public school systems

KRVRN, BSN, RN · Oct 12, 2014

If they ask for info and you give it they aren't violating HIPAA

Emergent, RN · Oct 12, 2014

Why wouldn't you want to share this with people who have the care of your children 6 hrs a day? Hopefully, parents and schools are collaborating for the better good of the children.

duskyjewel · Oct 12, 2014

Vaccinations are a public health issue, and schools have both a right and an obligation to ask about them. Especially if your kids aren't vaccinated, they need to know whom to order to stay home when there is a measles/mumps/pertussis outbreak. Unfortunately, those are happening more often these days due to the loss of herd immunity.

Here.I.Stand, BSN, RN · Oct 12, 2014

Hmm...three of my kids are school-aged, all in public school. The only record I have to submit is the VAR. This makes perfect sense because how else are they supposed to know, for the good of the entire staff and student body, if the child is vaccinated per their requirements? The other health forms are info that *I* provide--not actual medial records. They cannot access anything from the clinic without *my* consent. Therefore, no HIPAA vio.

My oldest has asthma, and the school has a form for her physician to fill out, basically clearing her to self-administer her inhalers during school. Again though, this is not her medical records that the school has somehow been able to gain access to w/o *my* consent.

If you think about it, the LSN is largely responsible for the children's health during school hours. She has mostly healthy children, some medically fragile ones, and many more in between with issues like asthma or food allergies. How is she supposed to do her job--not to mention protect her license--without knowing the basics of a child's health history? Daily and prn meds? Action plans? It would be like you going into the hospital and being asked to be responsible for your pt load without knowing their histories. RN, to pt who has become diaphoretic and seems a little confused: "Do you have diabetes? When did you last take insulin and when/what did you eat?" Pt: "I don't want to share that information. It's private."

JustBeachyNurse, LPN · Oct 12, 2014

First HIPAA does not apply to schools as they are not billing insurance. FERPA applies.

The school nurses are legally mandated to inquire about any conditions that affect active participation in school activities such as anaphylactic reactions, allergies, asthma, epilepsy, any medical condition that could restrict participation in physical activities (and require medical clearance) and physician orders for any scheduled or PRN medications that may be needed during the school day. Most are mandated to inquire if the child is covered by health insurance and offer the option to refer to the state children's health insurance program.

The school is also legally obligated to inquire about immunization status and has the right to exclude a child if a parent refuses to provide the records or refuses to get the full series without an exemption on file. (Types of acceptable exemption varies by state in my state only religious or medical are accepted. Other states permit philosophical exemptions). Vaccine status is a matter of public health.

If you refuse to provide medical clearance your child will be excluded from physical education but not excuses without medical documentation.

If your child has no conditions and takes no medication there is nothing to report other than healthy WNL.

If your child acquires a reportable communicable disease such as measles, chicken pox, strep throat the school is mandated to report to the state or county health department as a matter of public health.

FERPA protects these records from any one other than the school nurse and essential personnel (EMS if there is an emergency, public health if a mandated situation) viewing them without your permission. You must sign that the school nurse can release to the cafeteria staff and teachers if your child has a food allergy (it's a wise choice to keep your child safe) and may need an epipen.

The only solution if you want to keep your child's health and vaccination status "confidential " from school staff is to home school your children.

mc3, ASN, RN · Oct 13, 2014

Hmm...three of my kids are school-aged, all in public school. The only record I have to submit is the VAR. This makes perfect sense because how else are they supposed to know, for the good of the entire staff and student body, if the child is vaccinated per their requirements? The other health forms are info that *I* provide--not actual medial records. They cannot access anything from the clinic without *my* consent. Therefore, no HIPAA vio.
My oldest has asthma, and the school has a form for her physician to fill out, basically clearing her to self-administer her inhalers during school. Again though, this is not her medical records that the school has somehow been able to gain access to w/o *my* consent.
If you think about it, the LSN is largely responsible for the children's health during school hours. She has mostly healthy children, some medically fragile ones, and many more in between with issues like asthma or food allergies. How is she supposed to do her job--not to mention protect her license--without knowing the basics of a child's health history? Daily and prn meds? Action plans? It would be like you going into the hospital and being asked to be responsible for your pt load without knowing their histories. RN, to pt who has become diaphoretic and seems a little confused: "Do you have diabetes? When did you last take insulin and when/what did you eat?" Pt: "I don't want to share that information. It's private."

As a school nurse, I heartily thank you for the above. Also, to the OP, if I need to request any information, I must have you sign a release first.

900+ kids; I'm not really looking at anything but what we can do to help keep your child safe and happy in school.

mc3 :cat:

lalonzo27 · Oct 13, 2014

I dont agree. I dont expect people to even understand my view or the principle. My childs medical records are no ones business. Clearly if I dont want to offer up the information then she is obviously healthy and thats all the school needs. In my eyes its too much control and power the public education system has. If my child has allergies, diabetes etc... than I would have a different view. Btw the herd immunity has been debunked there is no scientific evidence to back that theory. lets talk about kids who come to school with lice. If the school can send out a form to inform parents of a lice outbreak than they can do that for children who are not vaccinated if theres a measles outbreak amonst the vaccinated children.

JustBeachyNurse, LPN · Oct 13, 2014

I think you may be over complicating things.

The school is mandated to notify families as a matter of public health if there is a mandated reportable condition whether strep, lice, chicken pox or measles or a plague. (Not all districts/states mandate lice notification though). All families are notified regardless of vaccination status. In case of an outbreak children not vaccinated (whether medically exempt or the family chooses a religious or philosophical objection) the health department may exclude those children from school, if the school even remains open.

If you live in a state where there are philosophical objections then exercise that right and sign the notification statement. In my state if you exercise a religious objection to vaccination a parental statement is all that is needed. You are not required to state your religion nor is a physician statement required. There is no philosophical objection in my state. If a child is vaccinated, then the vaccine record must be submitted to the school as a matter of public health.

I've once been asked to release my child's full medical records and declined as it had no bearing on my child's ability to attend school. There were no repercussions.

My child's physician signed a statement annually that my child is medically clear to attend school and could participate in all activities without restriction. No records or data required. This statement was required annually by each school my child attended.

So in summary, if you elect to not vaccinate and live in a state that permits religious or philosophical exemptions then sign a letter attesting to that.

If your child is healthy and has no allergies or conditions requiring medication or treatment, then submit a note from your pediatrician simply stating the child is healthy and has no restrictions. There is no reason to submit records, other than vaccination as applicable, for a healthy child.

If your child is asthmatic, allergic, diabetic, or epileptic then get an emergency care plan completed and signed by a physician. ( it seems this does not apply to you).

There is no mandate to sign full medical records over to a school. If your child develops a reportable condition such as strep, chicken pox, or pink eye you will be required to submit a physicians note that they are well enough to return to school.

elkpark · Oct 13, 2014

I dont agree. I dont expect people to even understand my view or the principle. My childs medical records are no ones business. Clearly if I dont want to offer up the information then she is obviously healthy and thats all the school needs. In my eyes its too much control and power the public education system has. If my child has allergies, diabetes etc... than I would have a different view. Btw the herd immunity has been debunked there is no scientific evidence to back that theory. lets talk about kids who come to school with lice. If the school can send out a form to inform parents of a lice outbreak than they can do that for children who are not vaccinated if theres a measles outbreak amonst the vaccinated children.

If you feel this strongly about it, you are welcome to pull your kids out of public school and home-school them. And when and where, exactly, was the herd immunity theory "debunked"? That's news to me. "Debunked" how? Can you provide some documentation of this (other than from a crackpot anti-vax conspiracy theory website)?

And I would certainly not make the assumption that a refusal by a parent to provide health information "obviously" means that the child is healthy. In fact, that refusal would be a big red flag for me that there may be something going on that the school needs to know about. But, hey, that's just me ...

duskyjewel · Oct 13, 2014

This person is clearly an anti-vaxxer who doesn't want the consequences that come with that choice. This was their first post ever on the site. I think we should all just let the conversation die by ignoring it. Anyone who claims herd immunity is fiction clearly is not, and never was, interested in valid science.

psu_213, BSN, RN · Oct 13, 2014

I think we should all just let the conversation die by ignoring it. Anyone who claims herd immunity is fiction clearly is not, and never was, interested in valid science.

Unfortunately I think we might be in for a sad, albeit predictable, debate--one side makes a rational claim about the benefits of vaccines, backed up with scientific evidence. The other side make claims based on nothing other than speculation and fear mongering (that has already started; see: herd immunity has been debunked!). Just wait until autism is thrown out there. :banghead: In the end no one's opinion will change.