Documents/Forms

Publications

• Addressing the Needs of the Whole Child: Social, Emotional, Behavioral, and Physical Health, as well as Academic Achievement in Connecticut's SRBI Process (Topical Brief 3)
• Antiepileptic Medication Administration Training Program
  • Diastat Child Administration and Q & A Sheet
  • Diastat Inspection Instructions
  • Sample Seizure Action Plan
  • Anti-epileptic Medication Administration Training Program for Connecticut’s Unlicensed School Personnel
  • Anti-epileptic Medication Administration Training Program for Connecticut’s Unlicensed School Personnel: Trainer Notes
• Bed Bug Guide for Connecticut Schools (Connecticut Coalition Against Bed Bugs)
• Clinical Procedure Guidelines for Connecticut School Nurses (CSDE)
• Concussion Education Plan and Guidelines for Connecticut Schools (CSDE)
• Connecticut School Health Survey (DPH)
• Diabetes
  • CSDE Diabetes Form June 2019
  • CSDE DPH Diabetes Guidance June 2019
  • Guidelines for Blood Glucose Self-Monitoring in School (CSDE)
  • Learning and Diabetes: A Resource Guide for Connecticut Schools and Families (CSDE)
• Education Guidelines for the Prevention and Management of Lead Poisoning in Children (CSDE)
• Emergency First Aid for Students Who Experience Allergic Reactions
  • Annual Epinephrine Administration Training Program for Connecticut’s Unlicensed School Personnel
  • Annual Epinephrine Administration Training Program for Connecticut’s Unlicensed School Personnel: Trainer Notes
  • Annual Epinephrine Administration Training Program for Connecticut’s Unlicensed School Personnel: Trainer Guide 
  • Annual Epinephrine Administration Training Program for Connecticut’s Unlicensed School Personnel: Trainer Guide 
• Field Trips: Guidance for School Nurses (CSDE)
• Guidelines for a Coordinated Approach to School Health (CSDE)
• Guidelines for Cumulative Health Records
• Guidelines for Excused and Unexcused Absences and Best Practices for Absence Prevention and Intervention
• Guidelines for Health Screenings: Vision, Hearing and Scoliosis
• Guidelines for Managing Life-Threatening Food Allergies in Connecticut Schools (Includes Guidelines for Managing Glycogen Storage Disease) (CSDE)
  
• Guidelines for the Sexual Health Education Component of Comprehensive Health Education (CSDE)
• Helping Our Children: Supporting their Mental Health
• Immunization Guidance: Revised April 4, 2023 (CSDE)
• Linking Lead and Education Data in Connecticut
  • The Impact of Early Childhood Lead Exposure on Educational Test Performance among Connecticut Schoolchildren: Phase I Report
  • The Impact of Early Childhood Lead Exposure on Educational Test Performance among Connecticut Schoolchildren: Phase II Report
• Meningococcal Vaccine Information
• Naloxone
  • Naloxone Guidelines (C.G.S. Section 10-212a(g)
  • Naloxone Training Program
• Poison Control School Nurse Poster (University of Connecticut Health Center)
• School Nurse Competencies
  • Competency in School Nurse Practice (Second Edition)
  • School Nurse Competencies Self-Evaluation Tool
  • School Nurse Competencies Evaluation Summary
• Suggested Recommendations for School Medical Advisors
• Supports for Students Displaced by Disasters
• The Nurse's Office: Cleaning the Safe and Healthy Way
• Tuberculosis Risk Assessment and User Guide

Forms

• Asthma Action Plan (Samples)
  • Asthma Action Plan & School Medication Authorization
  • Asthma Medication Authorization and Asthma Action Plan
• CSDE Diabetes Form June 2019
• Health Assessment Form 2022    
• Early Childhood Health Assessment Form 2022   Please print on yellow paper
• Healthcare Provider’s Certification of In Process Required School Immunizations
• HUSKY School Form (English)
• HUSKY School Form (Spanish)
• Immunization Requirements
• Individualized Health Care Plan
• Individualized Health Care Plan
• Medical Exemption Certification Statement (DPH)
• Sample HIPPA Form
• Sample HIPPA Form
• Sample Medication Authorization Form: Authorization for the Administration of Medication by School, Child Care, and Youth Camp Personnel