TRAINING PACKET

TRAINING PACKET1TABLE OF CONTENTSPage(s)Table of Contents....2Washington State Migrant Health Procedure.....3-5Migrant Physical exam and Health Data Reporting Form..6Migrant Physical Examination Summary Form..7Migrant Physical Exams: A Guide for Parents (English & Spanish)...8-9Physical Examination Requirements (English & Spanish)......10Migrant Physical Examination Check List.....11Record of Student Health History (English & Spanish)...12-15Parent Interview/Health History (English & Spanish).....16Current Health Concerns Form...17Provide the Following Documents if Available........18Referral Note, Medical (English & Spanish)....19Dental Outcomes......20Referral Note, Dental (English & Spanish)......21Form Distribution Protocol..22Migrant Dental Screenings (English & Spanish)....23Parent Notification of Exam (English & Spanish)..24Sample Letter to Parents (English & Spanish)....25-26Screening Room Set-up....27Tuberculin Skin Test (TST) Recommendations for Children...28PPD Referral (English & Spanish)......29Provider Evaluation....30-31School District Evaluation...32

2WASHINGTON STATE MIGRANT HEALTH PROCEDURERev. 09/07/11The Health Supervisor provides statewide-required trainings to local education agencies (LEAs) and clinic provider personnel in the physical examination process.Confirms examination dates with the LEA and the number of students to receive physicals utilizing Migrant Education Program (MEP) funds.Sets a proposed schedule utilizing the LEA physical exam survey and post schedule on the Migrant Education Health Program (MEHP) website under Physical Exam Dates by MERO to each LEA. Once requested, dates are confirmed by the health provider.Provides necessary forms for paperwork for examinations to each LEA and health provider. Any ensuing changes in the schedule must be made through the Health Supervisor at 509-682-0373/miket@ncesd.org or the Health Secretary at 509-682-3248/rosemarieh@ncesd.org.The LEA provides the following prior to their physical examination clinic:Download the Possible Priority for Services (PPFS) Without Exams Report from the Migrant Student Data and Recruitment (MSDR) Migrant Student Information System (MSIS) which identifies PPFS students and students that have not received a physical examination in the last three years. Students are allowed one Title I migrant funded physical examination every three years unless the LEA has a concern, which requires another assessment to determine a problem. Insured students are allowed as many exams as their insurance will allow.LEAs must serve PPFS students who have not received an exam for three (3) years first. Once those students have been served, you may serve other eligible, current migrant students.Print on-line copies of student lists as appropriate.Utilize the electronic Claim/Summary Forms found on the MSIS to develop student lists and electronically submit Summary Forms on line. Print on-line copies of their MSIS transfer document (health record) for the purpose of evaluation. This is attached to the Migrant Physical Exam and Health Data Reporting Form (see handout) to apprise the provider of any existing health problems. The LEA should make a copy for their files.After selecting students, parent/guardian(s) are contacted. Your home visitor or designee accomplishes the following by interviews with the parent/guardians:Prior to utilizing MEP funds, it is required by the No Child Left Behind legislation that all state and local resources must be utilized prior to federal funds. In the area of health, this is state, federal, or personal health insurance or other appropriate resources (see handout).If a student has had a recent physical examination through state, federal, or personal insurance (document your findings in their MSIS record), the student is not eligible for a MEP funded examination.If the student has state, federal or personal insurance but the parent/guardian if for any reason is unable to have the student assessed, then the LEA acquires a photo copy of the insurance card and includes the student in LEAs physical examination clinic.Eligible students without insurance or insurance coverage will have physical examinations funded through the MEP.Students and parent/guardians have the right to refuse all or any part of a physical examination. Indicate on Migrant Physical Exam and Health Data Reporting Form all screenings/tests refused by parent/guardians and/or student.Every effort should be made to have parent/guardian(s) present during examinations.3Once you have made your final selection, your staff must complete the following prior to the health providers assessment:Completes non-shaded sections of the Migrant Physical Exam and Health Data Reporting Form.Current height, weight, vision, and hearing screenings completed and noted on the Migrant Physical Exam and Health Data Reporting Form (provider will determine if height and weight are normal, abnormal, or undetermined). LEA staff will review the MSIS Transfer document and other available student records to determine any health-related concerns that the provider should be apprised of. The home visitor or designee interviews parent/guardians to gather most recent health profile data to obtain the following: health history, does student have a medical home and/or insurance, has the student had an exam in the past three (3) years. If a health concern is identified, it is noted on the Medically Diagnosed Alert Conditions Section of the Migrant Physical Exam and Health Data Form. Complete the electronic Parent/guardian Permission to Examine and Authorization for Release of Information forms and ensures that they are reviewed and signed by the parent/guardian/guardian (see handout). Completes the electronic Migrant Physical Examination Summary Form(s) at least two weeks prior to clinic date. This is located in the MSIS. Ensures that any questions from parent/guardians regarding the student's physical status are communicated to the provider, as appropriate.Has student on site and ready for examination.The Clinic Providers review the student's medical charts, if the student is a clinic patient. The clinic provider informs the LEA if the student recently had a complete physical. The LEA enters this in the students MSIS health record.Performs screens/labs and provides physical examinations as contracted.Screens records for any unresolved health problems and addresses these during physical examination.Completes all shaded areas of the Physical Examination Form as contracted. Enters PPD batch data on the electronic Summary Form.Notes health care problems by checking ( ) shaded side of the MEDICALLY DIAGNOSED ALERT CONDITIONS Section, ICD Codes; refers student for follow-up care as appropriate. Determines if height and weight are normal, abnormal, or undetermined.Notes in the Health Profile if the physical exam is normal or abnormal.Notes results in the HEALTH PROFILE Section as normal, abnormal, or undetermined which are indicated for each problem; refers student for follow-up care as appropriate.The Migrant Physical Exam and Health Data Reporting Form is signed by the examiner at the conclusion of the examination (or examination day).Indicates on all copies of the Migrant Physical Exam and Health Data Reporting Form all tests refused.Gives pink copy of Physical Examination Form to LEA on examination day for MSIS inputting and takes remaining three copies.Discusses necessary follow-up and referrals with migrant LEA staff after examinations are completed each day.Fills out Referral Forms, as appropriate.

4The LEA:Informs parent/guardians of examination results and assists in obtaining follow-up care, where necessary.Assists parent/guardians in obtaining insurance through state or federal program services (see handout).Reads PPDs within 48-72 hours and records in millimeters induration on the Electronic Physical Examination Summary Form within one week.Refers students with positive or questionable PPD results to local county health department or primary care provider as appropriate.Records clerk or designee inputs physical examination data into the MSIS.Completes Physical Examination Evaluation of Health Provider Form and submits to Health Supervisor.The Clinic Provider:Records PPD results on the Migrant Physical Exam and Health Data Reporting Form.Submits the yellow and goldenrod ESD copies of the Migrant Physical Exam and Health Data Reporting Forms to the Health Supervisor and electronically submits the ESD Service Claim Form within 30 days. Completes Migrant Physical Evaluation Form of LEA and submits to Health Supervisor.The Health Supervisor:Reviews Migrant Physical Exam and Health Data Reporting Forms and Service Claim Forms for accuracy and completeness. When approved, the Health Supervisor will submit the claim to the ESD fiscal office for payment.Returns any incomplete forms or contacts clinic for information before payment is approved.

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9PHYSICAL EXAMINATION REQUIREMENTS

ELIGIBILITY/PRIORITYEligibility for students physical examinations is based on meeting the following criteria:The parent(s) consent has been obtained on the Certificate of Eligibility (COE) for the physical examination. Parent and/or student may elect to decline any or all parts of the physical examination.The student has been enrolled in the Migrant Student Data and Recruitment Office (MSDR).All state, federal, and personal medical insurance resources must be pursued prior to the utilization of Title I Migrant Education funds.Priority for physical examinations is given to migrant students who have not received a physical examination for three years, or have a current health concern.Note: The Office of Superintendent of Public Instruction, Migrant Education Program, requires the inclusion of health services. Health data is reviewed to ensure completeness and accuracy.REQUISITOS PARA UN EXAMEN FISICOPRIORIDAD/ELELEGIBLELos requisitos para que un estudiante reciba un examen fsico se basan en la siguiente criterio.Para un examen fsico se ha obtenido el consentimiento de los padres en el certificado de elegibilidad (COE). Los padres y/o el estudiante pueden evadir una o todas las partes del examen fsico.Que el estudiante sea registrado en la Oficina de Datos y Reclutamiento para Estudiantes Migratorios (MSDR).Se deben utilizar todos los recursos necesarios, los del Estado, Federal y a seguranzas mdicas personales, antes de utilizar los fondos del Programa del Ttulo I de Educacin Migrante.A los estudiantes migrantes se les da prioridad para recibir un examen mdico, si no han tenido uno por un lapso de tres aos, y/o tienen algn problema de salud inmediato.Nota:La oficina del Superintendente de la Instruccin Pblica y el Programa de Educacin Migrante, solicitan que se incluyan servicios de salud. Las estadsticas son revisadas continuamente para asegurarse de su competencia y precisin.10T

MIGRANT PHYSICAL EXAMINATION CHECK LISTCheck When Completed1.Complete online at www.msdr.org Migrant Ed Health Program Migrant Physical Examination Summary Form. Utilize the electronic Claim/Summary Forms found on the MSIS to develop student lists and electronically submit Summary Forms on line. This will automatically be electronically sent to provider. Must be entered at least two weeks prior to the examination clinic.2.Parent Permission to Examine Form is accessed in the Summary/Claim Form Program.3.Complete all following areas of the Migrant Physical Exam and Health Data Reporting Form.Report Date (complete on day of exam)Reporter ID NumberSchool NameSchool District/CBO/Pre-schoolStudent Number (MSDR)Student Name, First, Last, Middle InitialDate of BirthAgeGenderParent(s) NamesSchool Contact Name and Phone Number Completes the electronic Parent Permission to Examine and Authorization for Release of Information forms and assures that they are reviewed and signed by the Federal Projects Director.4.Screens/LabsHeightWeightVisionHearing5.Immunizations (current, not previously reported). This section of the Migrant Physical Exam and Health Data Reporting Form is optional and included for your convenience.6.Medically Diagnosed Alert ConditionsPatient History/Limitations/Needs/Allergies/Medications7.Attach MSIS Transfer Document (preschool/kindergarten or 1-6 or 7-12) to the Migrant Physical Exam and Health Data Reporting Form, highlighting any unresolved problems.8.Attach a copy of the insurance card and/or Current Health Concern Form, if applicable.9.Ensure that any questions from parents regarding the students physical status are communicated to the examination provider, as appropriate.10.Highlight any refused procedures by writing refused in space where data is entered.If you are unable to complete any of the above examination procedures, please contact Mike Taylor, Migrant Health State Supervisor at 509-682-0373/miket@ncesd.org or Rosemarie Hanson, Migrant Health Secretary 509-682-3248/rosemarieh@ncesd.org.11ICDCODECONDITIONDESCRIPTION783.4Abnormal Physiological Development (lack of growth)Failure to thrive; developmental delay (physical, speech, mental abilities); growth in any particular area is not at the level of other children the same age.995.2Allergic ReactionAny number of reactions which might occur when a person is exposed to a substance that he/she is allergic to. Examples: rash, hives, watery eyes, breathing difficulties.285.9AnemiaLow blood hemoglobin, sometimes the result of not eating enough iron rich foods. Symptoms include fatigue, pale skin, and low energy level.716.9ArthritisInflammation of the joints. This condition may come and go or may become progressively worse.493.9AsthmaLong-term respiratory disease characterized by wheezing. Often treated with oral medication and inhalers.746.9Congenital Heart DisorderOne of the various heart deficits present at birth.737.3Curvature of Spine/ScoliosisS-shaped curve which develops in the spine of affected children as they progress through their growth spurt.521.0Dental disease/Gums-CavitiesCavities; baby bottle mouth; gum inflammation.250.0DiabetesA disease affecting the pancreas resulting in little or no insulin production.564Digestive Tract ProblemsConditions resulting in nausea, vomiting, stomach pain, diarrhea, or constipation.345.9EpilepsyA disease resulting in seizures. May be treated with medication.360Eye infectionsEye symptoms such as redness of the eyes, pussy drainage or pain in the eyes.368Eye (Visual) ProblemsSymptoms such as blurred vision, watery eyes, eye pain, frequent headaches, or uneven appearance when observing the eyes; may indicate visual problems.117.9Fungus infectionsFungal infections may result in the following symptoms: itching, cracked and burning feet which may be the result of athletes foot. Lesions on the skin, which are round, surrounded by a red ring or round patches of hair loss, which may be the result of ringworm.389.9Hearing Loss UnspecifiedHearing loss as identified through a hearing test. TRECORD OF STUDENT HEALTH HISTORYStudent Number: / / / / / / / /Student Name: LastFirstMIBirthdate:///Please indicate with a check mark in the appropriate column whether the child has had the illnesses listed below.12785.2Heart MurmurSounds from the heart other that those normally present.573.3Hepatitis AcuteInflammation of the liver, resulting in symptoms such as fatigue, nausea, vomiting, or stomach pain.573.0Hepatitis ChronicHepatitis which does not go away. The person continues to have it throughout his/her life.401.9HypertensionIncreased blood pressure.386.3Infection/Disorder-Middle EarEar infections which more frequently occur in children and often follow a cold.380.0Infection/Disorder-Outer EarEar infection of the outer ear canal.984.9Lead PoisoningLong-term poisoning which may occur in children who have ingested lead from paint and/or other substances.995.5Medications-Adverse ReactionAllergy to medicationspecify medication on examination form.367.1MyopiaNearsightedness.781.3Neuromuscular ConditionsDiseases which result from an interference with communication between the brain and muscles. Example: multiple sclerosis.278.0ObesityAbnormal amount of fat on the body. Individual is usually 20% to 30% over average weight for his or her age, sex, and height.136.9Parasitic ConditionsParasitic stomach and intestinal conditions resulting in diarrhea and weight loss.605PhimosisForeskin cannot be pushed back over the penis.795.5Positive Intradermal Skin Test (PPD)Skin test for tuberculosis indicating person has been exposed to tuberculosis.110Skin Problems/Dermatitis/RashRashes, acne, etc.752.5Testicle-Undescended/RetractileTesticle has not dropped down into the scrotum.010TuberculosisA bacterial lung infection characterized by coughing, weight loss, and breathing difficulties.519.9Upper Respiratory ConditionsColds resulting in sneezing, nasal drainage, and cough.490BronchitisInflammation of the bronchi resulting in cough, chest congestion, and wheezing.474Chronic Tonsils/AdenoidsPeriodic inflammation of the tonsils and adenoids resulting in sore throat and difficulty swallowing.487.0PneumoniaA lung infection characterized by cough, chest congestion, chest pain, and breathing difficulties.473.9SinusitisInflammation of sinuses characterized by facial pain, headache, and nasal congestion.034.0Strep/Sore ThroatA bacterial infection of the throat resulting in sore throat and elevated temperature.599.0Urinary Tract ConditionBladder infection or other disorder of the urinary tract.13ICDCodigosCONDICIONDESCRIPCION783.4Desarrollo Fisiolgico Abnorman (dejar de crecer)Desarrollo atrasado (fsiolgico lingustico, mental) el crecimiento en cualquier rea particular no esta al nivel de los nios de la misma edad.995.2Reaccin AlrgicaCualquier nmero de reacciones que pueden ocurrir al exponer a una persona a una substancia que le causa una alergia. Ejemplo: Sarpullido, ronchas, lagrimo de los ojos, dificultades con la respiracin.285.9La AnemiaHemoglobina de sangre baja, algunas veces resulta en una dieta que carece de alimentos ricos en hierro. Sntomas incluyen la fatiga, la piel palida, y niveles bajos de energa.716.9La ArtritisInflamacin de las conyunturas/los huesos/las aticulaciones. Esta condicin puede ir y venir o pogresivaments pude empeorar.493.9El AsmaUna enfermedad respiratoria de largo plazo caracterizada por silbidos del pecho. Muchas veces el tatmiento consiste de medicinas orales e inhaladores.746.9Desorden Congnito del CoraznUno de los varios dficits presents al nacer.737.30Curva en la Espin/La EscoliosisUna deformacin de la columna vertebral por cierta desviacin lateral. Una curva en forma de S que se desarrolla en la espina de nios afectados y progresa durante el crecimiento.521.0Enfermedad Dental/Encas-CariesCaries: inflaacin de las encas; problemad dentales que resultan cuando el bebe duerme conla botella llena de algn lquid dulce.250.0La DiabetisUna enfermedad que afecta el pncreas reduciendo la produccin de insulin.564Prolemas del Tubo DigestivoCondiciones que resultan en nuseas, vmitos, dolor de estmago, diarrhea o estreimiento.345.9La EpilepsiaUna enferedad nerviosa general y crnica, caracterizada por ataques con prdid del conocimiento y convulsions. Se puede tartar con medicaments.360Infecciones del OjoEnrojecimiento de los ojos, pus, drenaje o secrecin do los ojos o dolor en los ojos puden ser sintomas que resultan en infecciones del ojo.368Problemas Visuales del OjoVisin borrosa o empaada, ojos llorosos, dolor en los ojos, Dolores de cabeza frequentes, una apariencia desiqual al observer los ojos son sntomas que pueden indicar problemas visuals.117.9Infeccin de HongosUna infeccin de hongo pude resultar con los siguientes sintomas: picazn, grietas y ardor en los pies-(pie de atleta). Lesiones redondas en la piel y prdid de pelo (tia del cuerps).389.9Prdid de AudicinPrdida de audicin que se confirma a travs de un exmen de oidos.785.2Soplo CardiacoSonidos del Corazn que no son normales.573.3La Hepatitis AgudaUna inflamacion del higado que resulta en fatiga, nusea, vmito o dolor de estmago.573.0La Hepatitis CrnicaLa hepatitis que no se cura. La persona continua a tener esta enfermedad a travs de su vida. TESPEDIENTE DE LA SALUD MEDICA DEL ESTUDIANTENumero del Estudiante: / / / / / / / / /Fecha de Nacimiento: / / /Nombre del Estudiante:ApellidoPrimer NombreInicial

En la columna apropiada por favor marque las enfermedades que ha tenido el estudiante.14573.0La Hepatitis CrnicaLa hepatitis que no se cura. La persona continua a tener esta enfermedad a travs de su vida. 401.9La HipertensinLa presin alta de la sangre.386.30Infeccion/Desorden Odo MeioUna infeccion del ido-ocurren con ms frequencia en los ninos y usualmente despus de un catarro.380.00Infeccin/Desorden Odo ExternoUna infeccin del canal esterno del ido.984.9Envenenamiento de PlomaUn envenenamiento de plomo de largo plazo que ataca a los nios que han ingerido plomo contenido en la pintura de paredes o en otras substacias.995.5Medicinas-Reaccin OpuestaAlergia a las medicinas-especifique la medicina/as en la forma de examinacin.367.1MiopiaCorto de vista.781.3Condiciones NeuromuscularesEnfermedades que resultan a travs de interferencias entre los centros de comunicacin, elcerebro y los msculos del cuerpo humano. Ejemplo: la eslerosis mltiple.278.0La ObesidadCantidades abnormales de grasa en el cuerpo. Un indiciduo obeso usualmente esta 20% a 30% sobre el peso promedion para sue dad, sexo y altura.136.9Condiciones ParsitasUn estmago con parsitos y problemas intestinales que resulta en diarrhea y prdid de peso.605FimosisEstrecez del orificiodel prepucio.795.5Protena Purificada Dervada de la Tuberculina (PPD)Un exmen de la piel que indica si una persona ha sido expuesta a la tuberculosis110Problemas de la Piel/La Dermatitis/SarpullidoSarpullido, espinillas, grasas, barros.752.5Testculo-RetrcilEl tesculo no ha cado en el escroto.010La TuberculosisUna infeccin bacteriana de los pulmones caracterizada por tos, prdida de peso y dificultades a respirar.519.9Condiciones RespiratoriasResfriado o catarros que resultan en tos, estormudos y drenaje nasal.490La BronquitisUna inflamacin de los bronquios que resulta en tos, congestin y silbidos del pecho.474La Amigdalitis Crnica/La Adenoiditis CrnicaUno inflamacin peridica de las amgdalas y las adenoids rsultando en Dolores de garganta y dificultades al tragar.487.0La PulmonaUna infeccin del pulmn caracterizada por tos, congestin y dolor en el pecho y dificultades a respirar.473.9La SinusitisUna inflamacin de los senos (cara caracterizado por dolor facial y de la cabeza y congestin nasal.034.0Dolor de la Garganta/StreptococcusUna infeccin bacteriana de la garganta que resulta en dolor de garganta y temperature alta.599.0Condicin del Tracto UrinarionUna infeccin de la vejiga o cualquier otro desorden del tracto urinarion.T15Parent Interview/ Entrevista de Padres de FamiliaStudents NameDate of Birth: / / /

Nombre de EstudianteFecha de Nacimiento: / / /

MSDR NumberNmero del MSDR:

Does your child have a doctor?YesNoTiene su hijo(a) un doctor?SiNoIf yes, who? Si su respuesta es Si, Quin es?

Has your child recently had a physical eamination?Name of doctor seen last year?Ha tenido su hijo(a) un examen fsico recientemente? Nombre del doctor que vio el ao pasado?Does your child have a dentist?YesNoTiene su hijo(a) un dentista?SiNoIf yes, who?Name of dentist seen last year?Si su respuesta es Si, Quin es? Nombre del dentista que vio el ao pasadoHas your child recently had a dental examination? (Within 6 months to 1 year) YesNoHa tenido su hijo(a) un examen dental recientemente? (Entre seis meses a un ao) SiNoDoes your child have medical insurance?YesNoTiene su hijo(1 seguro Mdico/asequranza?YesNoPrivate InsuranceSeguro PrivadoMedicaid: Citizen or non-citizen) (ciudadano y no ciudadanos)Childrens Health Insurance Program (CHIPS)Basic Health Program (if student is 19 or older) (si el estudiante es mayor de tiene 19 aos)Do you want your child to have a physical examination at school provided by the Migrant Education Program at no cost to you?YesNoLe gustara que su hijo(a) tuviera un examen fsico en la escuela, proveido gratuitamente por el Programa de Educacin Migrante?SiNo

16CURRENT HEALTH CONCERNS FORMStudentBirthdateLast/First/MiddleMonth/Day/YearMSDR No.Health ConcernReporter's Name

School District

Reporter's Position17PROVIDE THE FOLLOWING DOCUMENTS IF AVAILABLETransfer document (health record)Immunization RecordCurrent Health Concern FormOnly if you have knowledge of a problem the provider should addressInsurance card If the student has coverage, if not, you should assist the family with the acquisition of services

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21FORM DISTRIBUTION PROTOCOLAt the conclusion of each clinic, the Migrant Physical Examination Form and Referral Forms need to be separated. The following protocol will assist you in this task.

MIGRANT PHYSICAL EXAMINATION FORMS:Provider white, goldenrod, and yellowSchool District pink

REFERRAL FORMS:Provider white and goldenrodSchool District pink and yellow

PROCEDURE:Provider retains the white Physical Examination Form and Referral Form copy for files.Provider submits the following to ESD: yellow and goldenrod copy of Examination Form, goldenrod copy of Referral Form, along with billing and itemized list of students examined during clinic.School retains pink copy of Physical Examination Form and Referral Form for district files.School routes yellow copy of Referral Form to parents for follow-up care.

DENTAL OUTCOMES:Provider retains white copy for files.Provider submits yellow copy to ESD.TSchool retains pink copy for district files.22Migrant Dental ScreeningsChilds Last Name First NameMIDate of Birth(month/day/year)Sex: MFAddressCityStateZipTelephone( )-Please Circle All that Apply:

Yes, I want my child to have a Dental ScreeningYes, I also want my child to have a Fluoride treatmentNo, I do not want my child to have a Dental Screening or Fluoride

If your child has other treatment needs we will contact you to try to schedule a follow up visit. A parent or guardian must be present at that follow up visit in order to do any dental procedures.Signature of Parent or Legal Guardian Date************************************************************************

ApellidoNombreMI

Fecha de Nacimiento (Mes/Da/Ano)Sexo: MFDireccinCiudadEstadoCdigo Postal Telfono ( ) -

Porfavor marque lo pertinente:

Si, Yo quiero que me nio/a obtanga un chequeo dental (realizado por dentist o higienista)Si, Yo quiero que mi nio/a obtenga tratmiento de fluoruroNo, Yo no quiero que me nio/a obtenga un chequeo dental e fluoruro

Si su nio necesita tratamiento adicional nos comunicaremos con usted para hacer una cita de seguimiento. Un padre?madre/tutor necesitar acompaar el/la nio/a a la cita para obtener servicios dentales.

Firma Padre/Madre o TutorFecha

23PARENT NOTIFICATION OF EXAMDear Parent:Your child has been scheduled for a migrant student physical examination on . This examination is provided at no cost to you. dateYou are invited and encouraged to attend your childs examination.If you do plan to attend, please contact nameat , so we can phone number, school nameensure that your child receives his/her exam while you are present.Sincerely,************************************************************Estimado(a) Padre/Madre:

Su hijo(a) tiene una cita para un examen fsico para estudiantes migrantes el . Este examen es provedo a ningun costo fechapara usted. Se le invita y se le anima a que asista a la examinacin de su hijo(a).

Si usted piensa atender, y para asegurar que su hijo(a) receiba el examen en su presencia, haga el favor de comunicarse con (nombre) al nmero en .nombre do escuelaSinceramente,

24* * * * SAMPLE LETTER TO PARENTS * * * * *IMPORTANT NOTICEDear :This letter is to inform you that your son/daughter, , received a physical examination on at . These services were provided through the Migrant Education Program. It is important that you keep this document with your childs permanent health records.The findings from the examination are as follows: Your child was found to be in satisfactory health Anemia Ear infection Excessive earwax Undescended testicles Positive T.B. test Heart murmur Failed vision screening Failed hearing screening Cavities Throat infection Urinary tract infection Warts Obesity Elevated blood pressure Acne Short stature Other The doctor recommended that your son/daughter be scheduled for an appointment with your family physician or a doctor of your choice.The following are health resources available that offer reduced cost or sliding fee scale according to your income.25* * * * MUESTRA: CARTA A PADRES DE FAMILIA * * * * *

EN LOS DISTRITOS ESCOLARESAVISO IMPORTANTEEstimado(a) Sra. :Esta carta es para infrmale de que su hijo(a) , recibi un examen medico el da localizado en . Estos servicios fueron provedos por medio del programa Educacin Migrante. Es importante que Ud. Mantenga este documento junto con los documentos mdicos permanentes de su hijo(a).Los resultandos del examen son los siguientes: Su hijo(a) est en buena salud Su hijo(a) padece de anemia Su hijo(a) padece de infeccin del odo Su hijo(a) padece de cerumen (cera en los odos) excesivo Su hijo padece de criptorquidia (defecto de posicin de los testculos) El resultado del examen tiene indicaciones positivas de tuberculosis Su hijo(a) padece de rumor cardiaco Su hijo(a) fallo en la prueba de audicin Su hijo(a) fallo en la prueba de vista Su hijo(a) tiene problemas dentales Su hijo(a) padece de infeccin de la garganta Su hijo(a) padece de infeccin urinaria Su hijo(a) padece de verrugas Su hijo(a) padece de obesidad Su hijo(a) padece de presin elevada Su hijo(a) padece de acn Su hijo(a) padece de estatura baja Su hijo(a) padece de otro problema El mdico recomienda que Ud. Haga una cita para su hijo(a) cnsul mdico familiar, o un mdico de su eleccin.La siguiente es una lista de agencies que proveen servicios mdicos a base de cobros reducidos o cobros variables basados en los ingresos familiares.

26SCREENING ROOM SET-UPOne Provider Team

* Electrical OutletChair

ChairWasteBasket Room must afford complete privacyBathroom in room or in close proximityWaiting areaOptional: Table with crayons and coloring books for waiting children. Chairs for parents.

Two or More Provider Team Screen* Electrical Outlet

Chair

Chair

WasteBasket

BedDeskTableBedDeskTable27

28PPD REFERRAL DateMSDR

NameBirthdate

Address

Directions

Parent's Names

Date PPD GivenResults (in mm)

PPD Given ByPPD Read By

School NameSchool District

Contact Person

Refer to your local health department if PPD results are 5 mm or greater of induration.Please bring this referral sheet. Child must be accompanied by a parent.

******************************************************************************PPD REFERRALFechaMSDR

NombreFecha de Nacimiento

Domicilio

Instruccines para alcanzar el domicilio

Nombre de padres

Fecha de PPDResultados (en mm)

PPD dado porPPD leido por

Nombre de la escuelaDistrito Escolar

Direccin de la escuela

Persona de contactar

Favor de reportar a su departamento local de salud si los resultados de PPD indican 5 mm o mas de induracin.Favor de traer esta forma. El padre debe de estar con el nio.

29WASHINGTON STATESCHOOL DISTRICT MIGRANT PHYSICAL EXAMINATION OF PROVIDER EVALUATION Date

1. Were physicals conducted at an appropriate time of year/date, taking impaction period into consideration, and school district preferred dates as submitted to the Health Supervisor? Yes No Comments:

2.Did provider arrive at school sites at the scheduled time? Yes___ No ___Comments:

3.Did provider spend a minimum of 10 minutes per child, hands-on physical examination (excluding lab and paperwork)? A maximum of five (5) children per hour should be examined. Yes ___ No ___Comments:

Was the necessary paperwork completed at the appropriate time? YesNo

Comments:5.Did provider meet with school staff to review any existing or unresolved health problems on the child's health record? Yes ___ No ___Comments:6.Did you encounter any difficulties in the scheduling and delivery of physical examinations? If so, please comment. Yes ___ No ___Comments:

7.Were parents encouraged to be present at examinations or to volunteer at the examination site? Yes ___ No ___Comments:

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8. Was time allowed for debriefing and providing information or referrals? Yes ___ No ___Comments:

9.In your opinion, what can be done to improve the health examination procedure or quality of examination?Comments:

10.How do you rate this year's physical examination?LowHighProcess:1 2 3 4 5 6 7 8 9 10

Quality of Examination:1 2 3 4 5 6 7 8 9 10Evaluation results will be compiled by the Migrant Health State Supervisor and shared at next year's contract renewal meeting.Evaluation by:Name/Title:

School District:DatePlease return to:Mike Taylor, Migrant Health State SupervisorNorth Central ESDP.O. Box 2424Chelan, WA 98816(509) 682-0373/miket@ncesd.orgFAX (509) 682-3407or (509) 682-3248/rosemarieh@ncesd.org

31WASHINGTON STATEPROVIDER MIGRANT PHYSICAL EXAMINATION EVALUATION OF LEA DATE

1. Did the LEA provide adequate facilities for the physical exams? Yes ___ No ___Comments:

2. Did the LEA complete the appropriate paperwork for providers and was the MSDR health record attached for each student? Yes ___ No ___Comments:

3. Did LEA staff meet with the provider to review any health problems that are classified as unresolved in health records as any existing health problems or parental concerns? Yes ___ No ___Comments:

4. What in your opinion would improve the health examination process?Comments:

5. Were PPDs recorded and information returned to the clinic on time? Yes ___ No ___Comments:

6.How do you rate this year's physical examination? Low HighProcess:1 2 3 4 5 6 7 8 9 10Quality of Examination:1 2 3 4 5 6 7 8 9 10

Evaluation results will be compiled by the Migrant Health State Supervisor and shared at next year's contract renewal meeting.School District: Clinic Name: Prepared By: Phone Number:Please return to:Mike Taylor, Migrant Health State SupervisorNorth Central ESDP.O. Box 2424Chelan, WA 98816(509) 682-0373/fax 682-3407/miket@ncesd.org

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