School Health Services

Immunization Requirements for Child care and Pre-K

Spinal Screening

The Texas Department of State Health Services (DSHS) Spinal Screening Program was established by the Texas Legislature to detect abnormal spinal curvature in students. School-based spinal screening helps to identify adolescents with abnormal spinal curves and refer them for appropriate follow-up by their primary care physician. Screening can detect scoliosis at an early stage, when the curve is mild and may go unnoticed. Early detection is key to controlling spinal deformities.

The Spinal Screening Policy has been reviewed and updated regarding ages and grades to be screened for the 2018-2019 school year. In compliance with Health and Safety Code, Chapter 37, all children shall undergo screening for abnormal spinal curvature in accordance with the following schedule:

•Girls will be screened two times, once at age 10 (or fall semester of grade 5) and again at age 12 (or fall semester of grade 7).
•Boys will be screened one time at age 13 or 14 (or fall semester of grade 8).

It is incumbent on schools to identify outliers (i.e., children promoted to higher grades or held back) and ensure their screenings align with appropriate ages rather than grades.

ESC-20 offers spinal certification classes throughout the year. Register in Connect20.

Spinal Screening Program Guidelines

Vision and Hearing Screening

The Vision and Hearing Screening Program, Texas Health and Safety Code requires that all children enrolled for the first time in any public, private, parochial, or denominational school or in a Department of Family and Protective Services licensed child-care center and licensed child care home in Texas, or who meet certain grade criteria (specified below), must be screened or have a professional examination for possible vision and hearing problems.

4-years-old by September 1st
Kindergartners
Any other first-time entrants
(4 years* through 12th grade) must be screened within 120 days of admission
1st-, 3rd-, 5th- and 7th--graders must be screened anytime within the school year (preferably within first semester)

Regional Vision, Hearing and Spinal Program Coordinator:
Austin Alonzo
Vision, Hearing and Spinal Screening Program
Department of State Health Services
Phone: (210) 449-1273

Vision and Hearing Program Rules

ESC-20 offers vision certification, hearing certification, and vision/hearing recertification classes throughout the year. Register in Connect20.

Acanthosis Nigricans

(Risk Assessment for Type II Diabetes)

Texas Risk Assessment for Type 2 Diabetes in Children (Acanthosis Nigricans) An online certification training program to perform the Acanthosis Nigricans Screening is available through the University of Texas – Pan American website at the following web link. Information on screening requirements and data submission is also available on the Texas Risk Assessment for Type 2 Diabetes in Children website.

UDCA Training

Guidelines for Training School Employees Who Are Not Licensed Healthcare Professionals

House Bill (HB) 984, 79[R], relates to the care of students with diabetes in schools. The bill mandates that principals identify unlicensed personnel to assist with caring for students during the regular school day or while participating in a school activity. The bill also mandates that the Texas Diabetes Council (TDC) develop guidelines for training school personnel to be diabetes care assistants.

American Diabetes Association Guidelines for Training School Employees who are not Licensed Healthcare Professionals to implement House Bill 984 (79th Legislature) related to the Care of Elementary and Secondary School Students with diabetes.

Resources for implementing HB 984.

ESC-20 offers UDCA training several times throughout the school year. Register in Connect20.

Bloodborne Pathogen Control

As a result of legislation passed in 1999, Texas public school districts are required to implement bloodborne pathogen exposure control plans. The Department of State Health Services (DSHS) School Health Program compiled information and resources to assist public school districts in adapting policies to ensure compliance with Title 25, Part 1, Chapter 96 (Bloodborne Pathogen Control) of the Texas Administrative Code (§§96.101, 96.201-96.203, 96.301-96.304, 96.401-96.402, 96.501, 96.601) and Chapter 81 of the Health & Safety code (§§ 81.301- 81.306).

Click to access the resources.

Resources

Texas Guide to School Health Programs

Texas School Nurse Consultant

Texas School Nurse Organization

National Association of School Nurses

School Health Services FAQ

Vision and Hearing Screening Certifications

How do I register for a vision and hearing certification course?

Who leads the vision and hearing certification courses?

Who can become certified to conduct vision and hearing screening?

The Texas Department of State Health Services requires individuals to either have a GED or High School Diploma in order to complete the training course to become a certified DSHS screener. LEAs may send individuals from their districts who meet these qualifications to become certified DSHS screeners and assist with conducting the vision and hearing screenings on campus.

LEAs may also accept screening results from licensed professionals, such as optometrists and ophthalmologists, who conduct screenings according to their professional standards.

Texas Administrative Code Rule §37.27Texas Administrative Code (state.tx.us)

What ages/grades are vision and hearing screenings required?

The following age/grades must receive vision and hearing screening:

Screened within the first 120 days of admission:

4-years-old by September 1st
Kindergartners
Any students entering school for first-time (4 years through 12th grade)

Screened within the School Year (preferable within first semester):

Grades: 1st, 3rd, 5th, and 7th

Handout: Vision Hearing and Spinal Screening Requirements (texas.gov)

What eye charts are approved to test for visual acuity?

Is photoscreening allowed?

Photoscreening devices may be used to conduct vision screening on children age 5 and younger, as well as on any individual with disabilities who does not respond well to other allowable screening methods.

Photoscreening does not test for visual acuity, therefore when screening children age 6 and older who do not have a disability the use of an approved eye chart to test visual acuity is required.

Texas Administrative Code RULE §37.23 Texas Administrative Code (state.tx.us)

Recertification

How long are my vision and hearing certifications valid for?

Reporting

Where do I report my vision and hearing screening results?

When is the report due?

Where can I learn more about the vision and hearing screening requirements?

Spinal Screening Certification

How do I register for a spinal certification course?

Who leads the spinal certification courses?

Who can become certified to conduct spinal screening?

The Texas Department of State Health Services requires individuals to either have a GED or High School Diploma in order to complete the training course to become a certified DSHS screener. LEAs may send individuals from their districts who meet these qualifications to become certified DSHS screeners and assist with conducting the spinal screenings on campus.

Texas Administrative Code Rule §37.146 Texas Administrative Code (state.tx.us)

I am a Registered Nurse (RN) is spinal certification required?

The Texas Department of State Health Services specifies that licensed professionals may conduct spinal screening assessments without prior completion of a certification course if their education included physical assessment, this includes: Physicians (MD/DO), Nurse Practitioners, Registered Nurses, Physicians Assistants, Chiropractors, and Physical Therapists. These individuals may choose to attend a spinal screening certification course if desired for additional practice and guidance on spinal assessment in the school setting.

What ages/grades are spinal screenings required?

The following age/grades must receive spinal screening:

Girls – Required to be screened twice

Age 10 – or fall semester of 5th grade and
Age 12 – or fall semester of 7th grade

Boys – Required to be screened once

Age 13 or 14 - or fall semester of 8th grade

Note: Schools must identify any students who do not fall into the grade category (i.e. student held back or promoted to different grade levels) and ensure they receive screening at the appropriate age.

Handout: Vision Hearing and Spinal Screening Requirements (texas.gov)

Reporting

Where do I report my spinal screening results?

When is the report due?

Recertification

How long is my spinal certification valid for?

Is there a recertification course for spinal screening?

Where can I learn more about the spinal screening requirements?

Unlicensed Diabetes Assistant Training (UDCA)

What is the requirement for Unlicensed Diabetes Assistants (UDCA)?

How many UDCAs are required per campus?

Who can lead the UDCA training for school employees?

When should the training be conducted?

How often is the training required?

Where can I find out more information regarding the UDCA training content?

Acanthosis Nigricans: Texas Risk Assessment for Type 2 Diabetes in Children (TRAT2DC)

What is screening for acanthosis nigricans?

Acanthosis nigricans is a skin marker that is associated with high levels of insulin and insulin resistance. The presence of this marker on the skin is considered a risk factor for the development of chronic diseases including Type 2 Diabetes. If a student has the acanthosis nigricans skin marker, additional assessments of blood pressure, body mass index (BMI), and BMI percentile are conducted. TRAT2DC: Risk Assessment Background (utrgv.edu)

What ages/grades must be screened?

When are the results of the acanthosis nigricans screening due?

How do I receive training on conducting screening for acanthosis nigricans?

Where can I get additional information on acanthosis nigricans?

Immunizations

Where do I locate the K-12 immunization requirements?

The current K-12 immunization requirements can be found on the Texas Department of State Health Services Texas School and Child Care Immunization webpage: Requirements | Texas DSHS

The state legislature determines Texas schools' and childcare facilities' immunization requirements. Texas Department of State Health Services sets the requirements and works with the Texas Education Agency to implement those requirements. These rules are meant to keep everyone healthy and prevent the spread of diseases. It is important to note that there are different requirements for students entering Pre-K and Kindergarten. Texas K-12 Immunization Requirements & Texas Pre-K Immunization Requirements

How often do the K-12 immunization requirements change?

When is the Annual Report of Immunization Status due?

The Texas Department of State Health Services sends out information to LEAs at the start of each school year regarding the submission of the Annual Report of Immunization Status. Typically, LEAs are required to select an assessment date to report immunization data between the last Friday in October and the second Friday in December. Generally, the deadline for submitting immunization data is the second Friday in December.

Where is the Annual Report of Immunization Status data submitted?

How long can a student attend school if he/she does not have the required immunizations?

In Texas, students who are not up-to-date on all of the required immunizations are not allowed to enroll and attend school. The only exceptions are if the student either meets the qualifications allowing for provisional enrollment or if the student has a current conscientious exemption form on file.

If the student has started a vaccine series, the student may be provisionally enrolled and attend school as long as the student continues progressing forward in the series as medically feasible.

What is provisional enrollment?

Is provisional enrollment 30 school days or 30 calendar days?

What students are eligible to receive provisional enrollment?

The following students may be enrolled in school provisionally:

Students who are homeless or in foster care;
Students who are transferring from another Texas public or private school;
Students who are military dependents of an individual who is on active duty with the armed forces of the United States
Students who are in-progress receiving the required immunizations series, to remain enrolled the student must receive the following doses in the vaccine series on schedule and as medically feasible.

What are allowable reasons for individuals to obtain exemption from the immunization requirements?

The Texas Administrative Code Rule §97.62 allows individuals to obtain exemptions from immunization requirements for the following reasons:

Medical contraindications;
Reasons of conscience, including a religious belief;
Active duty with the armed forces of the United States – this applies to active-duty military only, not to dependents of active-duty service members.

Texas Administrative Code (state.tx.us)

How does a parent or guardian obtain a conscientious exemption for immunizations form?

A parent or guardian may submit a request in writing via mail or in-person to the Texas Department of State Health Services or electronically through a secure online website: CO Request (texas.gov).

Additional information on the process for requesting the exemption affidavit can be found on the Texas Department of State Health Services website at the following web address: Obtaining Exemptions to Texas School Immunization Requirements

Does the form have to be notarized?

Can a copy of the vaccine exemption affidavit be submitted to the school?

How long is the conscientious exemption for immunizations form valid for?

Can a student enroll in school if he/she does not have the required immunizations and it is not eligible for provisional enrollment?

Can a LEA make a local decision to allow students to enroll in school despite being delinquent on vaccinations?

No, the Texas Department of State Health Services rules do not allow a student to enroll in school until immunization records are provided showing, either:

the student has received the required immunizations.
the student has a current conscientious exemption on file and follow all instructions from Texas Immunization Exemptions | Texas DSHS; OR
the student is entitled to provisional enrollment.

Can the LEA accept immunization records from Mexico and/or other countries?

Yes, LEAs may accept immunizations that were provided in Mexico. The CDC developed the Binational Immunization Tool to provide information on immunizations received in Mexico vs. the United States. This tool can be downloaded at the following web address: 2016 Binational Immunization Resource Tool for Children from Birth through 18 Years (slcc.edu).

In addition, the CDC published a link to a non-profit immunization advocacy resource to assist with translating vaccines into other languages, which can be accessed at the following web address: Translations | Immunize.org

The CDC has a valuable resource titled, "The Epidemiology and Prevention of Vaccine-Preventable Diseases", a.k.a. the "Pink Book," which provides healthcare professionals with the most comprehensive information on routinely used vaccines and the diseases they prevent. Table of Contents | Pink Book | CDC

A very useful and frequently utilized section of the Pink Book is, Appendix B: Vaccines | Pink Book | CDC; It provides comprehensive information about vaccines available in the United States.

Where can I find more information on school immunization requirements in Texas?

School Nursing

Are school nurses required in Texas?

If a LEA hires a school nurse, does it matter if the individual is a Registered Nurse (RN) or Licensed Vocational Nurse (LVN)?

It is important for LEAs to be familiar with the Texas Board of Nursing Scopes of Practice for RNs and LVNs. LVNs have a directed scope of practice under the supervision of a registered nurse, advanced practice registered nurse, physician, physician assistant, podiatrist, or dentist. According to the Texas Board of Nursing, when LVNs are utilized in the school setting they should be under the supervision of the RN. The RN is responsible for assigning activities to the LVN that are within the LVN's educational preparation and demonstrated competency to provide.

The RN needs to consider how closely they can supervise the LVN in the school setting and how the RN will direct, guide, and influence the outcome of the LVN’s performance and respond to any situations where the LVN needs onsite supervision. More information on the Role of LVNs and RNs in School Health can be found on the Texas Board of Nursing website at the following web address: Texas Board of Nursing - Practice - Nursing Practice

Where can a LEA access a copy of the RN and LVN scope of practice?

How is a school nurse defined in the Texas Administrative Code?

The Texas Administrative Code §153.022(a)(1)(D) defines the minimum salary schedule for certain professional staff, in these guidelines, a school nurse is an educator employed to provide full-time nursing and health care services and who meets all the requirements to practice as a registered nurse (RN) pursuant to the Nursing Practice Act and the rules and regulations relating to professional nurse education, licensure, and practice and has been issued a license to practice professional nursing in Texas.

Texas Administrative Code (state.tx.us)

Where can a school nurse find additional information on School Health Services and resources for practice?

The Texas Department of State Health Services has developed a comprehensive School Health Services website, which includes school nursing practice resources, DSHS-School Nurse Notes, Texas Guide to School Health Services, and a detailed guidebook on medication administration.

School Health Services (texas.gov)

The Texas School Nurse Organization (TSNO) and the National Association of School Nurses (NASN) are professional organizations that support the practice of school nurses. The TSNO and NASN websites include resources, toolkits, and publications to support school nurses in their roles.

TSNO Home - Texas School Nurses Organization (txsno.org)

Home - National Association of School Nurses (nasn.org)

Medication

Who can administer medication to students?

The Texas Education Code §22.052 provides civil immunity for school district employees when administering medication according to the LEA’s adopted medication administration policies. In accordance with the school district policies, the superintendent or campus principal can assign medication administration to school employees who are not healthcare professionals.

EDUCATION CODE CHAPTER 22. SCHOOL DISTRICT EMPLOYEES AND VOLUNTEERS (texas.gov)

Who can administer medications when the student is participating in a field trip or other off-site, school-related activity?

Similar to on-campus medication administration, the superintendent or campus principal may assign the task of medication administration to a school employee to provide the medication to the student off-site. Procedures for handling the medication off-site, documenting medication administered, as well as training of employees should be included the LEA medication administration policies.

Are there any medications that students are allowed to possess and self-administer in the school setting?

Yes, according to the Texas Education Code §38.015 a student with asthma or anaphylaxis is entitled to possess and self-administer prescription asthma or anaphylaxis medicine while on school property or at a school-related event or activity, if:

the prescription medicine has been prescribed for that student as indicated by the prescription label on the medicine;
the student has demonstrated to the student's physician or other licensed health care provider and the school nurse the skill level necessary to self-administer the prescription medication, including the use of any device required to administer the medication;
the self-administration is done in compliance with the prescription or written instructions from the student's physician; and
a parent provides to the school:
- a written authorization from the parent, for the student to self-administer the prescription medicine; and
- a written statement from the student's physician that states:
  - the student has asthma or anaphylaxis and is capable of self-administering the prescription medicine;
  - the name and purpose of the medicine;
  - the prescribed dosage for the medicine;
  - the times at which or circumstances under which the medicine may be administered; and
  - the period for which the medicine is prescribed.
  - The physician's statement must be kept on file at the school.

EDUCATION CODE CHAPTER 38. HEALTH AND SAFETY (texas.gov)

In addition, the Health and Safety Code §168.008 states that a student with diabetes, in accordance with the student’s individualized health plan (IHP), may attend to the management and care of his/her diabetes, which may include:

performing blood glucose level checks;
administering insulin through the insulin delivery system the student uses;
treating hypoglycemia and hyperglycemia;
possessing on the student's person at any time any supplies or equipment necessary to monitor and care for the student's diabetes; and
otherwise attending to the management and care of the student's diabetes in the classroom, in any area of the school or school grounds, or at any school-related activity.

HEALTH AND SAFETY CODE CHAPTER 168. CARE OF STUDENTS WITH DIABETES (texas.gov)

Can a LEA administer over the counter (OTC) medications?

A local school board may choose to adopt a policy to allow for the administration of OTC medications. It is recommended that any policies regarding medication administration comply with the Texas Education Code §22.052, including a written request from a parent/guardian to administer the medication and the medication being administered from the original, properly labeled container.

EDUCATION CODE CHAPTER 22. SCHOOL DISTRICT EMPLOYEES AND VOLUNTEERS (texas.gov)

Where can I find additional information on medication administration in the school setting?

Cardiopulmonary Resuscitation (CPR) and Automated External Defibrillators (AEDs)

What staff must be certified in CPR and First Aid?

The Texas Education Code §33.086 states the following individuals must be certified in CPR and First Aid: A school district employee who serves as the head director of a school marching band or as the head coach or chief sponsor for an extracurricular athletic activity, including cheerleading, sponsored or sanctioned by a school district or the University Interscholastic League must maintain and submit to the district proof of current certification in first aid and cardiopulmonary resuscitation issued by the American Red Cross, the American Heart Association, or another organization that provides equivalent training and certification.

EDUCATION CODE CHAPTER 33. SERVICE PROGRAMS AND EXTRACURRICULAR ACTIVITIES (texas.gov)

Additional staff at the school district may be required to maintain certification in CPR and First Aid related to health care licenses/certifications (i.e. Registered Nurse, Athletic Trainer)

Are there requirements on offering CPR and automated external defibrillator (AED) training?

The Texas Education Code §28.902 states that a school district must annually make available to district employees and volunteers instruction in CPR and the use of an AED. In addition, each school nurse, assistant school nurse, athletic coach or sponsor, physical education instructor, marching band director, cheerleading coach, and any other school employee specified by the commissioner and each student who serves as an athletic trainer must participate in the instruction in the use of an AED. These individuals must also receive and maintain certification in the use of an AED from the American Heart Association, the American Red Cross, or a similar nationally recognized association.

EDUCATION CODE CHAPTER 22. SCHOOL DISTRICT EMPLOYEES AND VOLUNTEERS (texas.gov)

Are LEAs required to have AEDs?

Yes, the Texas Education Code §38.017 requires each school district to have at least one AED available at each campus in the district. In determining the location to store the campus AED, the principal of the campus shall consider the primary location on campus where students participate in athletic activities.

Each LEA shall ensure the presence of at least one campus/district employee at each location at which an AED is required at any time a substantial number of district students are present at the location.

EDUCATION CODE CHAPTER 38. HEALTH AND SAFETY (texas.gov)

Are LEAs required to have AEDs at University Interscholastic League (UIL) athletic practices and competitions?

Yes, the Texas Education Code §38.017 requires a campus AED be readily available during any University Interscholastic League athletic competition held on the campus.

To the extent practicable, each LEA, shall make reasonable efforts to ensure that an AED is available at each UIL athletic practice held at a district campus.

Each LEA, shall determine the extent to which an AED must be available at each UIL athletic competition held at a location other than a district campus. The determination must be based on relevant medical information and whether emergency services personnel are present at the athletic competition under a contract with the school district.

EDUCATION CODE CHAPTER 38. HEALTH AND SAFETY (texas.gov)

Are students required to complete CPR training prior to graduation?

Does the student training have to result in certification?

Must the student training include a hands-on (psychomotor) component?

Who may instruct the CPR training for students?

The TAC §74.38(c) specifies the following individuals may instruct the CPR training for students: emergency medical technicians, paramedics, police officers, firefighters, representatives of the American Heart Association or the American Red Cross, teachers, other school employees, or other similarly qualified individuals to provide CPR instruction and training under this section. Except as specified in subsection (d) of this section, an instructor of this training is not required to be certified in CPR.

Does completion of the required CPR training need to be documented on the student’s transcript?

Yes, the Texas Administrative Code (Title 19, Chapter 74, Subchapter A, 74.5(j)) states: A student who completes the required instruction in cardiopulmonary resuscitation (CPR) as specified in §74.38 of this title (relating to Requirements for Instruction in Cardiopulmonary Resuscitation (CPR)) in Grade 9, 10, 11, or 12 shall have completion of the CPR instruction clearly indicated on the academic achievement record.

TAC §74.5: Texas Administrative Code (state.tx.us)

Bleeding Control Training (STOP the Bleed)

Which staff are required to receive bleeding control training?

The Texas Education Code, §38.030 requires that agency-approved training on the use of a bleeding control station in the event of an injury to another person be provided to the following LEA staff:

each school district peace officer or school security personnel employed who provides security services at the campus;
each school resource officer who provides law enforcement at the campus; and
all other district or school personnel who may be reasonably expected to use a bleeding control station

EDUCATION CODE CHAPTER 38. HEALTH AND SAFETY (texas.gov)

Is the bleeding control training for staff an annual requirement?

Are students required to receive training on STOP the Bleed?

What bleeding controlled training courses are approved for use by the Texas Education Agency (TEA)?

Where should bleeding control stations at campuses be located?

Seizure Recognition and Training

Are school nurses required to receive training on seizures?

Are school district staff required to receive training on seizures?

Is the training required annually?

The Texas Education Code §38.033 does not state the frequency the training on seizures is required by school nurses and school personnel. The agency is charged with the adoption of rules for the implementation of TEC §38.033, which may provide requirements for training frequency. At this time the rules have for implementation have not been adopted, thus training frequency is currently a local decision.

Where can I find the list of agency-approved seizure recognition trainings?

Individualized Health Plans (IHPs)

What is an Individualized Health Plan (IHP)?

Who can develop an IHP?

The licensed registered nurse (RN) should develop the IHP. In the development of the IHP, the RN can utilize information provided by the student, parents, teachers, and other members of the LEA team who support the student throughout the school day.

Note, in Texas, licensed vocational nurses (LVNs) cannot perform independent assessments as the LVN has a directed scope of practice under supervision; therefore, the LVN cannot develop IHPs for students with health care needs. The LVN may assist in the implementation of the IHP under supervision.

How does a LEA know if a student requires a IHP?

Where can I find additional resources and templates on IHPs?

Head Lice

Are schools required to send students home who have head lice?

No, there is not a state law nor public health requirement to exclude children with head lice or nits (lice eggs) from school. Each LEA may set local policies and procedures regarding head lice if desired. The Texas Department of State Health Services encourages LEAs to ensure any policies regarding head lice do not cause children to miss class unnecessarily nor encourage the embarrassment or isolation of students with repeated cases of head lice.

For additional guidance and considerations on the development of school policies regarding head lice and nits, LEAs are encouraged to review the Texas Department of State Health Services website, Managing Head Lice in School Settings and at Home: Setting Policies for School Districts. Managing Head Lice (Pediculosis) in School Settings and at Home (texas.gov)

Am I required to notify parents regarding cases of head lice on an elementary campus?

Yes, the Texas Education Code §38.031 requires the board of trustees of an independent school district to adopt a policy that requires a school nurse of a public elementary school who determines or becomes aware that a child enrolled in the school has lice to provide written or electronic notice of that fact to both:

(1) The parent of the child with lice (as soon as practicable but not later than 48 hours after becoming aware of that fact); and
(2) The parent of each child assigned to the same classroom as the child with lice not later than the fifth school day after the date of becoming aware of that fact.

EDUCATION CODE CHAPTER 38. HEALTH AND SAFETY (texas.gov)

Can I send an electronic notice if there is a case of head lice on campus?

Do head lice carry disease?

Where can I find more information on head lice?

Additional information on head lice can be found at the following web addresses:

Texas Department of State Health Services: Managing Head Lice in School Settings and at Home Managing Head Lice (Pediculosis) in School Settings and at Home (texas.gov)
1. Includes handouts and downloadable fact sheets in English and Spanish.
National Association of School Nurses: Head Lice Management in Schools: Head Lice Management in Schools - National Association of School Nurses (nasn.org)
American Academy of Pediatrics – Pediatrics Journal Article: Head Lice Head Lice | American Academy of Pediatrics (aappublications.org)

HIPAA

What is the difference between HIPAA and FERPA?

The Health Information Portability Accountability Act, HIPPA, are federal laws regarding the disclosure of confidential health and medical information. Detailed information on HIPAA can be found on the U.S. Department of Health and Human Services website at the following web address: Summary of the HIPAA Privacy Rule | HHS.gov

The Family Education Rights and Privacy Act, FERPA, are federal laws that protect the privacy of student records. Detailed information on FERPA can be found on the United States Department of Education website at: handout_hipaaferpa.pdf (ed.gov), and on the CDC website at Health Information & Privacy: FERPA and HIPAA | Public Health Law | CDC.

The American Academy of Pediatrics has summarized these two similar, but differing federal laws in this published article. HIPAA and FERPA Basics

Where can a LEA get more information on how HIPAA applies in a school setting?

The HIPAA Privacy Rules apply to covered entities, which individual health care plans, clearinghouses, and providers who transmit health information electronically. It is possible for a LEA to be considered a “covered entity” if, for example, the LEA processes medical claims for third parties or electronic transactions for payment (i.e., Medicaid, SHARs).

LEAs are encouraged to review the resources below for more detailed guidance on HIPAA in the school setting and consult with their legal counsel to determine how the HIPAA Privacy Rules apply to their LEA.

Texas Department of State Health Services: HIPAA School Health Information website School Health Information (texas.gov)
Comparison of FERPA and HIPAA Privacy Rule for Accessing Student Health Data Comparison of FERPA and HIPAA Privacy Rule | State Public Health | ASTHO

Health Records

What LEA staff are allowed access to student health/medical records?

Are parents/guardians allowed access to student health/medical records?

Where can a school find information on how long student health records must be maintained?

Epinephrine

Is a LEA allowed to stock unassigned epinephrine autoinjectors?

Yes, the Texas Administrative Code Rule §37.602 and the Texas Education Code §38.208 allows a school district, open-enrollment charter school, or private school to adopt and implement a written policy regarding the maintenance, administration, and disposal of unassigned epinephrine auto-injectors at each school campus.

Texas Administrative Code (state.tx.us)

EDUCATION CODE CHAPTER 38. HEALTH AND SAFETY (texas.gov)

Is a LEA required to stock epinephrine?

What staff training is required if a LEA adopts an unassigned epinephrine auto-injector policy?

The Texas Education Code §38.210 requires each LEA that adopts an unassigned epinephrine auto-injector policy to provide training school personnel and school volunteers in the administration of an epinephrine auto-injector. The training must include information on:

recognizing the signs and symptoms of anaphylaxis;
administering an epinephrine auto-injector;
implementing emergency procedures, if necessary, after administering an epinephrine auto-injector; and
properly disposing of used or expired epinephrine auto-injectors; and

EDUCATION CODE CHAPTER 38. HEALTH AND SAFETY (texas.gov)

How often is the training on epinephrine auto-injectors required?

Can a physician provide a LEA with a standing order for epinephrine auto-injectors?

Yes, the Texas Education Code §38.211 allows a physician or person who has been delegated prescriptive authority to prescribe epinephrine auto-injectors in the name of a LEA. The standing order under is not required to be patient-specific, and the epinephrine auto-injector may be administered to a person without a previously established physician-patient relationship. Additional details regarding the provisions of the standing order can be read in the Texas Education Code §38.211.

EDUCATION CODE CHAPTER 38. HEALTH AND SAFETY (texas.gov)

What reporting is required if epinephrine is administered on campus?

A school is required to submit a report no later than the 10th business day after the date school personnel or a school volunteer administers an epinephrine auto-injector in accordance with the unassigned epinephrine auto-injector policy.

The report must be submitted to the following groups:

school district, charter holder if the school is an open-enrollment charter school, or governing body of the school if the school is a private school;
the prescribing physician of the epinephrine auto-injector, and;
the commissioner of the Texas Department of State Health Services.

How does a school submit a report to the commissioner of the Texas Department of State Health Services (DSHS)?

Asthma Medication

Is a LEA required to stock asthma medication?

If a LEA has a policy to maintain and administer asthma medication, which students may be given the medication?

According to the Texas Education Code §38.208(b-1) if a policy is adopted, the policy must provide that the school nurse may administer prescription asthma medicine to a student only if the school nurse has written notification from a parent or guardian of the student that the student has been diagnosed as having asthma and stating that the school nurse may administer prescription asthma medicine to the student. In addition, a school nurse may administer the prescription asthma medicine only at a school campus.

Can a physician provide a LEA with a standing order for asthma medication?

Yes, the Texas Education Code §38.211 allows a physician or person who has been delegated prescriptive authority to prescribe asthma medication in the name of a LEA. The standing order under is not required to be patient-specific. The asthma medication may be given to an individual reasonably believed to be experiencing a symptom of asthma who has written notification from a parent or guardian that the student has been diagnosed as having asthma and stating the school nurse may administer prescription asthma medicine to the student. Additional details regarding the provisions of the standing order can be read in the Texas Education Code §38.211.

EDUCATION CODE CHAPTER 38. HEALTH AND SAFETY (texas.gov)

Where can a LEA learn more about Senate Bill (SB) 294, 88[R] - relating to the use of medication designated for treatment of respiratory distress on public and private school campuses?

Food Allergies

Is a LEA required to have a plan for food allergies?

Yes, the Texas Education Code §38.0151 requires the board of trustees of each school district and the governing body of each open-enrollment charter school to adopt and administer a policy for the care of students with a diagnosed food allergy at risk for anaphylaxis based on guidelines developed by the Commissioner of the Texas Department of State Health Services (DSHS) in consultation with the legislated SB-52 Ad-Hoc Committee.

How often is a LEA required to review/revise its policy for the care of students with a diagnosed food allergy at risk of anaphylaxis?

Where can a LEA locate a copy of the guidelines for the care of students with a diagnosed food allergy at risk for anaphylaxis developed by the Commissioner and legislated Ad-Hoc committee?

Are LEAs required to ask parents/guardians if their children have any food allergies when enrolling the students in school?

Yes, the Texas Education Code §25.0022 requires LEAs, upon enrollment of a child to a public school, to request a parent/guardian disclose whether the child has a food allergy or a severe food allergy that, in the judgment of the parent/guardian, should be disclosed to the district to enable the district to take any necessary precautions regarding the child's safety; and specify the food to which the child is allergic and the nature of the allergic reaction. The request can be made through a form or other method determined by the LEA.

EDUCATION CODE CHAPTER 25. ADMISSION, TRANSFER, AND ATTENDANCE (texas.gov)

Where should a LEA file information provided by the parent/guardian regarding a student’s food allergy?

The Texas Education Code §25.0022(d-f), specifies the following

Information provided by a parent/guardian regarding a child's food allergy, shall be retained in the child's student records, but may not be placed in the health record maintained for the child by the school district.
Documentation the LEA receives from a physician regarding a food allergy shall be placed in the health record maintained for the child by the LEA.
A registered nurse may enter appropriate notes about a child's possible food allergy in the health record maintained for the child by the LEA, including a notation that the child's student records indicate that a parent has notified the LEA of the child's possible food allergy.

EDUCATION CODE CHAPTER 25. ADMISSION, TRANSFER, AND ATTENDANCE (texas.gov)

Where can a LEA locate Emergency Care Plans for Students with Food Allergy templates?

Concussions

What is a Concussion Oversight Team (COT)?

Who should be on the Concussion Oversight Team (COT)?

The Texas Education Code §38.154 states that each COT must include at least one physician and to the extent practicable one or more of the following: athletic trainer, advanced practice nurse, neuropsychologist, or a physician assistant. If the LEA employs an athletic trainer, the athletic trainer must be on the COT; if the LEA employs a school nurse, the school nurse may be on the COT if requested by the school nurse. All members of the COT must have received training in the evaluation, treatment, and oversight of concussions at the time of appointment/approval as a member to the COT.

What is the role of the Concussion Oversight Team (COT)?

The COT is responsible for the development of a return-to-play protocol for the LEA, based on peer-reviewed scientific evidence, for a student's return to interscholastic athletics practice or competition following the force or impact believed to have caused a concussion. Requirements for return-to-play are further outlined in the Texas Education Code §38.157.

EDUCATION CODE CHAPTER 38. HEALTH AND SAFETY (texas.gov)

Who is required to receive training over concussions?

The Texas Education Code §38.158 specifies that the following individuals, who serve as members of the Concussion Oversight Team (COT), must take an approved course that is at least two-hours in duration once every two years:

a coach of an interscholastic athletic activity;
a school nurse who serves as a member of a concussion oversight team;
a licensed health care professional (including an athletic trainer) who serves as a member of a concussion oversight team (LEA employee and volunteers)

Additional Notes on Training Requirements:

A physician who serves as a member of a concussion oversight team shall, to the greatest extent practicable, periodically take an appropriate continuing medical education course in the subject matter of concussions.
A school nurse or licensed health care professional who is not in compliance with the training requirements under this section may not serve on a concussion oversight team in any capacity.

EDUCATION CODE CHAPTER 38. HEALTH AND SAFETY (texas.gov)

Where can I find more information on Concussion requirements in Texas?

Bloodborne Pathogens

Are LEAs required to follow bloodborne pathogen control standards?

Yes, the Texas Administrative Code §96.201 provides minimum bloodborne pathogen standards that apply to a governmental unit that employs employees who:

provide services in a public or private facility providing healthcare-related services; or
otherwise have a risk of exposure to blood or other potentially infectious material containing bloodborne pathogens in connection with exposure to sharps.

A public school district clinic is considered a governmental unit and is required to meet the minimum standards. Texas Administrative Code (state.tx.us)

What requirements related to bloodborne pathogens are LEAs required to follow?

Where can I find a copy of the Texas Department of State Health Service’s adopted Exposure Control Plan?

What staff should receive training on bloodborne pathogens?

How frequently do staff need to complete training on bloodborne pathogens?

Should the LEA provide Hepatitis B vaccine to employees?

What must be included in the bloodborne pathogens training for employees?

Where can I find additional information on bloodborne pathogens requirements?

Bloodborne pathogen requirements for LEAs are addressed in the Health and Safety Code §81.307-81.307 and the Texas Administrative Code §96.

HEALTH AND SAFETY CODE CHAPTER 81. COMMUNICABLE DISEASES (texas.gov)

Texas Administrative Code (state.tx.us)

The Texas Department of State Health Services has developed a FAQ regarding Bloodborne Pathogen Control in Texas Schools, which can be found at the following web address: Bloodborne Pathogen Control in Texas Schools FAQs

Sexual Education

What is the role of the SHAC in regards to sexual education curriculum selection?

The Texas Education Code §28.004(c)(3) specifies that the local school health advisory council's duties include recommending appropriate grade levels and methods of instruction for human sexuality instruction.

The Texas Education Code §28.004(e) requires that any course materials and instruction relating to human sexuality, sexually transmitted diseases, or human immunodeficiency virus or acquired immune deficiency syndrome be selected by the board of trustees with the advice of the local school health advisory council.

EDUCATION CODE CHAPTER 28. COURSES OF STUDY; ADVANCEMENT (texas.gov)

Does the human sexuality instruction taught have to be abstinence based?

Yes, the Texas Education Code §28.004(e)(1-5) requires that any course materials and instruction relating to human sexuality, sexually transmitted diseases, or human immunodeficiency virus or acquired immune deficiency syndrome must:

present abstinence from sexual activity as the preferred choice of behavior in relationship to all sexual activity for unmarried persons of school age;
devote more attention to abstinence from sexual activity than to any other behavior;
emphasize that abstinence from sexual activity, if used consistently and correctly, is the only method that is 100 percent effective in preventing pregnancy, sexually transmitted diseases, infection with human immunodeficiency virus or acquired immune deficiency syndrome, and the emotional trauma associated with adolescent sexual activity;
direct adolescents to a standard of behavior in which abstinence from sexual activity before marriage is the most effective way to prevent pregnancy, sexually transmitted diseases, and infection with human immunodeficiency virus or acquired immune deficiency syndrome.
teach contraception and condom use in terms of human use reality rates instead of theoretical laboratory rates, if instruction on contraception and condoms is included in curriculum content.

Can a LEA distribute condoms in connection with the human sexuality instruction?

Are LEAs allowed to separate students based on sex for the human sexuality instruction?

Are LEAs required to notify parents regarding human sexuality instruction?

Yes, the Texas Education Code §28.004(i) requires the school district, before the start of each school year, to provide written notice to parents of the board of trustees' decision regarding whether the district will provide human sexuality instruction to district students. If instruction will be provided, the notice must include:

a summary of the basic content of the district's human sexuality instruction to be provided to the student, including a statement informing the parent of the instructional requirements under state law;
a statement of the parent's right to:
1. review curriculum materials; and
2. remove the student from any part of the district's human sexuality instruction without subjecting the student to any disciplinary action, academic penalty, or other sanction imposed by the district or the student's school; and
information describing the opportunities for parental involvement in the development of the curriculum to be used in human sexuality instruction, including information regarding the local school health advisory council.

Are parents/guardians allowed to opt their students out of participation in human sexuality instruction?

Child Abuse

Are school professionals required to report suspected child abuse or neglect?

Yes, the Texas Family Code, Chapter 261 requires that a professional who has cause to believe that the child has been abused or neglected make a report within 48 hours. A professional may not delegate to or rely on another person to make the report. A professional is anyone licensed or certified by the state or works for an agency or facility licensed or certified by the state and has contact with children as a result of their normal duties, this includes teachers and nurses.

FAMILY CODE CHAPTER 261. INVESTIGATION OF REPORT OF CHILD ABUSE OR NEGLECT (texas.gov)

Are school professionals required to complete training over child abuse?

Yes, the Texas Education Code §38.0041 requires LEAs to provide training to increase awareness of issues regarding sexual abuse, sex trafficking, and other maltreatment of children, including prevention techniques and knowledge of likely warning signs indicating that a child may be a victim of sexual abuse, sex trafficking, or other maltreatment.

EDUCATION CODE CHAPTER 38. HEALTH AND SAFETY (texas.gov)

What school employees are required to participate in the training?

Is human trafficking considered a form of child abuse?

Yes, the Texas Family Code, Chapter 261 includes human trafficking in the definition of child abuse. The Texas Education Code §38.0041 requires LEAs to adopt and implement a policy addressing sexual abuse, sex trafficking, and other maltreatment of children.

FAMILY CODE CHAPTER 261. INVESTIGATION OF REPORT OF CHILD ABUSE OR NEGLECT (texas.gov)

EDUCATION CODE CHAPTER 38. HEALTH AND SAFETY (texas.gov)

Where can a LEA find a list of trainings that meet the requirements of the Texas Education Code §38.0041?

Are there any required postings related to child abuse?

Yes, the Texas Education Code §38.0042 requires each public school and open-enrollment charter school to post a sign in English and in Spanish that contains the toll-free telephone number operated by the Department of Family and Protective Services to receive reports of child abuse or neglect. The sign must be posted in a clearly visible location in a public area of the school that is readily accessible to students.

EDUCATION CODE CHAPTER 38. HEALTH AND SAFETY (texas.gov)

The TEA “No Go Tell” posters may be downloaded in English and Spanish from the TEA Child Abuse Prevention webpage: Child Abuse Prevention an Overview | Texas Education Agency

Where can a LEA find more information on child abuse and human trafficking?

The Texas Education Agency website has additional information on child abuse available at the following web address: Child Abuse Prevention an Overview | Texas Education Agency

The Texas Department of Family and Protective Services has additional information on reporting child abuse on their website at the following web address: Training on Reporting Suspected Abuse or Neglect of a Child (state.tx.us)

The Texas Education Agency website has additional information on human trafficking available at the following web address: Human Trafficking of School-aged Children | Texas Education Agency

Pregnancy Related Services (PRS)

What is Pregnancy Related Services (PRS)?

PRS include the support services provided to a student receives during the prenatal and postpartum pregnancy periods to help the student adjust academically, mentally, and physically and stay in school. These services may be provided to the student during the following time periods:

The student is pregnant and attending classes on a district campus,
A valid medical necessity for confinement occurs during the pregnancy prenatal period, which prevents the student from attending classes on campus, or
A valid medical necessity for confinement during the postpartum pregnancy period prevents the student from attending classes on campus.

Are Pregnancy Related Services required?

What is Compensatory Education Home Instruction (CEHI)?

CEHI provides academic services to the student at home or hospital bedside during the prenatal or postpartum pregnancy periods when a valid medical necessity for confinement prevents the student from attending classes on campus. CEHI must consist of face-to-face instruction by a certified teacher of the district. CEHI is a required component of PRS and must be provided if the district offers PRS.

Where can a LEA find more information on Pregnancy Related Services?

School Health Survey

What is the School Health Survey?

Who should complete the School Health Survey?

When is the School Health Survey due?

Bats

What should a LEA do if they find a bat on a school campus?

What is considered a potential exposure to rabies?

Does a potential exposure to rabies need to be reported?

Where doe a LEA report a potential rabies exposure?

Where can additional information be found on responding to bat incidents in schools?

School Nursing Peer Review

What is nursing peer review?

According to the Texas Occupation Code §303.001(5) "Peer review" means the evaluation of nursing services, the qualifications of a nurse, the quality of patient care rendered by a nurse, the merits of a complaint concerning a nurse or nursing care, and a determination or recommendation regarding a complaint.

Peer Review includes:

the evaluation of the accuracy of a nursing assessment and observation and the appropriateness and quality of the care rendered by a nurse;
a report made to a nursing peer review committee concerning an activity under the committee's review authority;
a report made by a nursing peer review committee to another committee or to the board as permitted or required by law;
implementation of a duty of a nursing peer review committee by a member, an agent, or an employee of the committee; and
the provision of information, advice, and assistance to nurses and other persons relating to:
- the rights and obligations of and protections for nurses who raise care concerns or report under Chapter 301 of the Texas Occupations Code or other state or federal law;
- the rights and obligations of and protections for nurses who request nursing peer review under this chapter;
- nursing practice and patient care concerns; and
- the resolution of workplace and practice questions relating to nursing and patient care.

OCCUPATIONS CODE CHAPTER 303. NURSING PEER REVIEW (texas.gov)

Is a LEA required to have a nursing peer review committee?

May a LEA contract with another entity to provide the nursing peer review process?

What is Safe Harbor?

The Texas Administrative Code Title 22 Rule §217.20 defines safe harbor as a process that protects a nurse from employer retaliation, suspension, termination, discipline, discrimination, and licensure sanction when a nurse makes a good faith request for nursing peer review of an assignment or conduct the nurse is requested to perform and that the nurse believes could result in a violation of the NPA or Board rules.

Safe harbor must be invoked prior to engaging in the conduct or assignment for which nursing peer review is requested, and may be invoked at any time during the work period when the initial assignment changes.

Texas Administrative Code (state.tx.us)

What is Incident Based Peer Review?

The Texas Administrative Code Title 22 Rule §217.19 incident-based nursing peer review focuses on determining if a nurse's actions, be it a single event or multiple events (such as in reviewing up to five (5) minor incidents by the same nurse within a year's period of time), should be reported to the Board or if the nurse's conduct does not require reporting because the conduct constitutes a minor incident that can be remediated. The review includes whether external factors beyond the nurse's control may have contributed to any deficiency in care by the nurse and to report such findings to a patient safety committee as applicable.

Texas Administrative Code (state.tx.us)

Does ESC Region 20 offer a nursing peer review committee for LEAs?

Where can a LEA find more information on the Peer Review Process?

Detailed information on the Peer Review Process, as well as Frequently Asked Questions, can be found on the Texas Board of Nursing website at the following web address: Texas Board of Nursing - Nursing Peer Review FAQ

The Texas Department of State Health Services developed a School Nurse Notes document on the Peer Review Process; this document can be downloaded from the following web address: Peer Review Process-BON DSHS SNN 2.18 pdf.pdf (texas.gov)

Communicable Diseases

Are schools required to report students that have communicable diseases?

Where do I access the current Communicable Disease Chart for schools?

Where do I report Communicable Diseases to?

Suspected or confirmed cases of communicable diseases should be reported to the local or regional health department, contact information by county can be found at the following web address: IDPS | Disease Reporting Contacts (texas.gov)

Reportable conditions in San Antonio and Bexar County are reported to San Antonio Metro Health Department: Reporting Diseases - What & Who (sanantonio.gov)

Miscellaneous School Health Related Questions

Is a LEA required to have a policy on teen dating violence?

Yes, the Texas Education Code 37.0831 requires each LEA to adopt and implement a dating violence policy to be included in the district improvement plan.

The dating violence policy must include a definition of dating violence that includes the intentional use of physical, sexual, verbal, or emotional abuse by a person to harm, threaten, intimidate, or control another person in a dating relationship.
The policy must address safety planning, enforcement of protective orders, school-based alternatives to protective orders, training for teachers and administrators, counseling for affected students, and awareness education for students and parents.

EDUCATION CODE CHAPTER 37. DISCIPLINE; LAW AND ORDER (texas.gov)

Is smoking or the use of e-cigarettes allowed on school property?

No, the Texas Education Code §38.006 requires the board of trustees of a school district to prohibit smoking or using e-cigarettes or tobacco products at a school-related or school-sanctioned activity on or off school property; prohibit students from possessing e-cigarettes or tobacco products at a school-related or school-sanctioned activity on or off school property; and ensure that school personnel enforce the policies on school property.

EDUCATION CODE CHAPTER 38. HEALTH AND SAFETY (texas.gov)