Academy at Middle Fork

Student Health Care Policy

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Appalachian State University Academy at Middle Fork
Student Health Care Policy

I. Introduction

The Appalachian State University Academy at Middle Fork ("Academy") adopts this policy on student health for the betterment of the health and welfare of all its students. It is a goal of the Academy to aid students in the development and maintenance of good physical and mental health.

  1. Pursuant to N.C.G.S. § 116-239.8(b)(9), the Academy will meet the same health and safety standards required of any North Carolina local Academy administrative unit.
  2. While students and parents are primarily responsible for student health, North Carolina law places certain duties and responsibilities upon public Academy personnel. Those duties include:
    1. To screen and observe pupils in order to detect health problems.
    2. To provide medical care to students in accordance with N.C.G.S. § 115C-375.1 and State Board of Education policy.
    3. To administer any drugs or medication prescribed by a health care provider upon written request of a parent.
    4. To give emergency health care when reasonable apparent circumstances indicate any delay would seriously worsen the physical condition or endanger the life of the pupil; and
    5. To perform any other first aid or life-saving techniques in which the employee has been trained in a program approved by the State Board of Education.
  3. A registered nurse shall be available to the Academy for assessment, care planning and the ongoing evaluation of students.

II. Scope

This policy shall apply to all students of the Academy. For purposes of this policy, every reference to "parent" shall include a parent, legal guardian, or other custodian having charge or control of a student attending the Academy.

III. Definitions

  1. Advisory Board - The Appalachian State University Advisory Board, established pursuant to NCGS 116-239.8(b)(1) to provide advice and guidance to the Chancellor regarding the operation of the Academy.
  2. Parent(s) - Includes parents, legal guardians, and legal custodians of students who are under 18 years old and who have not been emancipated. 

IV. Policy Statements

4.1 Student Health Services Generally

The Academy will provide health services to students as required by law. State law authorizes Academy employees to administer medication prescribed by a health care practitioner upon the written request of the parents; give emergency health care when reasonably apparent circumstances indicate that any delay would seriously worsen the physical condition or endanger the life of the student; and perform any other first aid or lifesaving technique in which training has been provided to Academy employees. A registered nurse will be available to provide assessment, care planning, and ongoing evaluation of students with special health care service needs in the Academy setting.

The Director of Laboratory Schools ("Director") may develop procedures or delegate the development of procedures to each principal for providing these health services and meeting the board requirements listed below.

  1. The principal shall determine at the beginning of each Academy year prior to the beginning of classes, and thereafter as circumstances require, which employees will be selected to participate in the health services program. The principal shall inform his or her staff about which health services duties are delegated to which employees.
  2. Any employee designated to provide health care services must receive appropriate training.
  3. Health manuals prepared by the governing state agencies must be followed in developing appropriate procedures and for determining which tasks must be performed by registered nurses.
  4. Procedures must be consistent with all related policies
  5. Procedures must be consistent with state and federal law for students with disabilities, including the Individuals with Disabilities Education Act, Section 504 of the Rehabilitation Act of 1973, and the Americans with Disabilities Act. The Policies Governing Services for Children with Disabilities will be followed, as applicable.
  6. Procedures must be consistent with guidelines adopted by the State Board of Education under G.S. 115C-12(31) to serve students with diabetes, including developing and implementing individual diabetes care plans for such students and providing information and training to Academy personnel to appropriately support and assist such students, in accordance with their individual diabetes care plans.
  7. Written information maintained by the Academy or Academy personnel regarding a student's medicinal and health needs is confidential. Parents and students must be accorded all rights provided by the Family Educational Rights and Privacy Act (FERPA) and state confidentiality laws. Any employee who violates the confidentiality of the records may be subject to disciplinary action.
  8. School personnel must obtain parental consent for medical services as required by law. Parents will be notified of their rights in accordance with policy 1310/4002, Parental Involvement.
  9. Health professionals will be consulted in the development of health services. Opportunities also will be provided for input from staff, parents, and students on the health services provided.

4.2 Immunizations, Physical Examinations & Screenings

4.2.1 Immunization

  1. No child shall attend the Academy unless a certificate of immunization indicating the child has received the immunizations required by N.C.G.S. § 130A-152 is presented to the Academy by the child's parent. A parent enrolling a child for the first time in the Academy is required to present to the Academy a certificate of immunization on the child's first day of attendance.
  2. If a certificate of immunization is not presented on or before the first day of Academy, the Principal shall present a notice of deficiency to the parent. The parent shall have thirty (30) calendar days from the first day of attendance to present the required certificate of immunization for the child or to obtain the required immunization for the child.
  3. If the administration of vaccine in a series of doses given at medically approved intervals requires a period in excess of thirty (30) calendar days, additional days upon certification by a physician may be allowed to obtain the required immunization.
  4. If the required certificate of immunization or other proof of immunization is not presented upon termination of thirty (30) calendar days from the child's first day of attendance, the Principal shall not permit the child to attend the Academy until the required certificate of immunization has been presented.
  5. The Academy shall file an annual immunization report with the North Carolina Department of Public Instruction by November 1 of each year. The report shall be filed on forms prepared by the Department of Public Instruction and shall state the number of children attending the Academy or facility, the number of children who had not obtained the required immunization within thirty (30) calendar days of their first attendance, the number of children who received a medical exemption and the number of children who received a religious exemption.
  6. If a physician licensed to practice medicine in North Carolina certifies a required immunization is or may be detrimental to a child's health due to the presence of one of the contraindications adopted by the Commission for Public Health, the child shall not be required to receive the specified immunization as long as the contraindication persists. The State Health Director may, upon request by a physician licensed to practice medicine in North Carolina, grant a medical exemption to a required immunization for a contraindication not on the list adopted by the Commission for Public Health.
  7. If the bona fide religious beliefs of a parent are contrary to the immunization requirements contained in this Policy, the child shall be exempt from the requirements. Upon submission of a written statement of the bona fide religious beliefs and opposition to the immunization requirements, the child may attend the Academy without presenting a certificate of immunization.

4.2.2 Pre-Enrollment Physical

  1. In accordance with N.C.G.S. § 130A-440, the Academy requires the parents of a child enrolling in kindergarten or a higher grade for the first time to have their child receive a health assessment. This assessment must be conducted no more than twelve (12) months prior to the date the child would have first been eligible for initial Academy entry and must be presented to the Principal. In accordance with N.C.G.S. §130A-441, health assessment results shall be submitted on the statewide standardized health assessment transmittal form developed by the Department of Public Instruction. If a child's parents are unable to pay for a physical examination, they shall be referred to the Academy nurse.
    1. The pre-enrollment health assessment for every Academy student must include verification that the student is able to independently provide for their own personal hygiene needs, including but not limited to managing their clothing, toileting and clean up, and hand washing. A child who does not meet this standard shall not be eligible for enrollment in the Academy.
  2. If a health assessment is not presented on or before the first day of Academy, the Principal shall present a notice of deficiency to the parent. The notice of deficiency shall include at least the following information: (i) the health assessment transmittal form must be submitted to the Principal within 30 calendar days of the child's first day of attendance or the child will not be permitted to attend Academy until the form is submitted and (ii) an explanation for how the child may make up work missed. The parent shall have thirty (30) calendar days from the first day of attendance to present the required health assessment transmittal form for the child. Upon termination of thirty (30) calendar days, the Principal shall not permit the child to attend the Academy until the required health assessment has been presented. A child shall not be suspended for absences accrued for failure to present the required health assessment transmittal form upon the termination of 30 calendar days, and the child shall be allowed to make up work missed.
  3. If the bona fide religious beliefs of the parent of a child are contrary to the health assessment requirements contained in this Policy, this Policy shall not apply to the child. Upon submission of a written statement of the bona fide religious beliefs and opposition to the health assessment requirements, the child may attend kindergarten without submitting a health assessment report.
  4. Within sixty (60) calendar days after the commencement of each Academy year, the Principal shall file a health assessment status report with the Department of Public Instruction on forms developed by the state. This report shall document the number of children in compliance and not in compliance with the health assessment requirement in N.C.G.S. § 130A-440(a).

4.2.3 Pre-Enrollment Vision Screening

  1. In accordance with N.C.G.S. § 115C-440.1, the Academy requires each child entering kindergarten for the first time to obtain vision screening in accordance with vision screening standards adopted by the Governor's Commission on Early Childhood Vision Care.
  2. Within 180 days of the start of the Academy year, the parent of the child shall present to the Principal certification the child has, within the past twelve (12) months, obtained vision screening conducted by a licensed physician, optometrist, physician assistant, nurse practitioner, registered nurse, orthoptist, or a vision screener certified by Prevent Blindness North Carolina, or a comprehensive eye examination performed by an ophthalmologist or optometrist. The health assessment form required hereinabove qualifies as certification the child obtained the required vision screening.
  3. Children who receive and fail to pass the pre-enrollment vision screening are required to complete a comprehensive eye examination. If a teacher, administrator, or other appropriate Academy personnel has reason to believe a child enrolled in kindergarten through third grade is having problems with vision, the Academy personnel may recommend to the child's parent that the child have a comprehensive eye examination. Notification to the parent shall also inform the parent that funds may be available from the Governor's Commission on Early Childhood Vision Care to pay providers for the examination, including corrective lenses.
  4. Any treatment recommendations by the optometrist or ophthalmologist, such as spectacles for Academy work, shall appear in the summary and Academy health card. The parent shall submit the comprehensive eye examination transmittal form to the Academy.
  5. No child shall be excluded from attending Academy for a parent's failure to obtain a comprehensive eye examination required by this Policy. If a parent fails or refuses to obtain a comprehensive eye examination or to provide the certification of a comprehensive eye examination, the Academy shall send a written reminder to the parent of required eye examinations and shall include information about funds that may be available from the Governor's Commission on Early Childhood Vision Care.

4.2.4 Post-Enrollment Physical

  1. Any Academy official who observes or detects in a student signs or symptoms of a physical or mental health problem may request the student's parent have the student examined by a health care professional. If the parent refuses and the problem continues to exist, the appropriate Academy official shall contact the Department of Social Services.
  2. If an enrolled student exhibits a documented pattern of toileting accidents (i.e., daily, more than once a week; weekly for multiple weeks; etc.), the Principal may follow the steps for a post-enrollment physical as set forth in this section. The Principal shall provide written and verbal notice to the parent of the documented pattern of toileting accidents. From that point forward, unless the student has a documented disability that prevents the student from being toilet trained, the parent will be expected to come and change the student or pick up the student from Academy. In order to protect the health and safety of other students, the Principal, in the Principal's sole discretion, may preclude the student from the classroom, Academy bus, or other areas as appropriate. Any time missed by the student in this situation shall be considered an absence in accordance with the Attendance Policy.

4.2.5 Post-Enrollment Screenings
The Academy will conduct periodic screenings of students:

  1. Vision Screenings should be conducted in first, third and fifth grades by Academy personnel and Academy volunteers trained by the nurse assigned to provide Academy nursing services to the Academy. Vision and hearing screening for the purposes of the School Assistance Team and Exceptional Children's (EC) process will be conducted by the Academy nurse upon request. Any student may be screened by Academy nurse upon request.
  2. Dental Screenings should be conducted in pre-kindergarten, kindergarten and third and fifth grades and on all EC students in pre-kindergarten through fifth grade by dental hygienists employed by the Forsyth County Health Department. Dental screenings on any student may also be conducted by the dental hygienist or the Academy nurse upon request.

4.3 Administration of Medications and Medical Procedures

  1. The Academy discourages the use and administration of medication at Academy but realizes it may be sometimes necessary for the health of the student. All medications and medical procedures which may be taken or given outside Academy hours without adversely affecting the health of the student should not be administered at Academy during Academy hours. Reasonable efforts should be made by the parent to obtain permission from the child's health care provider to adjust the dosages of prescribed medication so such may be provided at home before and/or after Academy hours.
  2. When medication is to be administered in Academy, Academy personnel shall communicate with the student's parent about its administration in Academy and explain the Academy's policy and its procedures for the administration of medications at Academy.
  3. In accordance with N.C.G.S. § 115C-375.1, the Academy authorizes Academy personnel to administer prescription and over the counter medications upon receipt of the written authorization of the health care provider and the written authorization of the student's parents.
  4. The responsibilities of the parent are to:
    1. Provide the Academy with each different medication in a separate appropriately labeled container.
      1. Prescription Medication shall be placed in a prescription container indicating the child's name, the name of the medication, the unit of dosage to be given, the number of dosage units, the time the medication is to be given, and how it is to be administered. (It is recommended the parent ask the pharmacist to provide two properly labeled containers – one for home and one for Academy).
      2. Over the Counter Medication shall be placed in the original container labeled with the student's name, the name of the medication, the dosage to be given and the time and method of administration.
      3. Provide to the Academy the "Parent's Request and Physician's Information for Administration of Medication in the School" form and ensure the form is completed, signed by the health care provider and parent, and returned to the Academy. The health care provider may use another format (letter, computer printout, etc.) to authorize the administration of medication as long as all information requested in the form is provided.
      4. Provide new containers with appropriate labeling each time the child's medication changes, and to remove from the Academy grounds any medications discontinued by the child's health care professional.
      5. Remove all medications from Academy premises at the end of each Academy year. If not removed, the Academy will dispose of all medications in its possession two (2) weeks after the last day of Academy for students.
      6. Parents are encouraged to bring medications directly to the Academy office and avoid sending the medications to the Academy via the student.
      7. The authorization for administration of medication will be valid for only one (1) Academy year.
      8. No medication (either prescription or non-prescription) will be administered without written order from the health care provider and the signed consent of the parent.
      9. If the completed form is not received and it is necessary for the medication to be given, the parent may come to the Academy and administer the medication.
  5. A secure storage area will be provided at the Academy for storage of medication. Exceptions may be made for medication requiring refrigeration. A staff member appointed by the Principal shall be responsible for this security and administration of medication. An alternate person shall be identified to fill in when needed.
  6. When it is necessary for a special medical procedure to be done at Academy, it is the responsibility of the parent to:
    1. a. Provide to the Academy and maintain all necessary supplies and equipment.
    2. Provide the Academy with the form, "Parent Permission for Special Medical Procedures", and ensure the form is completed, signed by the health care provider and parent, and returned to the Academy. The health care provider may use another format (letter, computer printout, etc.) to authorize the administration of a special medical procedure as long as all information requested in form is provided.
    3. The Parent Permission for Special Medical Procedures will be valid for only one (1) Academy year.
    4. The Academy nurse will develop a plan of care and determine whether this is a procedure that can safely be delegated to non-nursing personnel. If the procedure can safely be delegated to non-nursing personnel, the Principal will assign the task to non-nursing personnel who have the availability to perform the procedure. The Academy nurse will then provide training assuring the person has the skill to safely perform the procedure and will provide continued supervision to all non-nursing personnel who perform a delegated procedure.
  7. A daily medication/procedure log shall be maintained by the designated individual for each student receiving medication and/or procedure. The individual shall record on the log the name of the medication, date, dosage, and time of each administration or date and time of a procedure. The log also shall reflect whether or not the medication/procedure was prescribed and whether it was "as scheduled" or "as needed."
  8. The Academy nurse will review the medication/procedure log and forms authorizing the administration of medications/procedures at Academy periodically and will serve as a consultant to the Academy. The medication/procedure log, parental authorization and health provider orders for medication/procedure will be filed in the student's cumulative folder at the end of each Academy year or upon transfer of the student from the Academy.
  9. The Academy discourages students from bringing prescription and over the counter medications to Academy and administering such to themselves without the assistance of Academy officials. Students will not be allowed to possess or to self-administer prescription medications, other than asthma medications, diabetic medications, and/or medications for the treatment of anaphylactic reaction, except in cases of extreme health conditions properly documented in an individual health care plan developed by the Academy nurse in coordination with the student's health care provider. The Academy and its employees are not responsible for the improper self-administration of over the counter or prescription drugs at Academy by students.

4.4 Possession and self-administration of asthma medication by students with asthma or students subject to anaphylactic reactions, or both

A student with asthma or a student subject to anaphylactic reactions, or both, may possess and self-administer asthma or another prescribed medication on Academy property during the Academy day, at Academy-sponsored activities, or while in transit to or from Academy or Academy-sponsored events as provided by N.C.G.S. § 115C-375.2 and this Policy. As used in this policy, "asthma medication" means a medicine prescribed for the treatment of asthma or anaphylactic reactions and includes a prescribed asthma inhaler or epinephrine auto-injector.

  1. Pursuant to state law and this policy, the student's parent is required to provide to the Academy:
    1. Written authorization from the student's parent for the student to possess and self-administer asthma medication.
    2. A written statement from the student's health care provider verifying that the student has asthma or an allergy that could result in an anaphylactic reaction, or both, and that the health care provider prescribed medication for use on Academy property during the Academy day, at Academy-sponsored activities, or while in transit to or from Academy or Academy-sponsored events.
    3. A written statement from the student's health care provider who prescribed the asthma medication that the student understands, has been instructed in self-administration of the asthma medication, and has demonstrated the skill level necessary to use the asthma medication and any device that is necessary to administer the asthma medication.
    4. A written treatment plan and written emergency protocol formulated by the health care provider who prescribed the medicine for managing the student's asthma or anaphylaxis episodes and for medication use by the student.
    5. A statement provided by the Academy and signed by the student's parent acknowledging that the Academy and its employees and agents are not liable for an injury arising from a student's possession and self-administration of asthma medication.
    6. Other requirements necessary to comply with State and federal laws.
  2. The student must demonstrate to the Academy nurse, or the nurse's designee, the skill level necessary to use the asthma medication and any device that is necessary to administer the medication.
  3. The student's parent shall provide to the Academy backup asthma medication that shall be kept at the student's Academy in a location to which the student has immediate access in the event of an asthma or anaphylaxis emergency.
  4. Information provided to a Academy by the student's parent shall be kept on file at the student's Academy in a location easily accessible in the event of an asthma or anaphylaxis emergency.
  5. If a student uses asthma medication prescribed for the student in a manner other than as prescribed and in violation the Academy's Student Behavior Policy/Code of Conduct, a Academy administrator may impose on the student disciplinary action according to the Student Behavior Policy/Code of Conduct. An Academy administrator may not impose disciplinary action that limits or restricts the student's immediate access to the asthma medication.
  6. The requirement that permission granted for a student to possess and self-administer asthma medication shall be effective only for the same Academy and for 365 calendar days and must be renewed annually.
  7. Pursuant to N.C.G.S. § 116-239.8(b)(9) and N.C.G.S. § 115C-375.2, there shall be no liability on the part of Appalachian State University, the Academy, or any of their trustees, officers, employees, designees, agents, volunteers, in civil damages to any party for any act authorized by this subsection, or for any omission relating to that act, unless that act or omission amounts to gross negligence, wanton conduct, or intentional wrong doing.
  8. The Academy shall provide a supply of emergency epinephrine auto-injectors necessary to carry out the provisions of N.C.G.S. § 115C-375.2A.

4.5 Mental Health Plan

The Director of Laboratory Schools ("Director") shall develop a Academy-based mental health plan that includes a mental health training program and suicide risk referral protocol. The Director shall submit the plan to the Advisory Board for approval and direct implementation of the plan within all applicable deadlines.

By September 15 of each year, the Director shall report to the Department of Public Instruction on (1) the content of the Academy system's mental health plan, including the mental health training program and suicide risk referral protocol, and (2) the Academy system's prior Academy year compliance with the requirements of State Board of Education Policy SHLT-003. The Advisory Board will review the components of the Academy system's mental health plan at least every five years, starting August 1, 2025, and will update the mental health plan in accordance with any updated requirements provided by the State Board of Education.

4.6. Diabetes Care Plans

Pursuant to N.C.G.S. § 115C-375.3, the Academy shall ensure the guidelines adopted by the State Board of Education pursuant to N.C.G.S. § 115C-12(31) for assisting students with diabetes are implemented for Academy students with diabetes. In particular, the Academy shall require the implementation of the procedures set forth in those guidelines for the development and implementation of individual diabetes care plans. The Academy also shall make available necessary information and staff development to teachers and Academy personnel in order to appropriately support and assist students with diabetes in accordance with their individual diabetes care plans.

4.7 First Aid or Emergency Health Care

  1. The Principal shall request a minimum of two (2) staff members volunteer for training or periodic retraining in first aid and life-saving techniques.
  2. The Principal shall provide or facilitate training for the above staff volunteers in first aid and life-saving techniques on a periodic basis.
  3. All Academy personnel shall follow the procedures listed in the most current version of "North Carolina Emergency Guidelines For Schools" (published by the North Carolina Department of Health and Human Services) to handle student illnesses and injuries.
  4. In order to respond promptly and effectively to medical emergencies, the parents of Academy students shall be requested to provide the following information to their child's or children's Academy(s):
    1. A telephone number where they can be contacted during Academy hours;
    2. The name, address, and telephone number of their family doctor;
    3. Their preference of hospitals, if any; and
    4. A description of any chronic medical condition(s) which affects their child's health.
  5. If a child has special or unique health problems, a specific emergency plan should be developed and placed in the child's cumulative folder. The emergency plan for the individual student should be written by the student's physician(s) in consultation with Academy staff. The plan should include medical directions for the immediate care of the child in the event of an emergency or life-threatening incident. It is the parent's responsibility to assure that an emergency plan is developed for the child, and that written permission is given by the parent to institute measures when needed.

4.8. Liability of School Personnel

  1. Any Academy employee authorized to provide medical care to students in accordance with N.C.G.S. § 115C-375.1 shall not be liable in civil damages for any authorized act unless the act or omission amounts to gross negligence, wanton conduct, or intentional wrongdoing. Any person serving as a volunteer who has been authorized to act pursuant to N.C.G.S. § 115C-375.1 shall not be liable in civil damages for any authorized act unless the act or omission amounts to gross negligence, wanton conduct, or intentional wrongdoing.
  2. To the extent provided under the Defense of State Employees Act, N.C.G.S. § 143-300.2 et. seq., the State will provide a legal defense and liability coverage for Academy employees who, in the course and scope of their employment, in good faith and without malice or the reckless disregard for the welfare of a student, administer medication, provided first aid and/or provide emergency medical care for Academy students.

4.9. Concussion Monitoring: Return to Learn

The Academy must appoint a team of people responsible for identifying a return-to-learn or play needs of a student who has suffered a concussion. The team must develop a plan for addressing the needs of the student including, but not limited to (i) guidelines for removal of a student from physical and mental activity when there is suspicion of a concussion, (ii) a notification procedure to educate staff regarding removal from learn or play, (iii) expectations regarding annual medical care update from parents, medical care plan/Academy accommodations in the event of concussion; and (iv) delineation of requirements for safe return-to-learn or play following a concussion.

V. Authority

N.C.G.S. § 116-239.8(b)
N.C.G.S. § 116-239.8(b)(9)
UNC Policy Manual, The Code, Section 502

VI. Original Effective Date

July 30, 2018

VII. Revision Dates

November 6, 2023