SCHOOL NURSE MONTHLY REPORT

SCHOOL: __________________________ MONTH: __________________

OFFICE VISITS: ____________________

Health Records Reviewed: ___________ Incomplete files found: ________

Number of Parent/Guardian notification of non-compliance: ___________

Number of Students added to STI system: __________

Medications Given:

Daily Prescribed Medications: ____________

PRN Medications: ____________

Over-the-Counter Medications sent from home: ___________

Accident Reports:

Student Injury: __________________ Staff Injuries: __________________

Other (specify): __________________________________________________

ASSESSMENTS:

Finger Sticks	Ht & Wt Measurements
B P Screens	Hearing Referrals
BP Referrals	Vision Screens
Posture Screens	Vision Referrals
Posture Referrals	Dental Referrals

PREVENTIVE PROCEDURES:

Head Lice/Nits Screenings: _____________________

Students Identified with head lice/nits: ____________

POSSIBLE COMMUNICABLE DISEASE REFERRALS:

Pinkeye	Impetigo
Ringworm	Scabies
OTHER?

EDUCATION:

Attendance at organized meetings: _____

Classroom presentations: _____

Professional Seminars attended: _______

_____________________________

Signature