Missy Walztoni, BSN, RN


319.827.1700 option 6


FAX (319)827-3905

Hours during school: 7:30 AM – 3:30 PM

From the Desk of the School Nurse

Students with certain health concerns are required to have current health forms on file to meet their needs at school. Health forms must be renewed each school year. The following are common school health concerns:

  • Medication Administration at School
  • Asthma (especially with inhaler and/or nebulizer use)
  • Allergies
  • Food Allergies and Anaphylaxis (allergies that require Epi-pens)
  • Seizures
  • Diabetes
  • Health Concerns that may require an Emergency Action Plan (bleeding disorders, etc.)

  • The required health forms are listed below. Please notify the health office if your child is diagnosed with a new health condition or no longer has a health condition. If you have any questions regarding these requirements, please contact the school nurse at 319-827-1700 ext: 1105.

    ATTENTION: Emergency contact information is important to include when registering your student each year. Please ensure that you provide emergency contacts that can respond to school in a timely manner in the event we are unable to reach you and your student becomes ill or injured at school. Please notify the building secretary with any changes to contact information during the school year.

    Guidelines for Medications Distributed in Schools

    We recognize some students may need prescription and non-prescription medication at school. Please see the following guidelines if medications are required to be given at school to ensure the safety and correct administration:

    • Medications may not be administered until the student’s parent or guardian provides a signed and dated medication authorization form
    • Students who plan to carry an inhaler or EPI pen to self-administer must have a consent on file signed by a parent and healthcare provider. self carry authorization form
    • Authorization forms must be completed each school year.
    • The school nurse must be notified immediately if any changes are made to medication, dosage, and/or administration instructions and a new authorization form must be completed as soon as possible.
    • Medications must come to school in the original, labeled container as dispensed or the manufacturer’s labeled container.
      • Prescription Medication: a pharmacy labeled container may serve as the written prescriber’s order. Pharmacies will provide, at no cost, a second labeled bottle for school use.
      • Over the counter/nonprescription medication: must be sent to school in the original medication container with the students’ name attached.
    • To ensure the safety of all children, we request that a parent or responsible adult deliver medications to the nurse’s office when possible. If your child brings the medication to school, please place the labeled medication bottle in a sealed envelope with the number of tablets/capsules that are enclosed written on the outside of the envelope.
    • The first dosage of any new prescription should be given at home so the child can be more closely observed for possible side effects.
    • Students should not carry medication or keep it in their possession unless they have authorization on file to self-carry or administer.
    • Medication may only be given by the school nurse or school personnel who have completed a medication administration course.
    • By law, school nurses are not allowed to administer homeopathic or non-FDA approved medication.
    • Please notify the school nurse how any unused medication at the end of the school year will be picked up.

    Required Forms for Asthma

    Asthma Action Plan
    An asthma action plan gives personalized instructions on how to manage asthma at school. This plan is developed and signed by the physician and parent.  It is renewed at the beginning of each school year or as needed if changes are made during the school year.

    Medication Consent
    Please bring your child’s asthma medications to school with the asthma action plan and a Jesup School Medication Consent on the first day of school.  This consent must be signed by a parent and renewed yearly for any medication to be stored and given by the school nurse. Medication must be dropped off with prescription information noted on it.  Unlabeled inhalers without prescribing information will not be accepted due to safety reasons.

    Self-Administration Consent
    Students are able to self-carry and self-administer inhalers. If your child plans to do this, a self-carry inhaler form must be submitted to the school nurse.  This is required to be signed by the doctor and parent yearly.

    Required Forms for Food Allergies

    We are committed to providing a safe educational environment for food-allergic students so that exposure to food allergens are minimized for affected students.  Our school is nut aware, not nut free.  Please notify the school nurse and classroom teacher if your child has food allergies so we can make accommodations as necessary.

    Diet Modification Request Form
    This form is required before we can provide your student with anything other than the standard meal and also before we can omit/ eliminate items from their meal. It must be signed by a physician or chiropractor. Please ensure both pages of the form are completed and as detailed as possible. For example, if your student cannot have milk, we need to know if they cannot have milk to drink or if they cannot have any milk or dairy in their diet. Or if they cannot have eggs, we need to know if it is just hard boiled eggs, or if eggs cooked in products are allowed. This form is valid for a lifetime or until a physician submits documentation in writing to discontinue the diet.

    Food Allergy & Anaphylaxis Emergency Care Plan
    his care plan contains critical information on how to manage your child’s allergies. It must be signed by a physician and renewed every school year.

    Epinephrine Auto-Injector Self Administration Consent Form
    If student will self-carry Epinephrine and can self-administer injection, a consent must be signed by a physician and renewed each school year.

    Medication Consent If your student will keep their Epi pen in the nurse’s office to be given by school nurse or other trained school personal, a medication consent will need to be signed by the parent each school year.

    Required Forms for Seizures

    Seizure Action Plan
    Seizure Action Plans are an important tool that help parents and schools partner to keep children safe and healthy during the school day. It includes information on first aid and medications required specifically for your child in the event of a seizure. This form must be signed by the parent and the physician. It will be renewed each school year.

    Medication Consent
    For seizure medication that will be kept in the school nurse’s office or near the student, we need to have a medication consent signed by the parent each school year.

    Special Services

    Vision screening is performed by the school nurse on third graders and those referred by a teacher.  The local Lions Club will perform a vision screening on grades preschool through kindergarten at the beginning of the school year if parental consent is obtained.  If you have concerns about your child’s vision, please contact the school nurse to request a vision screening.

    Hearing screening is provided for children in grades PK-2 & 8th by AEA267. The screening is usually done in the fall. Audiograms are run on children with known losses regardless of grade. If you have concerns about your child’s hearing, please contact the school nurse and request a hearing screening.

    Speech services are provided through the AEA267. If you have questions, contact the principal at school. A school social worker, educational strategist, and school psychologist are employed by the Area Education Agency and are each at the Jesup Community School each week. If you feel your child would benefit from their services, contact the principal.

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