Clinic visit report checklist
Richardson isd
What does this form include?
This form contains 12 sections:
Clinic Environment
- Clinic is a nonhazardous environment (free of spills, clear traffic pattern, body fluids cleaned immediately).
- Emergency Bags are easily accessible and properly stocked.
- Campus crisis plan and white emergency flip chart are available and the role of the nurse is understood.
- Student health concerns are easily identifiable and accessible.
- Does the nurse have an updated notebook/written plan for substitutes to follow?
- Are parent emergency phone numbers easily accessible?
- Is the nurse properly identified as a registered nurse?
- Is the nurse using the most up-to-date forms (special procedure forms, staff training forms, accident reports, etc)?
AED(s)
- Are school AED(s) accessible to all school personnel during all hours (not stored in locked room or cabinet)?
- Are AED location signs posted in the school?
- Is each AED notebook up-to-date regarding the daily/monthly maintenance checks?
- Are the AED pads current (non-expired)?
- Are the correct pad expiration dates listed in the AED notebook?
- Is there a list of current personnel with valid certification expiration dates on the AED sheet?
Medications
- Are medications* stored out of reach of children in a locked cabinet? (*except for epinephrine injectors)
- Are emergency diabetic supplies and anaphylaxis medications easily accessible in a secure but unlocked location?
- Are inhalers stored in a manner that would be easily removed and carried during a fire/other emergency?
- Do all medications have a completed and signed Parent/Physician Authorization to Administer Medications form?
- Are all prescription medications in their original container and properly labeled with a pharmacy label that matches the Parent/Physician Authorization to Administer Medications form?
- Are all OTC meds in their original container and properly labeled with the student's first and last name?
- Are medications being signed off as given with the time and initials of administrator on the RISD Med form?
- Have all personnel administering medications signed off on the Medication Signature sheet?
- Is an up-to-date medication check-off sheet being utilized?
- Pull up this week's medication checklist in Star Student. Compare this checklist with the one being used in the med book. Have all medications been entered into Star Student (student Medication tab)?
Documentation
- Have clinic visits been entered into Star Student?
- Is the nurse maintaining hard copies of the clinic passes and/or sign-in sheets if utilized?
- Have student health conditions been entered into Star Student (Disease tab)?
- Is an EFFECTIVE documentation method in place when the nurse is out of the building?
- Are Individualized Healthcare Plans in place for pertinent students?
- Was the auditor able to review an IHP during the visit?
Immunizations
- Does the nurse have an effective system in place with the office staff for enrolling students (with regard to shot records and health concerns)?
- Does the nurse have a process in place to routinely monitor immunization compliance?
- Are there students enrolled at the campus that have a CO or medical exemption (1M or LM)?
Miscellaneous
- Hearing/Vision/AN screening
- Scoliosis Screening
- Growth & Development / HIV classes
Does the clinic have a functioning...
Clinic Equipment
- Temporal thermometer?
- Oral thermometer?
- Stethoscope (in addition to ones in emergency bags)?
- Nebulizer?
- Pulse Oximeter?
- Large Adult Blood Pressure cuff (in addition to ones in emergency bags)?
- Adult Blood Pressure cuff (in addition to ones in emergency bags)?
- Pediatric Blood Pressure cuff (in addition to ones in emergency bags)?
- Automatic Blood Pressure monitor (optional)?
- Wall mounted Stadiometer?
Reference Materials
- Blood-borne Pathogens Manual
- Community Council Resources
- Davis Drug Guide
- Dermatology
- Drug ID Bible
- Growth & Development materials
- Essentials of Musculoskeletal Injuries
- Medical Dictionary
- Merck Manual
- Health Care Plans for School Nurses
- Health Services Manuals
- Minor Emergencies
- PDR
- Redbook
- Special Procedures (purple spiral)
- Sports First Aid
- Whaley and Whong
- Yellow School Health Emergencies Book
School Nurse
Auditor
Use this template