DIVISION OF SCHOOL HEALTH

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• DIVISION OF SCHOOL HEALTH
• UPDATE
• August 9, 2006

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• Presented by
• Jon Dale Director
• Division of School Health
• Rosemary Danchick-Moyer
• State School Health Consultant

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DIVISION OF SCHOOL HEALTH

• Jon Dale, Director
• State School Health Consultants
• Beth Anne Bahn
• Rosemary Danchick-Moyer
• Administrative Officer Martie Drager
• Steps School Health Coordinator Bill Barbour
• Administrative Support Rich Brown
• Six District Located School Health Consultants

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School Health Consultants

• Northwestern District Linda Deeter
• North Central District Andrea Dale
• Northeastern District Patti Montalbano
• Southwestern District Cynthia Thomas
• South Central District Roxanne Lepore
• Southeastern District Susan Templin

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DISTRICT OFFICE PROGRAM STAFF

• HIV
• STD
• Communicable Disease
• Environmental Health
• Sanitarians
• Tuberculosis
• Immunization
• EMS Program Specialist
• Preparedness Coordin.

• Diabetes
• Cardiovascular
• Injury Prevention
• Chronic Disease
• Tobacco Prevention
• Maternal Child Health
• Special Health Care
• Public Health

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Steps To a Healthier PA

• 7.5 M U.S. Dept. of Health Human Services
  Cooperative Agreement
• 5 year project to implement chronic disease
  prevention efforts
• Directed to schools, health care delivery,
  communities businesses
• Targeted Communities
• Fayette, Luzerne Tioga Counties

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Focus Areas

• Chronic Diseases
• Asthma
• Diabetes
• Obesity

• Factors
• Tobacco Use
• Nutrition
• Phys Inactivity

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Steps School Health Activities

• Assisted w/ development of local wellness
  policies
• Facilitated establishment of School Health
  Advisory Councils
• Promoting evidence-based programs and resources

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Activities of note in Steps communities for
school year 2006 -2007

• Steps School Health Coordinators will be
  encouraging schools to use the School Health
  Index and will provide technical assistance to do
  so.
• The Youth Risk Behavior Survey (YRBS) will be
  conducted in schools in each Steps community in
  the Spring of 2007. Steps staff will attend
  training on the YRBS on August 29-31, 2006.

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Steps Program Resources

• HealthierUS Initiative www.healthierus.gov
• Steps to a Healthier PA
• Fayette Co. www.stepstoahealthierfayette
  county.org
• Luzerne Co. www.stepspalc.org
• Tioga Co. www.tiogapartners.org
• Philadelphia www.philasteps.org

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Department of Health Programs

• Sexually Transmitted Disease Program
• Posters available
• Traumatic Brain Injury Program
• Looking for help creating tools
• The Health Alert Network (HAN)
• HAN access for School Nurses

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Transition for Special Education Students

• Transition Checklist available on
• Department of Health website at
• www.health.state.pa.us/transitionchecklist
• Now includes a health component
• Health insurance
• Availability of medications
• Transportation to medical appts.

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Proposed Amendments 28 PA Code Chapter 27DOH
Regulations

• Communicable and Non-Communicable Disease
  Regulations
• Proposed changes are for clarification of the
  procedures related to communicable disease
  investigations in schools

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Proposed Amendments 28 Pa Code, Chapter 23 DOH
Immunization Regulation

• Effective school year 2007- 08
• 7th Grade - Booster of Tdap
• 7th Grade Meningococcal vaccine
• Restructured language to simplify requirements

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Immunization Registry

• SIIS-Statewide Information Immunization
  System.
• Currently being used in the public sector.
• Beginning to market to providers in the
  private sector.
• Working on view-only access for school nurses.

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FERPA Immunization Audits by Dept. of Health

• Section 99.31- Disclosure of personally
  identifiable student information without parental
  consent to state educational authorities.
• Section 99.35-Officials may have access to
  education records in connection with an audit of
  Federal or State supported education programs.

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22 PA CodePDE Regulations

• May be accessed at
• http//www.pacode.com

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22 PA Code Chapter 12 PDE Regulations Students
and Student Services

• Section 12.12
• Confidential Communications
• Section 12.41-Student Services
• (a) - Medication Policies
• (c)(4) - Provide basic health services
• (e) - Persons delivering student services
  shall be specifically licensed or certified
  as required by statute or regulation.

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CSPG 95-Principal
http//www.teaching.state.pa.us/teaching/lib/teach
ing/095_Principal.pdf
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CSPG 101-Paraprofessional

• http//www.teaching.state.pa.us/teaching/lib/teach
  ing/101_ParaprofessionalStaff.pdf

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How many Bills have been introduced?

• 2887 in the House
• 1293 in the Senate
• Total 4180
• How many Bills become Law?
• 96 in 2005
• 116 in 2006
• 212 Total

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Legislation Enacted 2005-2006

• Act 58 of 2006
• Continuing
• Nursing Education

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Legislation Enacted

• Act 114 of 2006
• (HB185)
• Competitive Food and Beverage Contracts
  Nutritional Guidelines BMI Interagency
  Coordinating Council for Child Health, Nutrition,
  and Physical Education Advisory committee to the
  Council and PDE, with DOH, to collaborate and
  seek Federal Grants for Coordinated School Health.

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LegislativeInitiatives of Interest

• Act 102 of 2002 Pharmacy Practice Act
  changes-(HB 751- signed into law June 29, 2002)
  Changed the definition of the practice of
  Pharmacy and provided for Pharmacists to
  prescribe or administer medications.

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Proposed Legislation

• SB 449 - Allergic Reaction Emergency Treatment
  Act
• SB 1170 - Allows school entities to replace up to
  50 of required Certified School Nurses with RNs
  with a BSN, CRNPs and/or PAs.
• HB 2348 and SB 1128 - Training of school
  employees in Diabetes care and treatment.
• HB 2106 - Crimes code - defining the offense -
  impersonating the holder of a professional
  license.

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Proposed Legislation

• HB 2543 - Nurse Licensure Compact
• HB 2721 - All schools where curricular or
  extracurricular athletics are held must have an
  AED onsite and at least one school employee
  trained to use the AED onsite.
• SB 676 (Conti) - Amendments to Health Services
  Chapter, Public School Code

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Healthy People 2010Focus Area 07

• Objective 07-04
• Percent of elementary, middle, junior high, and
  senior high schools (buildings) that have a nurse
  (LPN, RN, CSN) to student ratio of 1750 or
  less.

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Percent of Public School Districts with a total
nurse to student ratio of 1750 (or less)
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Certified School Nurses
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CSNs, RNs and LPNs Compared
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To Access Proposed Legislation

• www.legis.state.pa.us

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Pandemic Preparedness
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PA Initiatives

• State forum in Pittsburg, PA in May
• Regional forums (6) across the Commonwealth
• Point of Dispensing (POD) informational meetings
• Statewide Pandemic Planning Steering Committee
  workgroups

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PA Pandemic Preparedness  DOH workgroups

• Prevention, detection, policies, processes
• Workforce planning
• Isolation and quarantine procedures
• Vaccine and medication distribution

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DOH workgroups (continued) 

• Incident, coordination, response
• Public communications planning
• Local government
• Legal
• Preparation coordination

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Pandemic Preparedness Resources

• CDC website
• http//pandemicflu.gov
• Click on School Planning
• PA Pandemic website http//www.pandemicflu.state.p
  a.us/
• Click on Schools
• Coming soon The PA Pandemic Planning
  Toolkit for Schools

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Schools
State and Local Governments Individuals Businesses
Schools Health Care Providers Communities Agricul
ture Wildlife Stakeholder Sign-Up Q A What is
Pandemic Influenza? What is Avian Influenza? Is
it safe to eat chicken and duck? What is
Pennsylvania doing to prepare? What can I do to
prepare?
  Schools are a vital part of their communitys
planning process. Preparing will take the effort
of schools, and communities planning together for
a large number of absent students, staff
shortages, emergency closings and preventative
efforts to decrease the impact should there be a
pandemic.  This site has been developed to assist
schools in preparing for a pandemic or any
communicable disease outbreak.  Use the resources
below to assist in planning efforts. Letter
from Dr. Zahorchak, Secretary, Pennsylvania
Department of Education and Dr. Calvin Johnson,
Secretary, Pennsylvania Department of Health FAQ
for Schools from Pennsylvania Department of
Education Pennsylvania Pandemic Planning Toolkit
for Schools Colleges and Universities Checklist
(also in PDF) Child Care and Preschool Checklist
(also in PDF
DRAFT
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State and Local Governments Individuals Businesses
Schools Health Care Providers Communities Agricul
ture Wildlife Stakeholder Sign-Up Q A What is
Pandemic Influenza? What is Avian Influenza? Is
it safe to eat chicken and duck? What is
Pennsylvania doing to prepare? What can I do to
prepare?

• Pennsylvania Pandemic Planning Toolkit for
  Schools
• Introduction
• Integration with All-Hazard Plans
• Pandemic planning for schools should be done in
  conjunction with all-hazard emergency response
  planning
• NIMS and Schools
• NIMS provides a flexible framework and set of
  standardized processes, procedures and language
• Getting Started
• The first step for a school is to evaluate its
  overall emergency management crisis response plan
  (crisis plan)
• Resources to Complete the Task

DRAFT
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State and Local Governments Individuals Businesses
Schools Health Care Providers Communities Agricul
ture Wildlife Stakeholder Sign-Up Q A What is
Pandemic Influenza? What is Avian Influenza? Is
it safe to eat chicken and duck? What is
Pennsylvania doing to prepare? What can I do to
prepare?
Pennsylvania Pandemic Planning Toolkit for
Schools Introduction Integration with All-Hazard
Plans Pandemic planning for schools should be
done in conjunction with All-Hazard Emergency
Response Planning. Emergency Response Planning is
not new for schools. As early as July of 1988
every school district, in cooperation with the
local Emergency Management Agency, shall develop
and implement emergency preparedness plans. (35
Pa C.S.A., 7171, et seq) In addition, the
Pennsylvania Department of Education published a
School Emergency Planning Guide in 1996. Over the
years, these plans have evolved from focusing on
school violence into All-Hazards planning.
Pandemic Influenza is the newest hazard to be
considered by schools and included in their
All-Hazards plans. This toolkit provides
resources organized under the National Incident
Management System (NIMS) model to aide schools in
developing this component of an All-Hazards
Emergency Response plan. Tools Step 1
CDC Planning Checklist for Schools -This tool is
to be used to assess a schools (building,
campus, or district) readiness for responding to
a pandemic or other infectious disease crisis.
The assessment of readiness is the first step
toward developing a pandemic preparedness plan.
http//www.pandemicflu.gov/plan/schoolchecklist.ht
ml Step 2 Pennsylvania Pandemic Action
PlanningTool - This is a step by step action plan
to start the process that will lead your school
crisis team to an effective response in the event
of an infectious disease crisis. This tool is
flexible in that, following a schools
assessment, some action items may need to be
added while others deleted. Step 3 Pennsylvania
Pandemic Planning Template and Resources-Based on
the National Incident Management System (NIMS),
this tool provides phase by phase (mitigation,
preparedness, response and recovery) access to
important factors for consideration as well as a
myriad of resources that can be used to develop
the details of each schools plan.
DRAFT
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PA Pandemic Planning Template
State and Local Governments Individuals Businesses
Schools Health Care Providers Communities Agricul
ture Wildlife Stakeholder Sign-Up Q A What is
Pandemic Influenza? What is Avian Influenza? Is
it safe to eat chicken and duck? What is
Pennsylvania doing to prepare? What can I do to
prepare?
I. Mitigation A. Education of Faculty/Staff,
Students Families 1. Commonly Used
All-Hazard (including Pandemic) Planning
Acronyms 2. National Incident
Management System (NIMS) 3.
Identification Of Symptoms What To Do
4. Handwashing Cough/Sneeze
Etiquette 5. Flu Shots
6. Basic Readiness/Pandemic Readiness
Activities B. Surveillance 1.
Develop Means to Monitor Illness 2.
Monitor Staff, Students Families 3.
Conduct Risk/Vulnerability Assessment
DRAFT
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PA Pandemic Planning Resources
State and Local Governments Individuals Businesses
Schools Health Care Providers Communities Agricul
ture Wildlife Stakeholder Sign-Up Q A What is
Pandemic Influenza? What is Avian Influenza? Is
it safe to eat chicken and duck? What is
Pennsylvania doing to prepare? What can I do to
prepare?
Mitigation A. Education of Faculty/Staff,
Students Families 1. Commonly Used
All-Hazard (including Pandemic) Planning
Acronyms 2. National Incident
Management System (NIMS) a.
Powerpoint on NIMS http//www.ercm.org/views/docu
ments/NIMS_KellyAndCummings.ppt b.
Free on-line training 1) PA Dept. of Health
(DOH) Learning Management System To become a
registered user of LMS- www.health.state.pa.us/LMS
To access LMS- www.pahealthinfo.net 2) NIMS
Training website- http//training.fema.gov/emiweb/
IS/crslist.asp c. Pamphlets
1) Practical Information on Crisis
Planning A Guide for Schools Communities (the
pamphlet)- School Personnel- http//www.ed.gov/adm
ins/lead/safety/crisisplanning.pdf
2) Emergency Crisis Preparedness- (sample
pamphlet developed by Montgomery County Public
Schools Maryland)- Families
Communities http//www.mcps.k12.md.us/info/emerge
ncy/preparedness/CrisisPreparedness.pdf
DRAFT
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PA Pandemic Planning Resources
State and Local Governments Individuals Businesses
Schools Health Care Providers Communities Agricul
ture Wildlife Stakeholder Sign-Up Q A What is
Pandemic Influenza? What is Avian Influenza? Is
it safe to eat chicken and duck? What is
Pennsylvania doing to prepare? What can I do to
prepare?
Mitigation A. Education of Faculty/Staff,
Students Families 1. Commonly Used
All-Hazard (including Pandemic) Planning
Acronyms 2. National Incident
Management System (NIMS) a.
Powerpoint on NIMS http//www.ercm.org/views/docu
ments/NIMS_KellyAndCummings.ppt b.
Free on-line training 1) PA Dept. of Health
(DOH) Learning Management System To become a
registered user of LMS- www.health.state.pa.us/LMS
To access LMS- www.pahealthinfo.net 2) NIMS
Training website- http//training.fema.gov/emiweb/
IS/crslist.asp c. Pamphlets
1) Practical Information on Crisis
Planning A Guide for Schools Communities (the
pamphlet)- School Personnel- http//www.ed.gov/adm
ins/lead/safety/crisisplanning.pdf
2) Emergency Crisis Preparedness- (sample
pamphlet developed by Montgomery County Public
Schools Maryland)- Families
Communities http//www.mcps.k12.md.us/info/emerge
ncy/preparedness/CrisisPreparedness.pdf
DRAFT
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Learning Management System(LMS)

• School Health Track has been added
• Now offer on-line courses for school nurses and
  Act 48 hours through the DOSH
• Registered users are assigned a unique User ID
  and Password and are given access through the
  URL www.pahealthinfo.net.

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Learning Management System(LMS)

• To become a registered user
• Go to www.health.state.pa.us
• Send an email to LMS_at_state.pa.us and provide your
  name, email address, phone number and job title
  or description.

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Resources

• PA Dept. of Education - BECs, CSPG, Project
  PA,etc.
• www.pde.state.pa.us
• PA Dept of Health Information Clearinghouse
• http//www.health.state.pa.us
• CDC - Food Safe Schools, Heads Up, Changing the
  Scene
• www.cdc.gov

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Resources

• Mid Atlantic Center for Childrens Health and the
  Environment
• www.health-e-kids.org
• Available for phone consultations
• Clinical consultation evaluation
• Education and Outreach

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School Health Web Page

• www.health.state.pa.us/schoolhealth

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Pieces of the Pie
5. Growth Screening Program - BMI Percentile 6.
Federal mandate for Wellness Policies 7.
Legislation

• PA Obesity
• Study
• 2. PA Obesity
• Plan
• 3. Development
• of PANA
• 4. New CDC
• Growth Charts

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PA Growth Screening Program
Mandatory implementation and reporting for SY
05- 06 Grades K-4 SY 06- 07 Grades K-8 SY
07- 08 Grades K-12

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PA Growth Screening Statistics

• 8th Grade Study (2002) - 25,266 students
• 17 at-risk for overweight
• 18.20 overweight
• Pilot Study (2003) - 4,390 students
• 17.33 at-risk for overweight
• 21.03 overweight
• Voluntary BMI (2004-2005) - 233,724 students
• 13 at-risk for overweight
• 19 overweight

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PA Healthy Kids Compendium

• The Governor's Cabinet on Children and
  Families presents PA Healthy Kids -
  Pennsylvania's Strategy for Balancing Nutrition
  and Exercise in Kids, 
• It provides an overview of the Commonwealth's
  activities to prevent childhood obesity.
• An electronic document available soon through the
  school health web site.

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A resource to support schools in meeting school
health requirements.
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PANA Resourceswww.panaonline.org

• Keystone Healthy Zone Schools
• Keystone Healthy Zone Communities
• Enter the Zone Events
• Professional Trainings and Updates
• Youth Obesity Prevention and Weight
• Management Resources
• Action Kits and Resource Guides

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• Re-Charge After school program partnered with
  the NFL
• Conference April 30- May 1, 2007
• Wellness Policy Implementation

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Visit the AFHK Website

• www.ActionForHealthyKids.org

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New Electronic Reporting Via Web-based Application

• SHARRS
• School
• Health
• Annual
• Reimbursement
• Request
• System

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SHARRS

• Current Status
• Production completed
• Internal test Spring 2006
• Available for SY 05 - 06 (encouraged
• but not mandatory) after August 14,
• 2006
• Mandatory 2006-2007

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SHARRS

• Recap and Timeline
• Hardcopy template (w/ revisions) mailed Spring
  2005 (Draft advance copy)
• Instruction Manual for Annual School Health
  Report Security Approver info mailed Feb. 2006
• Spring 2006 mailing
• Final hardcopy report
• Security Approver Users Manual
• Since June 1, 2006, DOH has been assigning User
  IDs and Temporary Passwords (via e-mail, to
  Security Approver ONLY), and providing the SHARRS
  website
• Educational institution will NOT be able to
  submit report to DOH until after August 14, 2006

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SHARRS

• SECURITY APPROVER ROLE
• Only 1 user account can be established
• Account will be activated for Security Approver
  ONLY
• Security Approver may access system after June
  1, 2006
• only to
• Log in to system (will require temporary
  password to
• be changed to confidential password)
• Create other User Accounts
• Data Entry
• Business Manager
• Superintendent/CEO
• Can not enter data or submit reports

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SHARRS

• DATA ENTRY ROLE
• Only 5 user accounts can be established
• Enters financial demographic data
• Subsequent revisions
• View and print reports
• Can not access system until after August 14, 2006

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SHARRS

• BUSINESS MANAGER ROLE
• Only 3 user accounts can be established
• All functions of Data Entry role
• View and print payment vouchers
• Can not access system until after August 14, 2006

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SHARRS

• SUPERINTENDENT/CEO ROLE
• Only 1 user account can be established
• All functions of Data Entry and Business Manager
  roles
• Certifies and submits report and subsequent
  revisions
• Can not access system until after August 14, 2006

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SHARRS

• NOT a fully integrated system w/ school computer
  systems
• Data imports from schools NOT currently a viable
  solution SHARRS designed for manual data entry
  via Internet
• Post-production, DOH can review need for
  development of an electronic data transfer system
  using a prescribed interchange format

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The items in the drop down menu are displayed
here.
The items in the Special Dental Services drop
down menu are displayed here.
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01 Special Medical, Diagnostic Treatment
Services If claiming costs for psychological
assessments and evaluations, only those for
medical reasons are eligible, not those performed
for academic placement. DO NOT claim health care
provider costs to perform athletic examinations
or to support school athletic programs. See
Instruction Manual, Page 3, for a complete
description of this section. 02 Medical
Supplies, Equipment, Lab Services Educational
Materials Copies of invoices or itemized lists
of expenditures are no longer required to be
submitted. This documentation should remain on
file for future auditing purposes. ALL first
aid supplies used in conjunction with the School
Health program are eligible to be claimed for
reimbursement. DO NOT claim expenses related to
the Districts sports/athletic program. Non-reimb
ursable items include capital equipment such as
office furniture, including filing cabinets
window treatments typewriters computer
hardware, software, and technical support
professional membership fees, etc. See
Instruction Manual, Page 3, for a complete
description of this section.
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Alternative Students
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COMMON ERRORS

• Counting half time ADMs for AVTS students.
  Should claim one ADM per student.
• Including psychological evals. for academic
  placements under Special Examinations. Only
  psychological evals. for medical reasons are
  reimbursable.
• Including athletic physical exams under either
  School Physicians or Special Examinations. No
  athletic physical exams are reimbursable.

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The items in the drop down menu are displayed
here.
The items in the Special Dental Services drop
down menu are displayed here.
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01 Special Medical, Diagnostic Treatment
Services If claiming costs for psychological
assessments and evaluations, only those for
medical reasons are eligible, not those performed
for academic placement. DO NOT claim health care
provider costs to perform athletic examinations
or to support school athletic programs. See
Instruction Manual, Page 3, for a complete
description of this section. 02 Medical
Supplies, Equipment, Lab Services Educational
Materials Copies of invoices or itemized lists
of expenditures are no longer required to be
submitted. This documentation should remain on
file for future auditing purposes. ALL first
aid supplies used in conjunction with the School
Health program are eligible to be claimed for
reimbursement. DO NOT claim expenses related to
the Districts sports/athletic program. Non-reimb
ursable items include capital equipment such as
office furniture, including filing cabinets
window treatments typewriters computer
hardware, software, and technical support
professional membership fees, etc. See
Instruction Manual, Page 3, for a complete
description of this section.
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Alternative Students
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COMMON ERRORS

• Counting half time ADMs for AVTS students.
  Should claim one ADM per student.
• Including psychological evals. for academic
  placements under Special Examinations. Only
  psychological evals. for medical reasons are
  reimbursable.
• Including athletic physical exams under either
  School Physicians or Special Examinations. No
  athletic physical exams are reimbursable.

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COMMON ERRORS

• Including Supplemental Health Staff salaries w/
  the Certified School Nurse salaries. Should go
  under Cost of Medical Services, Supp. Staff.
• Including fringe benefits with Certified School
  Nurse and Supplemental Health staff salaries. No
  fringe benefits are reimbursable.
• Including Certified School Nurse outservice
  training and travel costs. Only CSN costs for
  travel between school bldgs. is reimbursable.

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COMMON ERRORS

• Entering ADM figures instead of actual student
  caseload figures per nurse per building.

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District CSNs will appear in drop down menu.
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COMMON ERRORS

• Listing a Dental Hygienist on the Other Health
  Professional page without listing a Dentist.

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Health Exams, Screens, Select Services (cont.)
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Mandated Formula for Reimbursement

• Medical Services The lesser of 1.60 X ADM or
  certified costs.
• Mandated Dental Services The lesser of .80 X
  ADM or certified costs.
• Dental Hygiene Services Program The lesser of
  2.00 X number of children served, not to exceed
  ADM by grade level, or certified costs.
• Nursing Services The lesser of 7.00 X ADM or
  certified costs.
• Act 25 Supplemental Allocation 9.70 X ADM

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School Health Web Sitewww.health.state.pa.us/sc
hoolhealthClick on link for Publications and
Documents

• PowerPoint Presentation on SHARRS
• Annual Report Instruction Manual
• Hardcopy Annual Report