Suggest that the student does stretching exercises before vigorous activity to decrease sore muscles in the future. Documentation: Findings from history, assessment, interventions and follow-up. Documentation: Findings from history, assessment, interventions and follow-up. Documentation: Findings from history, assessment, interventions and follow-up. Follow-up: Schedule child to see the tele-health provider within one week, or refer student to their PCP. In the event of a referral to provider, a follow-up will be made. Follow-up: In the event of a referral, follow-up will be made. Follow-up: In the event of a referral, follow-up will be made. Physician’s Signature: Date: health
Vaccinations Examples EXAMPLE VACCINATION Minnesota Dept of Health Attenuated Influenza Vaccine (LAIV) Vaccine Protocol Persons Age 2 through 49 Years accessed 1/26/2015 Condition for protocol: To reduce incidence of morbidity and mortality of influenza disease. Policy of protocol: The will implement this protocol for live attenuated influenza (LAIV) vaccination. Condition-specific criteria and prescribed actions: Attention persons adopting these protocols: The criteria below list indications, contraindications, and precautions that are necessary to implement the vaccine protocol. The prescribed actions include examples shown in [ ] but may not suit your institution’s clinical situation and may not include all possible actions. A licensed prescriber must review the criteria and actions and determine the appropriate action to be prescribed. (Delete this paragraph before version is signed.) Criteria Prescribed Action Indications Currently healthy person age 2 through 49 years. Proceed to vaccinate if meets remaining criteria. Person is age 6 through 23 months of age or 50 or older. Do not give LAIV. Vaccinate the age-appropriate IIV protocol. Person has any reported chronic medical condition, including asthma or recurrent wheezing in children age 2 through 4 years. Do not give LAIV. Vaccinate the age-appropriate IIV protocol. Pregnant woman. Do not give LAIV. Vaccinate the age-appropriate IIV protocol.
Overweight Children and Adolescents: Recommendations to Screen, Assess, and Manage, CDC Growth Chart Training Modules: http://www.cdc.gov/nccdphp/dnpa/growthcharts/training/modules/module1/text/mainmodules.htm Expert Committee Recommendations Regarding the Prevention, Assessment, and Treatment of Child and Adolescent Overweight and Obesity: Summary Report Note: The Appendix that can be found in the attachment on pages S186-S189 gives specific treatment recommendations and timelines. DeVos Healthy Weight Center: University of Michigan, MPOWER program: NHP/ WISEWOMAN MCIR BMI Module -Survey for Patients 2-5 Year Old 6-11 Year Old (example) -Survey for Parents/Caregivers of Children 2-5 Year Old (example) 12-18 Year Old -Clinical Support 2-5 Year Old Healthy Weight (example) 2-5 Year Old Obese 6-11 Year Old Healthy Weight 6-11 Year Old Overweight 6-11 Year Old Obese 12-18 Year Old Healthy Weight 12-18 Year Old Overweight 12-18 Year Old Obese accessed Feb 4, 2015 FORMS: Period for which standing order applies: The standing applies until it is either replaced by a new order covering the same subject or is cancelled in writing by the issuer. Requirements: Issuer must review the standing order annually and then re-sign and re-date.