Fabens ISD Food Allergy Management Plan

Transcription

1 Fabens ISD Food Allergy Management Plan CARE OF THE STUDENT WITH FOOD ALLERGIES AT RISK FOR ANAPHYLAXIS PURPOSE: To provide guidance in managing students with food allergies at risk for anaphylaxis at school. BACKGROUND: In response to the increase in students with diagnosed food allergies at risk for anaphylaxis, Senate Bill 27 (2011, 82 nd Legislative Session) amends Chapter 38 of the Texas Education Code by adding Section This section requires the Board of Trustees of each school district to adopt and administer a policy for the care of students with diagnosed food allergies at risk for anaphylaxis. This policy requires each school district to develop and implement a student food allergy management plan which includes training employees on allergies, methods for requesting specific food allergy information from parents of students with diagnosed food allergies, implementation of food allergy action plans and an annual review of the district s management plan. INTRODUCTION: A food allergy is an abnormal response to a food, triggered by the body s immune system. Symptoms of a food induced allergic reaction may range from mild to severe and may become life-threatening. Reactions vary with each person. The severity of an allergic reaction to each exposure is not predictable. Eight foods account for over 90 percent of allergic reactions in affected individuals: milk, eggs, peanuts, tree nuts, fish, shellfish, soy and wheat (Sampson, 2004 & Schierer S., 2002). Although most allergic reactions are attributed to theses eight foods, any food has the potential of causing a reaction. There is no cure for a food allergy. Strict avoidance of allergens and early recognition and management of allergic reactions are important to the safety of children with food allergies at risk for anaphylaxis. Children spend up to 50 percent of their waking hours in school, and foods containing allergens are commonly found in schools. Thus, the likelihood of allergic reactions occurring in schools is high (Sheetz, 2004). Studies show that percent of children with food allergies have had allergic reactions to accidental ingestion of food allergens while in school. Moreover, foodinduced anaphylaxis data reveals that 25 percent of anaphylactic reactions in school occur among students without a previous food allergy diagnosis (Sicherer, 2010 & Nowak-Wegrzyn, 2001). PATHOPHYSIOLOGY AND TREATMENT: Anaphylaxis is defined as a serious allergic reaction that is rapid in onset and may cause death (Simons, 2008). Anaphylaxis includes a wide range of symptoms that can occur in many combinations and is highly unpredictable. The signs and symptoms of an allergic reaction 1

2 (anaphylaxis) usually involve more than one system of the body. The mouth, throat, nose, eyes, ears, lung, stomach, skin, heart, and brain can all be affected. The most dangerous symptoms include breathing difficulties and a drop in blood pressure or shock, which is potentially fatal. Treatment of Anaphylaxis- Epinephrine (Adrenaline) is the first-line treatment in cases of anaphylaxis. Other medications have a delayed onset of action. Epinephrine is a quick acting hormone that helps to reverse symptoms of an allergic reaction by opening the airways, improving blood pressure, and accelerating heart rate. In approximately one third of anaphylactic reactions, the initial symptoms are followed by a delayed wave of symptoms two to four hours later. Therefore, it is imperative that following the administration of epinephrine, the student be transported to a hospital even if the symptoms appear to have resolved. With the increasing prevalence of food allergies in the past two decades, care of students with life-threatening allergies has become a major issue for school personnel (Sheetz, 2004). Currently, management of food allergies consists of educating children, parents, care givers, and school personnel in strict avoidance of the food allergen. Education also includes recognizing the signs and symptoms of an allergic reaction, and initiating emergency treatment in case of an unintended ingestion or exposure. In order to address the complexities of food allergy management in schools, it is important that students, parents/caregivers, and school personnel work cooperatively to create a sage and supportive learning environment (National School Boards Association, 2011). IDENTIFICATION OF A STUDENT WITH FOOD ALLERGIES AT RISK FOR ANAPHYLAXIS: Notification of a food allergy: In accordance with Texas Education Code , Fabens ISD requests that the parent or guardian disclose a child s food allergies on an annual basis and at time of enrollment on the district s Student Emergency Information and Consent for Medical Treatment form as well as on the Request for Food Allergy Information form. (See Appendix A and B). These forms request disclosure of a child s food allergy or severe food allergy, risk of anaphylaxis and /or prescribed epinephrine (Epi-pen) in order to enable the district to take necessary precautions regarding the student s safety. Additional information regarding food allergies, including the maintenance of records related to a student s food allergies, can be found in the Board policies at FD and FL. The District is required to maintain confidentiality regarding any food allergy information provided and may only disclose the information to teachers, counselors, nurses, and other appropriate school personnel within the limitations of the Family Educational Rights and Privacy Act and Board policy FL. After a student s severe food allergy, risk of anaphylaxis and/or prescribed Epi-pen has been disclosed by a parent or guardian, a Severe Allergy Action Plan should be completed by the parent and student s physician and be submitted to the school nurse. Parents and 2

3 guardians can obtain a Severe Allergy Action Plan from the school nurse or from the district s website, under Nurse s Corner. If the child s food allergy is severe enough that diet modifications and/or substitutions of meals provided by FISD cafeterias need to be put in place, a Special Dietary Needs Request Form (See Appendix C) signed by the child s parent and healthcare provider delineating all modifications and/or substitutions, must be completed and submitted to the food services director, cafeteria manager or school nurse. Upon receipt of the completed Severe Food Allergy Action Plan, the school nurse will: Develop an IHP for management of the student s severe food allergy. Initiate the 504 process, if appropriate. Notify the campus cafeteria manager of disclosed severe food allergies. Notify appropriate teachers or school staff of disclosed severe food allergies. CREATING AN ALLERGEN-SAFE SCHOOL ENVIRONMENT: DISTRICT- WIDE PROCEDURES: All campus staff will complete Level I- Awareness Training for Food Allergies. This training will cover the following subjects: Most common food allergens. The hazards related to the use of food for instructional purposes. Importance of environmental controls in protecting the health of students at risk for food allergy related anaphylaxis. Signs and symptoms of an anaphylactic reaction to food. How to administer an Epi-pen. Recognizing and implementing a Severe Allergy Action Plan. Designated staff will complete Level II- Comprehensive Training for Food Allergies. Designated staff includes any staff member who is responsible for the care of individual students with a severe food allergy during any part of their school day- including school sponsored events, extra-curricular programs, athletics or other school programs. Training will cover Level I training as well as the following subjects: Identifying students at risk for anaphylaxis. Signs and symptoms of anaphylaxis. How to administer and store an Epi-pen. Planning for students who do not have epinephrine at school. Implementation of a Severe Allergy Action Plan. Development and implementation of IHP s/504 Plans. Communication procedures for initiating emergency protocols that include substitute staff. Environmental control measures to reduce the risk of exposure to a food allergen, including safe food handling, hand washing and cleaning procedures. Initiating emergency procedures and notification of local EMS. Post anaphylaxis debriefing and monitoring of the food allergy management plans on the campus. 3

4 When a student has been identified with a severe food allergy at risk for anaphylaxis, special precautions will be taken to avoid allergen foods in the classroom, cafeteria, hallways, common areas in the school, and other learning environments used by children with food allergies at risk for anaphylaxis, at all campuses. Special precautions will also be enforced on any bus used by a child with severe food allergies as well as during all school-sponsored activities, including field trips, athletic events, and before and after school activities. No child with severe food allergies at risk for anaphylaxis should be excluded from any school sponsored activity based on their food allergies. A Note to the Chef card with the child s information and picture will be given to the cafeteria manager to easily identify children with severe food allergies at risk for anaphylaxis. (See Appendix D). Pre-packaged food items with readable ingredient lists will be required for projects, activities and celebrations in elementary and middle school classrooms of children with food allergies at risk for anaphylaxis so potential food allergens can be identified. Parent letters will be sent home indicating the need to only send pre-packaged and properly labeled food items for classroom celebrations and other school sponsored activities, where a child with a severe food allergy at risk for anaphylaxis will be participating. (See Appendix E). School staff and parents will be educated and encouraged to send or use non food items for celebrations, rewards or activities in the classroom of a child that has been identified as having a severe food allergy at risk for anaphylaxis. Schools that have a child with a severe food allergy at risk for anaphylaxis may post visible signs encouraging the need to avoid a particular food allergen (i.e. lunch tray stickers, classroom and/or school posters). Schools that have been identified as having a child with a peanut allergy will be labeled as peanut-aware campuses. All students and staff will be asked to refrain from having peanut or peanut containing products on campus. Appropriate cleaning protocols will be followed on campuses, with special attention to identified high-risk food allergy areas (i.e. cafeteria tables). Any principal-designated staff plus Level II trained staff on each campus will be trained in emergency medication administration for anaphylaxis in the nurse s absence. A post exposure meeting will be held if an anaphylactic event occurs. Information concerning the FISD Food Allergy Management Plan will be included in the student handbook and will be available on the FISD Health Services webpage. ACTIONS FOR ANAPHYLAXIS Students with life-threatening allergies may require emergency assistance from any staff member! 4

5 POSSIBLE SYMPTOMS OF AN ALLERGIC REACTION: SEVERE SYMPTOMS: Mouth: Itching, tingling, or swelling of lips tongue or mouth. Skin: Hives, itchy rash, swelling of the face or extremities. Gut: Nausea, abdominal cramps, vomiting, diarrhea. Throat*: Tightening of throat, hoarseness, hacking cough. Lung*: Shortness of breath, repetitive coughing, wheezing. Heart*: Thready pulse, low blood pressure, fainting, pale, blueness *Potentially life-threatening. The severity of symptoms can quickly change. MILD SYMPTOMS: Mouth: Skin: Gut: Itching in mouth. A few hives around mouth/face and or other body parts, accompanied with mild itching. Mild nausea and discomfort. RESPONSE TO AN ALLERGIC REACTION: To be followed by any staff member who becomes aware that a student is having an allergic reaction: 1. STAY CALM! 2. Stay with the student. NEVER LEAVE A STUDENT UNATTENDED. 3. Call Call for school nurse or trained personnel. 5. Send for AED. 6. Move other students away from the area if possible. 7. Initiate allergy action plan and when indicated administer Epi-Pen. It is important not to delay the administration of Epi-Pen. 8. Contact the parents. 9. Encourage student to sit upright and stay calm or ease student to the floor if necessary. 10. For a severe reaction, consider keeping student lying on back with legs raised. 11. Loosen tight clothing and place something soft and flat under head. 12. If the student becomes unconscious check for breathing and initiate CPR if needed. 13. If student is breathing turn student on his/her side to keep the airway clear and prevent aspiration of fluids into the lungs. 14. Document incident and give to School Nurse. 15. Note: Effects of Epi-Pen last only minutes. Emergency medical care (911) must be obtained immediately. 5

6 SCHOOL GUIDELINES FOR MANAGING STUDENTS WITH FOOD ALLERGIES: Family s Responsibility: Notify the school of the child s food allergies in accordance with TEC, section Work with the school team to develop a plan that accommodates the child s needs throughout the school including in the classroom, in the cafeteria, in after school programs, during school sponsored activities and on the bus. Provide the school with written and signed medical documentation, instructions, diet modifications and medications as directed by a physician, to include FISD Allergy Action Plan. Include a photo of the child on written form. Provide properly labeled medications and replace medications after use or upon expiration. Educate the child in the self-management of their food allergy including: Safe and unsafe foods Strategies for avoiding exposure to unsafe foods Symptoms of allergic reactions How and when to tell an adult they may be having an allergy-related problem How to read food labels (age appropriate) If age appropriate, the importance of keeping their emergency medication on them and administering their personal asthma and anaphylaxis medications as prescribed Importance of not sharing their medications with anyone (i.e. inhalers) Parent attendance on elementary field trips is strongly encouraged. Notify the school nurse if you are unable to attend a field trip with your child so preparation for emergency medications can be provided. Review policies/procedures with the school staff, the child s physician and the child (if age appropriate) after a reaction has occurred. Provide emergency contact information and update as needed. Student s Responsibility: No trading of food with others Avoid eating anything with unknown ingredients or known to contain any allergens. Be proactive in the care and management of their food allergy and reactions based on their developmental level. Immediately notify an adult if they eat something they believe may contain a food to which they are allergic to. School s Responsibility: Campus Administrator: Each campus administrator will ensure compliance of the FISD Food Allergy Management Plan in their campus. 6

7 Each administrator will provide Level I and Level II Food Allergy Training for their staff annually and will maintain documentation of trained staff. Offer professional development for staff regarding confidentiality and compliance with FERPA, in order to protect student s privacy. Ensure that administrative staff, school nurse, athletic coaches/sponsors, PE teacher(s), marching band director(s), cheerleading coach(s), athletic trainers and student athletic trainers are current in CPR/AED certification. Designate school personnel who are properly trained by the school nurse to respond to exposure or allergic reactions, and /or administer Epi-pens or medications when a school nurse is not available (i.e. person who gives medications when nurse is unavailable). Ensure that a food-allergic student is included in all school activities. Students should not be excluded from school activities solely based on their food allergy. Ensure that teachers have a plan in place and it is adhered to in notifying substitute teachers that they have a student with a severe food allergy who is at-risk for anaphylaxis in their classroom. Ensure that a Level II trained staff member attends field trips or school outings when a parent is not in attendance. A student should not be excluded from any school sponsored activity due to lack of parental attendance. Coordinate with custodial staff to ensure that appropriate cleaning of allergy-free areas in cafeteria is being followed and that proper training has been provided. Coordinate with the school nurse to ensure medications are appropriately stored and easily accessible in case of an emergency. Students should be allowed to carry their own Epi-pens, if age appropriate, after approval from the student s medical practitioner and parent or guardian. Coordinate and participate in campus post anaphylaxis meeting. After School Activities: Conduct all activities in accordance with FISD policies and procedures regarding students with food allergies who are at risk for anaphylaxis. Provide the school nurse with a list of students who are participating in the After School Program. Provide Level I and Level II Food Allergy Training for all after school program staff annually. Maintain documentation of trained staff. Ensure that a level II trained staff member is available at all after school activities involving any student with a life threatening severe food allergy. Registered Nurse: Review submitted Student Emergency Information and Consent for Medical Treatment and Request for Food Allergy Information forms, at time of registration and annually. 7

8 Identify students with a severe food allergy at risk for anaphylaxis and contact parents/guardians who have not submitted a Fabens ISD Allergy Action Plan for the current school year. Review submitted allergy action plans and/or completed medication forms for students who have not submitted an allergy action plan. Coordinate with parents/guardians and student s health practitioner, as needed, in the review and completion of Fabens ISD Allergy Action Plan, medication permission form and creating IHP s. Notify appropriate staff when a Fabens ISD Allergy Action Plan has been added or modified for a student. Notify Child Nutrition Services Manager and 504 coordinators of a student with a severe food allergy at risk for anaphylaxis as needed and provide a copy of Fabens ISD Allergy Action Plan and Note to the Chef, as appropriate. Review and modify IHP s annually and as needed. Facilitate the training of principal-designated staff and Level II trained staff annually in responding to exposure or allergic reactions and administration of Epi-pen and/or medications when a school nurse is not available. Ensure that emergency life-saving medication (Epi-pen) is properly labeled and stored in an accessible but unlocked area, and dates have not expired. Collaborate with after school program staff, coaches, sponsors and trainers on care of students with a severe food allergy at risk for anaphylaxis to include access to medication and whether a student is allowed to carry and self administer medication. Participate in campus post anaphylaxis meeting. Classroom Teacher/Specialist: Complete Level I and/or Level II Food Allergy Training annually. Review and implement Fabens ISD Allergy Action Plan for your student(s). Ask the school nurse for any clarification needed regarding plan(s). Ensure that all substitute teachers, pull out teachers (Special Ed, interventions, Dyslexia, etc.) are informed of the student s food allergy. When indicated avoid the use of food allergens in the classroom, to include educational tools, arts and craft projects, incentives, classroom snacks and celebrations. Notify all parents/guardians of any restricted allergen foods in the classroom. Inform parents and campus nurse of any events where food will be served. Enforce district policy on bullying related to food or other allergens. Do not put a student on the bus if there are any signs or symptoms of an allergic reaction. Classroom Activities: Ensure that a food-allergic student is included in all school activities. Students should not be excluded from school activities solely based on their food allergy. 8

9 Allow only pre-packaged food items with complete ingredients lists in the classrooms of students with food allergies at risk for anaphylaxis. This includes projects, activities and celebrations so that potential food allergens can be identified. Use non-food items such as stickers, pencils, etc. as rewards instead of food. Promote and monitor good hand washing practices before and after snacks and lunch and anytime potential allergens may have been touched. Alcoholbased hand sanitizers are NOT effective in removing allergens from hands. Encourage students to avoid sharing or trading food. Encourage parents/guardians to send a box of safe snacks for their child. Field Trips and Off Campus School Sponsored Activities: Notify the school nurse at least two days prior to any field trip or off campus outing, for necessary preparation. Ensure that Fabens ISD Allergy Action Plan and students prescribed Epi-pen or medication(s) are taken on all field trips or off campus outings, where applicable. Call 911 if an allergic reaction occurs and/or Epi-pen is administered. Collaborate with parents/guardians of students with severe food allergies when planning field trips or off campus outings where meals or snacks will be provided. Meal planning is crucial to reduce the risk of an allergic student s exposure to food allergens. Enforce FISD procedure of no eating/drinking on the bus except for water. Special considerations may be given for trips of extended duration or unique circumstances involving meal schedules. Encourage parents/guardians of students with a severe food allergy at risk for anaphylaxis to accompany student on school trips or off campus outings, and/or to act as a chaperone. However, a student should not be excluded from any school sponsored activity due to lack of parental attendance. Collaborate with your campus administrator to ensure that a level II trained staff member is in attendance on any field trip or off campus outing. Plan for ways to wash hands and encourage hand washing before and after eating. After School Activities: Collaborate with the school nurse to identify students in your care who have a Fabens ISD Allergy Action Plan in place. Ask the school nurse for any clarification needed regarding implementation of plan. Collaborate with the school nurse on having access to student emergency medications. Restrict the use of foods that are known allergens to students with food allergies at risk for anaphylaxis. 9

10 Promote and monitor good hand washing practices before and after snacks and anytime potential allergens may have been touched. Alcohol-based hand sanitizers are NOT effective in removing allergens from hands. Nutrition/Food Service Director: Provide Level I and Level II Food Allergy Training, as indicated for food service staff annually. Maintain documentation of trained staff. Review the legal protections for students with life-threatening allergies and ensure that students with severe food allergies that participate in the federally-funded school meal programs are given safe food items as outlined by the physician s signed statement. Participate in Section 504 meetings, when applicable. Upon receipt of diagnosis of a severe food allergy or Special Dietary Needs Request Form from a healthcare provider, make appropriate substitutions or modifications for meals served to students with severe food allergies, as specified by the healthcare provider/prescribing physician. Train all food service staff and their substitutes to read product food labels and recognize food allergens. Maintain contact information for manufacturers of food products (Consumer Hotline). Review and follow sound food handling practices to avoid cross-contamination with potential food allergens. Follow cleaning and sanitation protocol to avoid cross-contamination. Maintain current menus via the website with notifications of any menu changes. Provide specific ingredient lists to parents upon request. Be prepared to take emergency action for a student in the event of an allergic reaction. Athletic Directors, Head Coaches, Trainers, Sponsors and Other Persons in Charge of School-Sponsored Activities: Conduct the program or school sponsored activity in accordance with FISD policies and procedures regarding students with food allergies who are at-risk for anaphylaxis. Provide Level I and Level II Food Allergy Training for all coaches and other key staff annually and maintain documentation of trained staff. Ensure that all coaches, trainers and student trainers are current in CPR/AED certification. Consult with the school nurse to identify students in your care who have a severe food allergy at risk for anaphylaxis. Obtain a copy of the Fabens ISD Allergy Action Plans of students in your care and ask campus nurse for any clarification needed regarding plan. Ensure that all coaches and sponsors are notified if the student is self-carrying an Epipen and/or other medication and/or where the student s Epi-pen and/or medication is located on the campus. 10

11 Restrict the use of foods that are known allergens to students with food allergies at risk for anaphylaxis. Enforce FISD procedure of no eating/drinking on the bus except for water. Special considerations may be given for trips of extended duration or unique circumstances involving meal schedules. Transportation Department Director/Coordinator: Provide Level I Food Allergy Training to all bus drivers annually. Provide Level II Food allergy training to bus drivers as needed. Maintain documentation of trained staff. Ensure that bus drivers know how to contact EMS in the event of an emergency. Enforce no consumption of food/drink (other than water) on all buses. Special considerations may be given for trips of extended duration or unique circumstances involving meal schedules. Special considerations may be given to students with medical accommodations (i.e. students with diabetes). Work with school nurse on plan for all students safety if this issue occurs. 11

12 APPENDIX A FABENS INDEPENDENT SCHOOL DISTRICT STUDENT EMERGENCY INFORMATION AND CONSENT FOR MEDICAL TREATMENT Student s Last Name First Name Date of Birth ID# School Grade Homeroom Teacher Address P.O. Box Home Phone/Cell CONTACT INFORMATION: Mother/Guardian Work Phone Cell Phone Father/Guardian Work Phone CellPhone In case of an emergency or illness and I cannot be located, please call: (List at least 2 phone numbers for each contact) Emergency Contact Relationship Phone/Cell Emergency Contact Relationship Phone/Cell Emergency Contact Relationship Phone/Cell Student s Physician/Health Care Provider: Phone: Hospital of Choice Medical Insurance: CHiP Medicaid Private Ins. Military Ins. Name of Insurance/Group Number: HEALTH INFORMATION: A written statement from your child s Physician/Health Care Provider must accompany any medical condition that is indicated below. Does the student have a medical condition that has been diagnosed by a healthcare provider? Yes No List the Medical Condition(s) Does the student take any medications that have been prescribed by a healthcare provider? Yes No List all Medication(s) Will the student require administration of prescribed medication(s) during school hours? Yes No Does the student have any food allergies? Yes No Is the allergy a severe food allergy? Yes No (If yes please complete the attached form titled Request for Food Allergy Information.) Does the student have any other allergies that have been diagnosed by a healthcare provider? Yes No List all Allergies Name of Physician/Healthcare Provider that diagnosed any of the above conditions I understand that it is my responsibility to notify the school of any changes in my child s medical condition. I authorize an authority of Fabens Independent School District to give consent to a physician and/or hospital for emergency medical and/or surgical treatment of my child for injuries/illness which requires such treatment during school hours or after hours while attending school sponsored activities, provided an authorized school representative is present. I understand that Fabens ISD will not assume any financial responsibility for expenses for such treatment. I also understand that the school will notify us as soon as possible following an emergency, but in no way is treatment to be delayed until we have been notified. I also authorize my child to participate in health services and screenings provided by the school. Parent/Legal Guardian Signature Date 12

13 APPENDIX A DISTRITO ESCOLAR INDEPENDIENTE DE FABENS INFORMACION DE EMERGENICA ESTUDIANTIL Y CONSENTIMIENTO PARA TRATAMIENTO MEDICO Apellido del Estudiante Nombre Fecha de Nacimiento ID# Escuela Grado Maestro Domicilio P.O. Box # de Teléfono/Celular INFORMACIÓN DE CONTACTO: Madre/Tutor Teléfono de Trabajo Celular Padre/Tutor Teléfono de Trabajo Celular En caso de una emergencia o enfermedad y no puedo ser localizado, favor de llamar (Ponga al menos 2 números de teléfono) Contacto de Emergencia Parentesco Teléfono /Celular Contacto de Emergencia Parentesco Teléfono /Celular Contacto de Emergencia Parentesco Teléfono /Celular Medico del Estudiante: Teléfono: Hospital de Preferencia Seguro Medico CHiP Medicaid Seguro Privado Seguro Militar Nombre del Seguro y Número de Grupo: INFORMACION DE SALUD: Se requiere declaración médica escrita y firmada por el médico tratante de su niño(a) sobre cualquier condición médica que se indique a continuación. Padece el estudiante de condición(es) médica(s) que haya(n) sido diagnosticada(s) por un médico? Si No Liste las Condiciones Médicas El estudiante toma medicamentos que han sido recetados por un médico? Si No Liste el medicamento recetado Requiere el estudiante administración de medicamento prescrito durante las horas de escuela? Si No Padece el estudiante de alergia(s) a alimentos? Si No La alergia de alimentos es severa? Si No (Si su respuesta es Si por favor de contestar el formulario adjunto titulado "Solicitud de Información Sobre Alergias Alimentarias".) Sufre el estudiante de otras alergia(s) que haya(n) sido diagnosticada(s) por un médico? Si No Liste la(s) alergia(s) Nombre del médico que diagnosticó cualquiera de las condiciones anteriores Comprendo que es mi responsabilidad notificar a la escuela de cualquier cambio en el estado de salud de mi hijo. Autorizo al representante del Distrito Escolar de Fabens, a dar consentimiento para tratamiento hecho por un médico, cirujano, o hospital para mi hijo(a) en caso de enfermedad o accidente durante horas de escuela o después de clases en los eventos patrocinados por la escuela, siempre y cuando esté presente un representante autorizado por la escuela. También tengo entendido que el representante de Fabens ISD no asumirá ninguna responsabilidad de tipo financiero por gastos de tratamientos médicos. Comprendo que la escuela me notificará tan pronto sea posible en caso de emergencia médica y por ningún motivo se demorara tratamiento médico hasta notificarme. Autorizo que mi hijo (a) participe en servicios y exámenes de salud proveídos por la escuela.firma del Padre/Tutor Fecha 13

14 APPENDIX B THIS FORM MUST BE FILLED AND SIGNED, EVEN IF THE STUDENT HAS NO ALLERGIES FABENS INDEPENDENT SCHOOL DISTRICT REQUEST FOR FOOD ALLERGY INFORMATION Student s Name: (Last) (First) (MI) Date of Birth Grade School Beginning with the school year, Texas Education Code requires that school districts request that the parent or guardian disclose a child s food allergies at the time of enrollment in public school. Additional information regarding food allergies, including the maintenance of records related to a student s food allergies, can be found in the Board policies at FD and FL. The District is required to maintain confidentiality regarding any food allergy information provided and may only disclose the information to teachers, counselors, nurses, and other appropriate school personnel within the limitations of the Family Educational Rights and Privacy Act and Board policy FL. This form allows you to disclose whether your child has a food allergy or severe food allergy that you believe should be disclosed to the district in order to enable the district to take necessary precautions for your child s safety. Severe food allergy means a dangerous or life-threatening reaction of the human body to a food-borne allergen introduced by inhalation, ingestion, or skin contact that requires immediate medical attention. In addition, if the student has severe food allergies, the parent is encouraged to contact: 1. The campus nurse at and/or 2. The Fabens ISD Nutrition and Food Service Department (if the student will be having meals prepared by the school cafeteria and have allergies that may require the district to make food substitutions). Yes No My child, named above, has a food allergy or severe food allergy that, in my judgment, should be disclosed to the d istrict to enable the d istrict to take any necessary precautions regarding my child s safety. If yes, please list any foods that cause an allergic reaction that is severe enough to affect your child s health and safety, as well as the nature of your child s allergic reaction to the food: Food Nature of Allergic Reaction to the Food Yes No My child s food allergy (ies) has (have) been diagnosed by a health care provider. Yes No My child has been prescribed medication to treat his/her allergy (ies). Parent/Guardian Name(Please Print) Home Phone Cell Number Parent/Guardian s Signature Work Number Date Date received by campus: 14

15 APPENDIX B ESTA FORMA DEBE SER LLENADA Y FIRMADA, AUN CUANDO EL ESTUDIANTE NO TENGA ALERGIAS DISTRITO ESCOLAR INDEPENDIENTE DE FABENS SOLICITUD DE INFORMACIÓN SOBRE ALERGIAS ALIMENTARIAS Nombre del Estudiante: (Apellido) (Primer Nombre) (Inicial Media) Fecha de Nacimiento Grado Escuela Empezando el año escolar , el Código de Educación de Texas requiere que los distritos escolares soliciten que el padre o el tutor legal revelen si el niño(a) padece de alergia de alimentos en el momento de inscripción en las escuelas públicas. La información adicional en cuanto a alergias de alimentos, incluso el mantenimiento de archivos relacionados con las alergias de comida de un estudiante, puede ser encontrada en las Normas de Consejo en FD y FL. El Distrito requiere mantener la confidencialidad en cuanto a cualquier información de alergia de alimentos proporcionada y sólo puede revelar la información a profesores, consejeros, enfermeras, y otro personal escolar apropiado dentro de las limitaciones de Derechos Educativos de la Familia y La Ley de Privacidad y Normas del Consejo FL. Esta forma permite que usted revele si su niño(a) padece de alergia de alimentos o alergia severa de alimentos y cree que es necesario revelar esta información al distrito a fin de permitir al distrito tomar precauciones necesarias para la seguridad de su niño(a). "Alergia Severa de Alimentos" significa una reacción peligrosa o mortal del cuerpo humano a un alérgeno transmitido por los alimentos introducidos por inhalación, ingestión o contacto con la piel que requiere atención médica inmediata. Si el estudiante sufre de alergias severas de alimentos, se recomienda al padre o tutor legal estar en contacto: 1. Con la enfermera escolar y/o 2. El Departamento de Servicio de Nutrición de Fabens ISD, (si el estudiante comerá los alimentos que dan en la cafetería escolar y tiene alergias severas hacia alimentos y requiere que el distrito haga substituciones de estos alimentos). Si No Mi niño(a), nombrado anteriormente, sufre una alergia de alimentos o alergia severa de alimentos que, en mi juicio, debería ser revelada al distrito para permitir al distrito tomar cualquier precaución necesaria en cuanto a la seguridad de mi niño. Si la respuesta es sí, liste los alimentos que causan una reacción alérgica y es lo suficientemente grave como para afectar la salud y seguridad de su hijo(a). También liste el tipo de reacción alérgica que sufre su hijo(a): Alimentos Tipo de reacción alérgica hacia alimentos Si No La alergia(s) de alimentos de mi hijo(a) ha(n) sido diagnosticados por un médico. Si No Mi hijo ha sido recetado con medicamento para tratar su(s) alergia(s). Nombre del Padre/Tutor (Imprima Por Favor) Teléfono de Trabajo Teléfono/Celular Firma de Padre/Tutor Fecha Date received by campus: 15

16 APPENDIX C FABENS INDEPENDENT SCHOOL DISTRICT CHILD NUTRITION SERVICES Eating and Feeding Evaluation: Children with Special Dietary Needs Student s Name PART A Name of School Grade Level Classroom Age Does the Child have a Disability? If Yes, describe the major life activities affected by the disability. Yes No Does the child have special nutritional or feeding needs? If Yes, complete Part B of this form and have it signed by a licensed physician. Yes No If the child is not disabled, does the child have special nutritional or feeding needs? If yes, complete Part B of this form and have it signed by a recognized medical authority. Yes No If the child does not require special meals, the parent can sign at the bottom of this form and return the form to the school food service. List any dietary restrictions or special diet. PART B List any allergies or food intolerances to avoid. List foods to be substituted. List foods that need the following change in texture. If all foods need to be prepared in this manner, indicate All. Cut up of chopped into bite size pieces: Finely ground: Mashed: Pureed or Blended: List any special equipment or utensils that are needed. Indicate any other comments about the child s eating for feeding patterns. Person/s Completing this form Printed Name/ Title: Date: Signature: Parent Printed Name: Date: Signature: Physician or Medical Authority: Printed Name: Date: Signature: Initials and date received: School Nurse: Initial sand date received: Cafeteria Manager: Initial sand date received: Teacher: Revised - 08/

17 APPENDIX C FABENS INDEPENDENT SCHOOL DISTRICT CHILD NUTRITION SERVICES Information Card: Children with Special Dietary Needs Student s Name Teacher s Name Special Diet or Dietary Restrictions Food Allergies or Intolerances Food Substitutions Foods Requiring Texture Modifications: Chopped: Finely Ground: Mashed: Pureed or Blended: Other Diet Modifications: Feeding Techniques: Supplemental Feedings: Physician or Medical Authority: Name: Telephone: Fax: Additional Contact: Name: Telephone: Fax: Additional Contact: Name: Telephone: Fax: Child Nutrition Representative/Person Completing Form: Name/Title: Telephone: Date: Signature: Initial and date received by child nutrition services director: Revised - 08/

18 APPENDIX D NOTE TO CHEF: Place Student Photo Here Student Name: Grade: ID# WARNING! I am allergic to the following food(s). In order to avoid a life-threatening reaction, I must avoid all foods that might contain including the following ingredients: Please ensure that my food does not contain any of these ingredients and that all utensils and equipment used to prepare my meals, as well as prep surfaces, are thoroughly cleaned prior to use. Thank you for your cooperation. NOTE TO CHEF: Student Name: Place Student Photo Here Grade: ID# WARNING! I am allergic to the following food(s). In order to avoid a life-threatening reaction, I must avoid all foods that might contain including the following ingredients: Please ensure that my food does not contain any of these ingredients and that all utensils and equipment used to prepare my meals, as well as prep surfaces, are thoroughly cleaned prior to use. Thank you for your cooperation. 18

19 APPENDIX E FABENS INDEPENDENT SCHOOL DISTRICT PARENT NOTIFICATION OF FOOD ALLERGY Dear Parent/Guardian, We are asking for your help in providing a safe learning environment for all students. One or more students in your child s class and/or grade level has/have a severe food allergy to. Food allergies can be potentially fatal, and there is no cure. The only way to avoid a reaction is to avoid the offending food. We know that many parents like to send special treats to celebrate birthdays and other occasions. We encourage parents to celebrate with non-food items such as stickers, pencils, themed erasers, or other trinkets, rather than food. Any food sent in to share with students should be pre-packaged and contain an ingredient label. Please give these items to your child s teacher for distribution. Please instruct your child to not share food with other classmates unless a teacher gives approval to do so. Students will be encouraged to wash their hands before and after eating lunch and snacks. To learn more about food allergies, you may visit the Food Allergy & Anaphylaxis Network s website, Thanks in advance for your cooperation. We look forward to a great school year. Sincerely, School Principal 19

20 APPENDIX E DISTRITO ESCOLAR INDEPENDIENTE DE FABENS NOTIFICACION DE LOS PADRES DE ALERGIAS ALIMENTARIAS Queridos padres o Tutor, Estamos pidiendo su ayuda para proporcionar un ambiente de aprendizaje seguro para todos los estudiantes. Uno o más estudiantes en la clase de su hijo y/o grado escolar tienen una grave alergia alimentaria a. Las alergias a los alimentos pueden ser potencialmente mortales, y no hay una cura. La única manera de evitar una reacción es evitar el alimento. Sabemos que muchos de los padres les gusta mandar alimentos especiales para celebrar cumpleaños y otras ocasiones. Animamos a los padres que celebren con artículos no alimentarios como etiquetas engomadas, lápices, gomas de borrar, o otras cosas de poco valor, en lugar de alimentos. Cualquier alimento enviado para compartir con los estudiantes debe estar pre-empaquetado y debe contener una etiqueta de ingredientes. Entregue estos artículos al maestro de su hijo para su distribución. Por favor, Enséñele a su hijo a no compartir comida con otros compañeros de clase, ha menos que el maestro allá dado consentimiento para hacerlo. Los estudiantes serán animados a lavarse las manos antes y después de comer. Para obtener más información sobre alergias a los alimentos, puede visitar la pagina web de Food Allergy & Anaphylaxis Network, Gracias de antemano por su cooperación. Esperamos un gran año escolar. Sinceramente, Director Escolar 20