6114.8  Form #2

________________ PUBLIC SCHOOLS

_________, Connecticut

HEALTH OFFICE FOLLOW-UP REPORT

Date:   ________________   Time: _________     Contact Person: ________________________

Fever:     ___ YES         ___ NO      Temperature: ________     Date of Onset: _______________

Cough:    ___ YES         ___ NO                                Vomiting/Diarrhea:     ___ YES        ___ NO

Sore Throat:     ___ YES         ___ NO                    Body Aches/Chills:      ___ YES         ___ NO

Seen by MD or MD appointment: ____________________________     Date: _______________

Instructions to the Parent/Guardian by school nurse after gathering above information:

1)  If your child has both:  Fever (>100ºF or 37.7ºC) and a sore throat or cough, then you must keep your child home until they are fever free for 24 hours without medication.   Your child may have the flu.  Other symptoms can include runny nose, body aches, vomiting, and diarrhea.

2)  But if your child has: Fever alone, OR vomiting or diarrhea, OR sore throat or new cough with no fever, then you must keep your child home until symptoms are gone for 24 hours.

3)  Please remember to call into school every day your child will be absent.   The Gilbert School will be monitoring for influenza-like illness in the school.  This our effort to assure you that we have the health and safety of your children as our number one priority,  Thank you for helping us to keep the school environment as healthy as possible for all students and staff.

4)  Guidance on how long to keep a child with influenza-like symptoms home is subject to change.  Our information is obtained from the Connecticut Flu Watch website http:/www.ct.gov/ctfluwatch

Health Office Nurses:  You may have to use the back of this form to follow-up with this child’s daily absences and progress concerning health issues.  Please remember to document date, time, contact person and pertinent information such as symptoms, underlying chronic diseases, and other family members who may become ill.  All information is confidential according to CT State Laws and the Department Health and Education.

IMMEDIATE DISPOSITION_____________________________________________________________