appropriate measures to protect confidential information shared for the purpose of providing care to students School Staff ● Takes appropriate measures to protect confidential information shared for the purpose of providing care to students This Memorandum of Agreement, 2023-2024, has been reviewed and approved. ____________________________________ ______________________ Quintana Stewart, MPA Date Orange County Health Department Health Director ____________________________________ ______________________ Erica Pettigrew, MD, JD, MPH Date Orange County Health Department Medical Director ____________________________________ ______________________ Dr. James Merrill Date Orange County Schools Interim Superintendent DocuSign Envelope ID: CEF0A315-C0D6-4618-8F2A-729FFE153BB6 1/30/2024 1/16/2024 1/10/2024 4884-1724-9679, v. 1 ____________________________________ ______________________ Sylvia Compton, R.N., B.S.N, N.C.S.N. Date Orange County Schools District Lead Nurse DocuSign Envelope ID: CEF0A315-C0D6-4618-8F2A-729FFE153BB6 1/11/2024 4884-1724-9679, v. 1 Appendix I MEDICATIONS AUTHORIZED FOR ADMINISTRATION TO FACULTY/STAFF/STUDENTS/VOLUNTEERS OCHD has issued standing orders for the following medications to be administered as indicated below by OCS school nurses: 1. Hepatitis A vaccine (for staff use upon request) Administer per OCHD protocol according to manufacturer’s guidelines. 2. Hepatitis B vaccine series (for staff use upon request and for student use, with written or documented parental consent) Administer per OCHD protocol according to manufacturer’s guidelines. 3. Hepatitis A/Hepatitis B Combination Vaccine (for staff use upon request) Administer per OCHD protocol and according to manufacturer’s guidelines. 4. Influenza virus vaccine – Trivalent/quadrivalent (for staff/immediate family use - adult & child – upon request, with written or documented parental consent for administration to minors) Administer per OCHD protocol according to manufacturer’s guidelines. 5. Meningococcal vaccine (for student use, with written or documented parental consent) Administer per OCHD protocol and according to manufacturer’s guidelines. 6. Epi-pen - Junior and Regular strengths (for faculty/staff/student use in an emergency). Administer per NC Senate Bill 744, Appropriations Act of 2014, Section 8.23 Supply… EPI -Pen protocol according to manufacturer’s guidelines 7. Epinephrine 1:1000 (for faculty/staff/student use in an emergency). Administer per OCHD protocol according to manufacturer’s guidelines and OCHD’s emergency procedures 8. Narcan (naloxone HCL) Nasal Spray, 4 mg (for staff/student/visitor use in emergency) for suspected opioid overdose, administer according per OCHD protocol according to manufacturer’s guidelines and OCHD’s emergency procedures. (Current information on naloxone can be found at Community Distribution of Naloxone | Naloxone Saves) a. (Note: If OCS wishes to stock this emergency medication in schools, OCS will adopt written procedures detailing naloxone procurement, storage, training, and administration .) 7. Diphenhydramine (Benadryl) Elixir (12.5 mg per 5 ml) (for student use to the extent authorized under G.S. 115C-375.1) Administer per OCHD protocol according to manufacturer’s guidelines and OCHD’s emergency procedures. 8. Diphenhydramine (Benadryl) Capsules (25 mg. per capsule) (for staff/ use upon request and for student use to the extent authorized under G.S. 115C-375.1) Administer per OCHD protocol according to manufacturer’s guidelines and OCHD’s emergency procedures. 9. Human Papillomavirus (HPV) vaccine (for staff use upon request and for student use with written or documented parental consent) Administer per OCHD protocol according to manufacturer’s guidelines. 10. Tetanus/Diphtheria/Pertussis vaccine (Tdap) (adolescent/adult formulation) (for staff use upon request and for student use with written or documented parental consent). Administer per OCHD protocol and according to manufacturer’s guidelines. 11. Varicella (Chickenpox) Vaccine (for student use with written or documented parental consent) Administer per OCHD protocol according to manufacturer’s guidelines. 12. Hydrocortisone cream 1% (for staff/student use) (for first aid procedures to the extent authorized by G.S. 115C-375.1) 13. Anti-itch lotion/gel (i.e., Calergy, Calagel, Calamine, etc.) [for staff use upon request and for student use to the extent authorized under G.S. 115C-375.1] DocuSign Envelope ID: CEF0A315-C0D6-4618-8F2A-729FFE153BB6 4884-1724-9679, v. 1 14. Antibiotic ointment/cream (i.e., Polysporin, generic triple antibiotic ointment/cream) [for staff use upon request and for student use to the extent authorized under G.S. 115C-375.1] DocuSign Envelope ID: CEF0A315-C0D6-4618-8F2A-729FFE153BB6 4884-1724-9679, v. 1 Appendix II ORANGE COUNTY HEALTH DEPARTMENT Employee Conditions of Employment Statement Confidentiality I acknowledge that, in my role as a school nurse employed by the Orange County Board of Education I may have access to information that is confidential as mandated by state and federal law, including but not limited to the Federal Educational Rights and Privacy Act (FERPA), the Health Insurance Portability and Accountability Act (HIPAA), and Orange County Schools and/or Orange County Health Department policies. I recognize my legal obligation to maintain the confidentiality of information that is protected under those laws or policies. I agree to preserve the security of computer access by unauthorized persons by not storing information about my computer access code in any place that might be accessible to such persons. I understand that release of information determined to be confidential by law to unauthorized persons may result in civil or criminal liability. I further understand that the failure to maintain legally required confidentiality of information may lead to disciplinary action by Orange County Schools and/or restrictions on or removal of my affiliation with the Orange County Health Department for purposes of receiving medical oversight and direction from the Orange County Health Department Medical Director . If a question arises regarding whether a release of information may be public record vs. confidential information, I will seek assistance from my supervisor. Title X Information Requirement To the extent applicable, I agree to comply with all requirements of Title X of the public Health Service Act, 42 U.S.C. 300 to 300a-6. Public Health Activities Outside of Normal Working Hours In order to fulfill the responsibilities of the department in emergency situations or in training, I understand that I may be asked to work outside the regular work schedule at emergency shelters or other locations designated by the health director or emergency operations and agree to do so if approved by the Orange County Schools’ Superintendent or designee. I certify that I have read and understand the conditions stated above. I have had an opportunity to discuss the conditions and requirements of my position with my supervisor or designated agency representative. School Employee Signature: ______________________________ Date: __________________ Agency Representative: ____________________________ Date: __________________ DocuSign Envelope ID: CEF0A315-C0D6-4618-8F2A-729FFE153BB6