"Unless exempted for personal, medical, or religious objections as provided in Section 53A-11-302,a student may not attend a public, private, or parochial kindergarten, elementary, or secondary school through grade 12, nursery school, licensed daycare center, child care facility, family care home, or headstart program in this state unless there is presented to the appropriate official of the school a certificate of immunization from a licensed physician or authorized representative of the state or local health department stating that the student has received immunization against communicable diseases as required by rules adopted under Section 53A-11-303.

School districts may not receive weighted pupil unit money for a student unless the student has obtained a certificate of immunization under this section or qualifies for conditional enrollment or an exemption from immunization under Section 53A-11-302".

USIIS (Utah State Immunization Information System) Link

21 Day Conditional Enrollment Letter

Exclusion Letters

Exclusion Notice for Inadequate Immunizations - English

Exclusion Notice for Inadequate Immunizations - Spanish

School Requirements for Immunizations

Order Pink Immunization (USIR) cards

Department of Health Order Form for Record Cards

DSD Warehouse - ENCORE Warehouse item #01024155 (Utah School Immunization Record Card 50/PKG)

Utah Immunization Guide Book Link

Davis County Health Department Clinic Hours

Immunization Rule

Training Modules, Understanding the Utah Immunization Rule

Module I - Laws Admissions and Requirements

Module II - Utah School Immunization Record

Module III - Online Immunization Reporting Procedures

Individualized Health Care Plan Signing Instructions

Encore Health Plan Review & Signing Instructions for Teachers

Steps for Parents to electronically sign IHCP in MyDSD

Medication Policy & Forms

Medication Policy
Medication Administration Authorization Forms

Medication Policy

DSD Medication Administration Policy

DSD Superintendent Medication Letter

Medication Administration Authorization Forms

School Medication Authorization

Asthma Action Plan, Medication Authorization and Self Administration Form

Asthma Medication Authorization Form (Self-Administration) No Action plan

Allergy and Anaphylaxis Emergency Action Plan

Epinephrine Authorization Form

Diabetes Medication Management Orders (DMMO)

Seizure Medication Management Orders (SMMO)

Medication Intake Checklist for Secretary

Printable Posters and Forms

Asthma General Emergency Protocol

CPR Health Room Poster

DSD Diaper Changing Procedure

DSD Pull-Ups Changing Procedure

First Aid for Seizures

First Aid for Seizures for Wheelchair

Food Restriction Poster

Hypoglycemia and Hyperglycemia Poster

Nut Allergy Poster

Oxygen in Use

School Seizure Tracking Log

Stock Epi-Pen Instruction Sheet

Universal Precautions

Recess Guidelines

Guidelines for Indoor Recess (DSD)

Guidance for Indoor Recess (Utah Dept of Health)

Current Air Quality Link

Standards of Care for Handling Outside Food, Special Meal Request Form Link

Standards of Care for Handling Outside Food in the School Setting

Medical Statement to Request Special Meals, Accommodations and Milk Substitutions

Davis Count Health Department: Rules for Approved Food Use in Schools

Student Injury Report

Utah Department of Health - Student Injury Reporting System

Scoliosis

Scoliosis Parent Letter

Scoliosis Parent Letter - Spanish

5th Grade Maturation

Disposable Sharps Containers

Field Trip Forms

Field Trip Guidelines and Health Room Field Trip Notification Form

Baggie Labels for Field Trips

Elementary School Field Trip Form

Duties & Responsibilities

Duties of the Health Clerk

Health Clerk, 504+ and 504 TA Responsibilities at School

Health Room Forms

First Aid Supply Inventory Tracking Form

Health Clerk Data Summary

Health Room Logbook

Health Room Supply Order Form

RN/UAP Weekly Review

Health Concerns Forms & Posters

Seizure Tracking Log

Hypoglycemia & Hyperglycemia Posters

Diabetes Education Program (DEP)

Levels 1-4 Certificates and Levels 1-5 Completion Letters
Log Sheets
Miscellaneous
Quizzes

Levels 1-4 Certificates and Levels 1-5 Completion Letters

Teacher Level 1 Completion Notice

Teacher Level 2 Completion Notice

Level 1 and 2 Completion Certificates

Teacher Level 3 Completion Notice

Teacher level 4 Completion Notice

Level 3 and 4 Completion Certificates

Teacher level 5 Completion Notice

Log Sheets

Pump (Lunch, Recess & PE)

Pump (Lunch Only)

Miscellaneous

Instructions for DEP (Owner's Manual)

Quick List of Tasks in Each Level

Adult Assistant Check List

Diabetes Education Program Booklet

Lunch Carb Count Sheet

Hypo & Hyperglycemia Symptoms Poster

Student Diabetes Smiley Chart

Quizzes

Quiz 5 - Dinner at Home

Training

Allergy Recognition and Treatment
Asthma Recognition and Treatment
CPR/AED/Choking/Good Samaritan
Diabetes
Diabetes Education Program - DEP
Medication - General Overview
Multiple Topic Trainings
Naloxone Narcan
Seizures

Allergy Recognition and Treatment

Allergic Reaction and Anaphylaxis

Asthma Recognition and Treatment

UDOH Asthma Program - PPT

CPR/AED/Choking/Good Samaritan

CPR/AED/Heimlich/Good Samaritan

Diabetes

Diabetes 1 - All School Staff

Diabetes 2 - Works with a student who has Diabetes

Diabetes 3 - Directly helps student manage Diabetes

Diabetes - Student is Independent in Managing

Diabetes Education Program - DEP

Levels 1-4 Certificates and Levels 1-5 Completion Letters
Log Sheets
Parent Packet
Teacher Packet
Miscellaneous
Quizzes

Levels 1-4 Certificates and Levels 1-5 Completion Letters

Teacher Level 1 Completion Notice

Teacher Level 2 Completion Notice

Level 1 and 2 Completion Certificates

Teacher Level 3 Completion Notice

Teacher level 4 Completion Notice

Level 3 and 4 Completion Certificates

Teacher level 5 Completion Notice

Log Sheets

Pump (Lunch, Recess & PE)

Pump (Lunch Only)

Parent Packet

Introduction Letter to Parents

Explanation for Each Task

Parent One Month Trial Letter

Graduation Letter for Parents (at end of one month trial)

Disaster or Emergency Kit Tips

Responsibilities of School Personnel

Snack Kit Suggestions

Who is the Adult Assistant?

Teacher Packet

Introduction Letter for Teachers

Field Trip Tips

Substitute Teacher Responsibility

Teacher Responsibility

Miscellaneous

Instructions for DEP (Owner's Manual)

Quick List of Tasks in Each Level

Adult Assistant Check List

Diabetes Education Program Booklet

Lunch Carb Count Sheet

Hypo & Hyperglycemia Symptoms Poster

Student Diabetes Smiley Chart

Quizzes

Quiz 5 - Dinner at Home

Medication - General Overview

Medication Training PPT

Medication Documentation Encore

Multiple Topic Trainings

Training A - Teachers-Admin-Health Concerns

Training B - Teacher-Admin-Policy-Procedure

Training C - Secretary-Health Concerns

Training D - Secretary-Policies, Protocol

Training E-Basic Medical Training for School Personnel

Naloxone Narcan

Naloxone (Narcan) Administration Training for Secondary Schools

Seizures

Seizures (no rescue meds)

VNS Training

Seizures DSD Nasal Versed Training

Nurse Resources

DSD Nurse Guidebook

USNA

NASN

State Vision Report (Q90)

UDOH EPICC Program

Nurse Practice Act Rule

Our Nurses

Elementary School Nurses
Secondary & Alternative School Nurses
Special Ed Nursing Staff

Elementary School Nurses

Schools: Burton, Columbia, Heritage,
Kay's Creek, Kaysville, Snow Horse

Diane Broadhead, RN
dbroadhead@dsdmail.net
Cell: 801-425-7379

Schools: Clinton, Crestview, Ellison Park, Fremont, Holt, Lakeside, West Point

Marci Christiansen, RN
machristiansen@dsdmail.net
Cell: 801-928-9831

Schools: Bluff Ridge, Parkside, Sunset, Syracuse, West Clinton, Whitsides

Irene Scott, RN
iscott@dsdmail.net
Cell: 801-882-3420

Schools: Adams, Morgan, Mountain View,
South Clearfield, South Weber, Wasatch

Peggy Petersen, RN
ppetersen@dsdmail.net
Cell: 801-433-7470

Schools: Eagle Bay, Farmington, Meadowbrook, Tolman, West Bountiful

Sarah Hoskins, RN
shoskins@dsdmail.net
Cell: 801-989-9732

Schools: Centerville, Reading, East Layton, Taylor, Valley View, Woods Cross

Jana Page, RN
janpage@dsdmail.net
Cell: 801-458-8721

Schools: Adelaide, Foxboro, Odyssey, Orchard, Washington

Lorill Solomon, RN
losolomon@dsdmail.net
Cell: 801-513-7089

Schools: Antelope, Boulton, Bountiful, Holbrook, Muir

Emma Qoroya, RN
eqoroya@dsdmail.net
Cell: 801-888-8665

Schools: Buffalo Point, Cook, Doxey,
Hill Field

Melanie Schenck, RN
mschenck@dsdmail.net
Cell: 801-888-9137

Schools: Canyon Creek, Creekside,
Endeavor, Vae View

Jennifer Clausse, RN
jclausse@dsdmail.net
Cell: 801-928-9796

Schools: King, Knowlton, Lincoln,
Windridge, FEC Preschool

Shana Robbins, RN
srobbins@dsdmail.net
Cell: 801-888-8762

Schools: Layton, Sand Springs,
Oak Hills, Stewart

Heidi Diediker, RN
hdiediker@dsdmail.net
Cell: 801-529-7458

Secondary & Alternative School Nurses

Schools: Centennial Jr, Centerville Jr, Central Davis Jr, Fairfield Jr, Farmington Jr, Kaysville Jr, North Davis Jr, South Davis Jr, Clearfield High, Davis High, Layton High, Northridge High, Viewmont High

Kathy Pozzuoli, RN
kpozzuoli@dsdmail.net
Office: 801-402-5188
Cell: 801-425-7380

Schools: Bountiful Jr, Legacy Jr, Millcreek Jr, Mueller Park Jr, North Layton Jr, sunset Jr, Syracuse Jr, West Point Jr, Bountiful High,
Syracuse High, Woods Cross High

Jen Nielsen, RN
jennielsen@dsdmail.net
Cell: 801-809-8328

Schools: Mountain High
Renaissance Academy

Tracy Highley, RN
thigley@dsdmail.net
Office: 801-402-0466
Cell: 801-628-8249

Special Ed Nursing Staff

Catherine Sparks, RN
csparks@dsdmail.net
Office: 801-402-5953
Cell: 801-888-9214
Fax: 801-402-5925

Helen Hunter, RN
hhunter@dsdmail.net
Office: 801-402-5954
Cell: 801-808-9511
Fax: 801-402-5925

Sheree Bennion, RN
sbennion@dsdmail.net
Office: 801-402-5952
Cell: 801-703-7444
Fax: 801-402-5951

Georgette Haacke
SPED Nurse TA
ghaacke@dsdmail.net
Office: 801-402-5950

Traumatic Brain Injury

DSD Traumatic Brain Injury Support Team

Health Care Plans

Sharing Student Health Information- It is important to list any health information pertinent to the school setting in the “Health Problem” space on the Registration/Demographic Card. If there are no health concerns, put a line through the “Health Problem” box. If the health status changes during the school year, ask the office to update the registration card and inform the school nurse. Some health conditions may require an Individualized Health Care Plan.

Students with health issues requiring assistance may need an Individualized Health Care Plan

- A school nurse and guardian will work together to form a plan of care that will be in place for a 12-month period or until modified.

- Please ensure your student’s health needs are taken care of until the guardian, teacher and nurse sign an Individualized Health Care Plan.

- You may view and sign your student’s current plan by using your myDSD login. (instructions found in link below)

Steps for Parents to Electronically Sign Health Care Plans