702 KAR 1:160. School health services.
RELATES TO: KRS 156.160(1)(h), (i), (j),
156.501, 156.502, 158.035, 158.160, 158.838, 161.145, 214.034, 214.036, 29
C.F.R. 1910.1030
STATUTORY AUTHORITY: KRS 156.070,
156.160(1)
NECESSITY, FUNCTION, AND CONFORMITY: KRS
156.070(1) requires the Kentucky Board of Education to manage and control all
the common schools and all programs operated in these schools. KRS
156.160(1)(h) requires the board to promulgate administrative regulations
governing medical inspection, physical and health education and recreation, and
other administrative regulations necessary or advisable for the protection of
the physical welfare and safety of the public school children. KRS
156.160(1)(i) and (j) require the board to promulgate administrative
regulations governing a required vision examination and a dental screening or examination.
This administrative regulation establishes criteria for preventive student health
care examinations at the local school district level.
Section 1. School Employee Medical
Examinations. (1) Except as provided in subsection (2) of this section, a local
board of education shall require a medical examination of each certified or
classified employee, including each substitute teacher. The medical examination
shall:
(a) Be conducted prior to initial
employment; and
(b) Include a tuberculosis (TB) risk
assessment.
1. If the individual is identified by
that assessment as being at high risk for TB, the individual shall be required
to undergo the administration of a tuberculin skin test (TST) or a blood test
for Mycobacterium tuberculosis (BAMT).
2. The TB risk assessment shall be
performed and reported by a physician, an advanced practice registered nurse, a
physician’s assistant, or a registered nurse.
(2) The medical examination requirement
shall not apply to school bus drivers who are covered by 702 KAR 5:080.
(3) A local board of education may
require by policy that a school employee physical examination be conducted no
earlier than a ninety (90) day period prior to initial employment.
(4) A medical examination shall be
reported on the form Medical Examination of School Employees, KDESHS001, or an
electronic medical record that includes all of the data equivalent to that on
the Medical Examination of School Employees form.
(5) A person who tests positive for TB
shall be required to comply with the directives of the local board of health
and the Kentucky Department for Public Health for further evaluation and
treatment of the TB infection.
(6)(a) Following the required medical
examination for initial employment and any subsequent examinations as may be
required for positive tuberculin reactors, a school district employee other
than a bus driver shall submit to the local school superintendent the completed
Medical Examination of School Employees form or an electronic medical record
that includes all of the data equivalent to that on the Medical Examination of
School Employees form required by subsection (4) of this section.
(b) The medical examination shall be performed
and signed for by a physician, physician's assistant, or an advanced practice
registered nurse. Transmission of an electronic medical record to the school
district via email from the health care provider’s office may be accepted as
the official signature.
(7) Documentation of a TST, BAMT, and
chest x-ray, if performed, shall include:
(a) The date given;
(b) Type of test;
(c) Millimeters of induration;
(d) Date read and by whom; and
(e) Date x-ray taken and results as
related to TB status.
(8)(a)1. A local board of education shall
require all school personnel exhibiting symptoms of chronic respiratory disease
to undergo a TB risk assessment and examinations as indicated.
2. The evaluation and any recommended
treatment for TB infection shall be based upon the directives of the local
board of health and the Kentucky Department for Public Health.
(b) An employee exposed to infectious TB
shall be tested and, if necessary, treated for TB infection according to the
directives of the local board of health.
(c) The school district shall require
school district employees to undergo more extensive testing for TB if:
1. The number of active TB cases in the
county is equal to or greater than the national average, as established by the
Department for Public Health, Division of Epidemiology and Health Planning,
Tuberculosis Prevention and Control Program; and
2. The local board of health, with the
approval of the Kentucky Department for Public Health, requires more extensive
testing for TB of school district employees.
Section 2. Preventive Student Health Care
Examinations. (1)(a) A local board of education shall require a preventive
health care examination for students within one (1) year prior to initial entry
to school.
(b) A second examination shall be
required within one (1) year prior to entry into the sixth grade.
(c) A third examination may be required
by policy of the local board of education within one (1) year prior to entry
into the ninth grade.
(2) An out-of-state transfer student
shall be required to submit documentation of a preventive health care examination.
(3) A local board of education may extend
the deadline by which to obtain a preventive student health care examination,
not to exceed two (2) months.
(4) A preventive student health care
examination shall be performed and signed for by a physician, an advanced
practice registered nurse, a physician's assistant, or by a health care
provider in the early periodic screening diagnosis and treatment programs.
Transmission of an electronic medical record to the school district via email
from the health care provider’s office may be accepted as the official
signature.
(5) A preventive student health care
examination shall be reported on the Preventive Student Health Care Examination
Form, KDESHS002, or an electronic medical record that includes all of the data
equivalent to that on the Preventive Student Health Care Examination Form, and
shall include:
(a) A medical history;
(b) An assessment of growth and
development and general appearance;
(c) A physical assessment including
hearing and vision screening; and
(d) Recommendations to the school
regarding health problems that may require special attention in classroom or
physical education activities.
(6)(a) A vision examination shall be
reported on the form, Kentucky Eye Examination Form for School Entry,
KDESHS004, or other electronic medical record that includes all of the data
equivalent to that on the Kentucky Eye Examination Form for School Entry.
(b) A dental screening or examination
shall be reported on the form, Kentucky Dental Screening/Examination Form for
School Entry, KDESHS005, or other electronic medical record that includes all
of the data equivalent to that on the Kentucky Dental Screening/Examination
Form for School Entry.
(7) A local school district shall
establish a plan for implementation and compliance required for the sixth grade
preventive student health care examination.
(8) A current Immunization Certificate,
EPID-230, incorporated by reference into 902 KAR 2:060, or an immunization
certificate meeting the requirements of 902 KAR 2:060, Section 4, shall be on
file within two (2) weeks of the child's enrollment in school.
(9) (a) A board of education shall adopt
a program of continuous health supervision for all currently enrolled students.
(b) Supervision shall include scheduled
screening tests for vision and hearing.
(10) A school shall have emergency care
procedures, which shall include:
(a) First aid facilities meeting the
requirements of 702 KAR 4:170, including provisions for designated areas for
the child to recline;
(b) A requirement that whenever children
are present during school hours, there shall be at least one (1) adult present
in the school who is certified in a standard first aid course which includes
CPR for infants and children;
(c) A requirement that, at all times when
enrolled students, for whom documentation under KRS 158.838(2) or (7) has been
provided to the school, are present during school hours or participating in
school-related activities, there is a school employee who is trained to
administer and can administer or assist with the self-administration of
glucagon, insulin, or seizure rescue medications. A student shall be permitted
to conduct the actions and possess the supplies and equipment described in KRS
158.838(7) at school-related activities regardless of whether the student is a
participant or mere observer of the school-related activity;
(d) A number at which parents can be
reached; and
(e) The name of a family physician.
Section 3. Cumulative Health Records. (1)
A school shall initiate a cumulative health record for each student entering
its school.
(a) The record shall be maintained
throughout the student’s attendance.
(b) The record shall be uniform and shall
be on the form Student’s Cumulative Health Record, KDESHS006, or the record
shall be maintained electronically in the student information system.
(c) The record shall include screening
tests related to growth and development, vision, hearing, and any dental
screenings other than the initial dental screening recorded on the Kentucky Dental
Screening/Examination Form for School Entry, KDESHS005, and findings and
recommendations of a health care provider and a dentist.
(d) A follow-up by the proper health or
school authorities shall be made on each abnormality noted, and the result
shall be recorded.
(2) A local school district shall report
all known or suspected cases of communicable disease immediately to the local
health department.
Section 4. School District Health
Personnel. (1) A superintendent shall designate a person to serve as school
health coordinator for the district. The person designated shall meet the following
minimum qualifications:
(a) A valid license to practice as a
registered nurse, issued under KRS 314.041 by the Kentucky Board of Nursing,
and three (3) years of registered nursing practice, as defined in KRS 314.011(6);
(b) A school psychologist certificate,
issued by the Education Professional Standards Board (EPSB) pursuant to 16 KAR
2:090, and a minimum of three (3) years of related work experience in a school
setting; or
(c) A school social worker certificate,
issued by the EPSB pursuant to 16 KAR 2:070, and a minimum of three (3) years
of work experience practicing social work in a school setting.
(2) The school health coordinator shall
work in cooperation with all school personnel, the local board of education,
the department, the local health department, and family resource and youth
services centers, in promoting and implementing a school health services
program.
Section 5. Delegation to Perform
Medication Administration. A local board of education shall require proof that
all unlicensed school personnel who have accepted delegation to perform medication
administration in school have completed a training course provided by the
department or allowed under KRS 158.838(1)(c). The department’s course shall be
developed in consultation with the Kentucky Board of Nursing to ensure
compliance with 201 KAR 20:400 and KRS 156.502.
Section 6. Incorporation by Reference.
(1) The following material is incorporated by reference:
(a) "Medical Examination of School
Employees", KDESHS001, January 1, 2015;
(b) "Preventive Student Health Care
Examination Form", KDESHS002, January 1, 2015;
(c) "Student’s Cumulative Health
Record", KDESHS006, January 2, 2015;
(d) "Kentucky Eye Examination Form
for School Entry", KDESHS004, January 1, 2015; and
(e) "Kentucky Dental
Screening/Examination Form For School Entry", KDESHS005, January 2, 2015.
(2) This material may be inspected,
copied, or obtained, subject to applicable copyright law, at the Division of
District Support, Department of Education, 500 Mero Street, Frankfort, Kentucky
40601, Monday through Friday, 8 a.m. to 4:30 p.m. (SBE
48.011; 1 Ky.R. 81; eff. 11-13-1974; Am. 5 Ky.R. 1086; eff. 8-1-1979; 7 Ky.R.
28; eff. 9-3-1980; 8 Ky.R. 1162; 9 Ky.R. 114; eff. 6-22-1982; 1315; eff.
7-6-1983; 17 Ky.R. 2245; eff. 3-13-1991; 18 Ky.R. 1202; 2256; eff. 1-10-1992;
19 Ky.R. 2494; 20 Ky.R. 75; 509; eff. 8-5-1993; 26 Ky.R. 1449; eff. 3-10-2000;
27 Ky.R. 1332; eff. 1-15-2001; 34 Ky.R. 628; 1421; eff. 1-4-2008; 36 Ky.R. 653;
1218; eff. 1-4-2010; Recodified from 704 KAR 4:020, 1-13-2012; 38 Ky.R. 1799;
39 Ky.R. 28; eff. 7-13-2012; 41 Ky.R. 597; 1101; 1337; eff. 1-5-2015.)