Frequently Asked Questions

Q. Can schools accept religious exemption forms from another state?

A religious exemption from another state is not recognized in Virginia. Parents/guardians are required to complete the Religious Exemption form for the state of Virginia. The form should be notarized. Copies are not accepted.

Additional Resources:

• Religious Exemption Form
• School and Day Care Minimum Immunization Requirements (webpage)
• School and Day Care Minimum Immunization Requirements (PDF)

Q. Is a school division required to send home vaccine letters to families?

Schools are required to have education materials/information, approved by the Board of Health, sent to the parents/caregivers of students entering the 7^th grade: Code of Virginia § 32.1-46. Immunization of patients against certain diseases.

Q. What is the guidance for conditional enrollment?

As per Code of Virginia 22.1-271.2, children with incomplete immunizations may be conditionally admitted if the parent/guardian provides documentation at the time of enrollment that the child has received at least one dose of the required immunizations and has a written schedule for completing the remaining doses within 90 days. If the student needs more than two doses of hepatitis B vaccine, the conditional enrollment period will be 180 calendar days. Review School and Day Care Minimum Immunization Requirements for a list of the required immunizations.

• Military-Connected: Children of military families without documentation of immunizations should be immediately enrolled and given 30 days from the date of enrollment to obtain any immunizations required by the receiving state. (Code of Virginia § 22.1-360)
• Mckinney Vento: Students experiencing homelessness cannot be excluded from school attendance because the immunization information required of other students cannot be provided. School divisions must immediately refer the student to the school division liaison to assist the student in obtaining the necessary proof of completion of immunizations.
• Foster Care: If the proof of immunization is not immediately available upon taking the child into custody, the placing social services agency should ensure immunization requirements are completed within 30 days of the child's enrollment. (Code of Virginia § 63.2-900.D)

Q. If a student is missing the HPV vaccine, will they be allowed to attend school?

A parent or guardian has the right to decide if a child receives the HPV vaccine. No documentation is required, and a student is allowed to attend school and be without the HPV vaccine. Parents are encouraged to discuss recommended vaccines with a healthcare provider.

Q. What are the training requirements for school health staff?    

Required training with supporting guidance and resources can be found here. Local school divisions should document training of school personnel per their local policy and note date/time of training, title, training content, and participant(s).

Q. I am a registered school nurse at a private school. What training requirements should I follow?

If a private school is accredited through the Virginia Department of Education (VDOE), they must meet the training requirements found on the VDOE School Health Guidance, Resources, and Required Training webpage.

If the private school is accredited through The Virginia Council for Private Education (VCPE), schools will need to consult with the VCPE on training requirements for licensed and unlicensed staff.

Q. How do I train school bus drivers to respond to emergencies that may occur on a school bus?

If a school division would like to train bus drivers for specific health issue emergencies that may occur while students are on a bus, it should be a part of the local school policy.

If a school division moves forward with training bus drivers to respond in an emergency, consider these recommendations:

1. Documentation should be contained in the 504, IEP, and emergency plans.
2. Bus driver should be adequately trained on the specialized healthcare procedures required for specific medical conditions.
3. Documentation of training for school records and ensuring medication is readily available to and from school and/or school-related activities.

VDOE always recommends that local school boards consult with their school board attorney regarding this policy and related action.

• McKinney Vento/Homelessness
  School divisions must immediately refer the student to the school division liaison. For additional information, visit the Project Hope webpage.

• Military-Connected Families
  For resources, guidance, and recommendations regarding military families visit the VDOE, Resources for Military Families webpage.
• New to Country
  School divisions are not permitted to inquire into a prospective student's citizenship or visa status in order to enroll that student in school. Per Code of Virginia § 22.1-3, school divisions may not deny a free public education to undocumented school-age children. For additional information, visit the VDOE Enrollment Requirements webpage.

Q. If a student is enrolled in preschool, do they need a new physical for kindergarten?

All students entering kindergarten for the first time require a school entrance physical dated up to 12 months prior to school starting. Physicals completed for prekindergarten (Pre-K) programs are not acceptable unless they were completed within 12 months before your child’s entry into school.

Code of Virginia § 22.1-270. Preschool physical examinations.

Additional Resources:
School Entrance Health Form (MCH213G)

Q. If a student is retained in kindergarten, will they need another physical?
Kindergarten students who have been retained do not require another physical.

Q. Is a physical required for students enrolling in preschool?
Pre-K students provide a physical during registration that meet the requirements for program enrollment. Review your local school division’s policy for school enrollment requirements.

Q. Who completes each section of the school entrance physical?

The School Entrance Health Form has three parts.

• Part I: Health Information Form - This section is to be completed by a parent/guardian. Part I is to be completed and signed by the parent or guardian and reviewed for accuracy by the medical provider conducting the comprehensive physical examination.
• Part II: Certification of Immunization - This section is to be completed by a medical As per 12VAC5-110-70, documentary proof is required of all students being adequately immunized to attend school. A school registered nurse (RN) meets the definition of a medical provider and may sign the "Certification of Immunization" for students enrolled in their school.
• Part III: Comprehensive Physical Examination Report - This section is to be completed by a medical provider. The physical examination must be completed by a qualified licensed in Virginia physician, nurse practitioner, or physician assistant, and must be completed within 12 months prior to the date such child first enters public kindergarten or elementary school.

Additional Resources:
School Entrance Health Form (MCH213G)

Q. When does the school entrance physical have to be completed?

Per Code of Virginia §22.1-270, school entrance physicals must be completed within 12 months of the date the student first enters public kindergarten or elementary school.

Q. Are rising middle and high school students required to complete a school entrance physical?

Per Code of Virginia §22.1-270, only students entering public kindergarten or elementary school for the first time require a physical. Middle and high school students do not need a school entrance physical. However, rising middle and high school students require updated immunizations that are appropriate for the grade level in which they are entering, and may need a TB screening per school policy. Section F of Code of Virginia §22.1-270 does require the parent/guardian to provide health information for all students, which many school divisions already include such documentation in back to school packets and enrollment requirements.

Q. Where can families get a physical for school enrollment?

There are many community providers (healthcare providers, federally qualified healthcare centers, walk-in clinics) that can work with families to obtain a school entrance physical. The local health department may also complete school entrance physicals if child meets income range requirements.

Code of Virginia § 22.1-270. Preschool physical examinations.

Additional Resources:
bridge2resourcesva.org

Q. Is an alternative physical form acceptable for school enrollment?

The State Health Commissioner approves the Virginia form (MCH213G) that is used for school enrollment; however, that specific form does not have to be used. The school nurse can compare the alternative physical document(s) to the MCH 213G form and as long as all the components (systems check, a developmental screening, and updated immunizations) are included, it can be accepted for school enrollment.

Code of Virginia § 22.1-270. Preschool physical examinations.

Q. How can I help families new to the country enroll their child in school?

The State Health Commissioner approves the Virginia form (MCH213G) that is used for school enrollment; however, that specific form does not have to be used. The school nurse can compare the alternative physical document(s) to the MCH 213G form and as long as all the components (systems check, a developmental screening, and updated immunizations) are included, it can be accepted for school enrollment. If needed, the local health department can assist families that require a TB screening and follow up testing.

Additional Resources:
Every Student Succeeds Act (VDOE)

Enrollment in Virginia Public Schools

Q. What are the tuberculosis (TB) requirements for school enrollment?

All children should be screened for risk factors for tuberculosis (TB) prior to school entry. Those with a risk factor should receive a test for TB infection. Persons from high-burden TB countries should be screened for TB and TB infection.

Some school divisions have specific requirements for screening certain populations. Healthcare providers should be knowledgeable of the unique requirements for their localities.

Additional Resources:
Screening & Testing - Tuberculosis

Q. How can I support Mckinney Vento families with meeting school entrance physical requirements?

School divisions must immediately refer the student to the school division liaison to assist the student in obtaining the necessary physical examination for enrollment.

Additional Resources:
Project Hope

Q. Who can perform a school entrance physical?

Per Code of Virginia § 22.1-270. Preschool physical examinations, physicals are only required for first-time enrollment in elementary school and can be performed by a qualified licensed (licensed in the United States) physician, nurse practitioner, or physician assistant acting under the supervision of a licensed physician.

Q. I am a school nurse of a medically fragile child, and the parent/guardian provided a DNR order to the school. What are my next steps?

In the event of an emergency during school hours, school staff and the school's nurse will follow protocols outlined within the students' individualized health care plan and emergency action plan. VDOE always recommends that local school boards consult with their school board attorney regarding policy and related action.

Emergency medical services should be called as per protocol and should be made aware during the call that the student has a DNR order on file. Once EMS staff arrives to the school, they will follow their protocols related to DNR orders. The likelihood of a child succumbing during school hours is rare, however the school should ensure that all orders and healthcare plans are up-to-date and signed by a medical provider.

Protocols and procedures should also include protecting the student's privacy.

Q. How often should a student’s individualized healthcare plan (IHP) be updated?

The IHP should be updated at least annually (i.e., at least once each school year) or when significant changes occur in the student’s health status. Please refer to your school policies for additional guidance on supporting students with special health care needs.

Q. Is there a waiver form for students with disabilities who cannot successfully complete CPR training as a graduation requirement?

Students shall be trained in emergency first aid, cardiopulmonary resuscitation (CPR), and the use of automated external defibrillators (AED), including hands-on practice of the skills necessary to perform cardiopulmonary resuscitation. Students with an IEP or 504 Plan that documents they cannot successfully complete this training shall be granted a waiver from this graduation requirement, as provided in 8VAC20-131- 420(B).

Q. What is the Emergency Care Plan or Emergency Action Plan?

The Emergency Care Plan (ECP) is required when a chronic condition has the potential to result in a medical emergency. The ECP is a component of the IHP and contains the necessary orders for safe care, healthcare provider contact information, and parental consent needed to provide care to a student in the school setting.

For those students with a known life-threatening allergy anaphylaxis, an Emergency Action Plan (EAP) is needed. VDOE provides guidance and recommendations for schools: to provide safe care to students: Guidelines for Recognition and Treatment of Anaphylaxis in the School Setting.

Please refer to your school policies for additional guidance on supporting students with special health care needs.

Q. How do I support a student with diabetes?

VDOE provides diabetes management guidance in the Diabetes Management In Schools: Manual For Unlicensed Personnel. The comprehensive manual provides guidance for managing diabetic care during school hours and maintaining a student’s Diabetes Medical Management Plan (DMMP). VDOE always recommends that local school boards consult with their school board attorney regarding policy and related action.

• Field Trips: The school nurse or trained diabetes personnel should accompany the student with diabetes on field trips, as well as be available at school-sponsored extracurricular activities.
• Extracurricular Activities: There may be adjustments in insulin coverage on the day of games or events in order to maintain blood glucose for sports- related activity. These changes can be added to the student’s Diabetes Medical Mangement Plan (DMMP) using a healthcare provider note or letter and/or the DMMP may be amended to reflect any changes related to sports/activities. Most school divisions require coaches to be trained in CPR/AED/First Aid. Schools may want to consider providing training to a member of the school staff that works with the team or club.
• Continuous Glucose Monitoring In Schools: Remote monitoring of the Continuous Glucose Monitor (CGM) in the school setting by staff is not required as the child is usually adult supervised by trained staff and alarms are used to identify urgent glucose levels requiring action. However, in certain unique cases (e.g. preschool age, non-verbal, impaired cognition) monitoring/remote monitoring may be appropriate and the school nurse along with the Section 504 Team, will do an assessment and determine the accommodations based on the student’s individual need(s) and the DMMP/healthcare orders. When determined appropriate, the school nurse will indicate these accommodations on a Section 504 plan and the Individualized Health Plan.

Additional Resources:
Schools-CGM-Position-Statement-Rev.5.12.20.pdf (virginiadiabetes.org)

• Insertion/Re-Insertion of Insulin Pump: In accordance with the Code of Virginia § 0-274.01:1 B a local school board employee who is a registered nurse, licensed practical nurse, or certified nurse aid and who has been trained in the administration of insulin and glucagon may assist a student who is diagnosed with diabetes and who carries an insulin pump with the insertion or reinsertion of the pump or any of its parts. Prescriber authorization and parental consent shall be obtained for any such employee to assist with the insertion or reinsertion of the pump or any of its parts. Nothing in this section shall require any employee to assist with the insertion or reinsertion of the pump or any of its parts. VDOE always recommends that local school boards consult with their school board attorney regarding policy and related action.
• Emergency Action Plans for Hypoglycemia and Hyperglycemia: School nurses may develop a plan of care including an emergency action plan (EAP) in consultation with the parents, healthcare provider (HCP), and the 504/IEP team. The Emergency Action Plans (EAP) for hypoglycemia and hyperglycemia are developed by the school nurse and are based on the medical orders from the Diabetic Medical Management Plan (DMMP). The EAP is individualized for the student, states symptoms of hypoglycemia and hyperglycemia, and the steps to take in an emergency.

Q. What is the scope of practice for licensed practical nursing (LPN)?

Per Code of Virginia §54.1-3000, "Practical nursing" or "licensed practical nursing" means the performance for compensation of selected nursing acts in the care of individuals or groups who are ill, injured, or experiencing changes in normal health processes; in the maintenance of health; in the prevention of illness or disease; or, subject to such regulations as the Board may promulgate, in the teaching of those who are or will be nurse aides. Practical nursing or licensed practical nursing requires knowledge, judgment and skill in nursing procedures gained through prescribed education. Practical nursing or licensed practical nursing is performed under the direction or supervision of a licensed medical practitioner, a professional nurse, registered nurse or registered professional nurse or other licensed health professional authorized by regulations of the Board.

Q. What is the scope of practice for registered nursing (RN)?

Per Code of Virginia §54.1-3000, "Professional nursing," "registered nursing" or "registered professional nursing“ means the performance for compensation of any nursing acts in the observation, care and counsel of individuals or groups who are ill, injured or experiencing changes in normal health processes or the maintenance of

health; in the prevention of illness or disease; in the supervision and teaching of those who are or will be involved in nursing care; in the delegation of selected nursing tasks and procedures to appropriately trained unlicensed persons as determined by the Board; or in the administration of medications and treatments as prescribed by any person authorized by law to prescribe such medications and treatment. Professional nursing, registered nursing and registered professional nursing require specialized education, judgment, and skill based upon knowledge and application of principles from the biological, physical, social, behavioral and nursing sciences.

Q. What duties can unlicensed assistive personnel (UAP) do?

Delegation of certain nursing tasks and procedures not involving assessment or evaluation can be completed by adequately trained unlicensed personnel under the direct supervision of a RN. The RN is responsible and accountable for the delegated tasks.

Additional Resources: School Health Activity Chart

Q. What should be considered when delegating duties?

Appropriate delegation of nursing tasks and procedures includes determining:

• Right task.
• Right circumstance.
• Right person.
• Right direction/communication.
• Right supervision.

Q. What duties cannot be delegated?

Activities that cannot be delegated to unlicensed personnel include:

1. Nursing assessment, problem identification & outcome evaluation which require independent nursing judgment.
2. Coordination & management of care involving collaboration, consultation &
3. Emergency & nonemergency
4. Administration of

Additional Resources:

Virginia Board of Nursing Decision-Making Model for Determining RN/LPN Scope of Practice

Q. Can an Emergency Medical Technician (EMT) on the school staff provide care for students at school?

An EMT will function as an unlicensed school health team member. EMT’s function under the authority of a medical director which is usually an emergency room physician and follow specific protocols developed and approved by the hospital authority for EMS response. This authority does not extend to their role as a school employee. If the EMT is part of the school health staff, they must complete all mandated training as per school policy. Many school nurses are also EMT’s, but must be cognizant and stay within their Scope of Practice as a school employee. What they do on a squad call and how they handle a situation in a school setting can be very different.