Health Services » School Health Services

School Health Services


Documents and Forms

A student’s health status is directly related to his or her ability to learn. Children with unmet health needs have a difficult time engaging in the educational process. The school nurse supports student success by providing health care through assessment, intervention, and follow-up for all children within the school setting, addressing the physical, mental, emotional, and social health needs of students and supporting their achievement in the learning process.

Health Records

The school nurse is responsible for maintaining health records for each student. Information concerning the following must be given to the nurse:
  1. Physical examination record prior to enrollment in school, before entry into middle school, and annually prior to  participation on a school athletic team (JLCA)
  2. Record of illness, injury, hospitalization, allergy and / or special needs
  3. Results of vision or hearing tests that are done outside the school setting
  4. Immunization record satisfying current NH statute (required at entry by RSA 200:38)
  5. Transfer students must provide a copy of the cumulative health record from their previous school


All school-aged children must have immunization records on file in the health office.  All students who have less than the minimum requirement must have either a medical or religious exemption, or a physician-approved schedule for reaching those requirements.
Students who have not been fully immunized will not be in compliance with the law. Failure to comply with this provision may result in exclusion from school for the child. A child may be “conditionally” enrolled when the parent/guardian provides documentation of at least one dose for each required vaccine AND the appointment date for the next dose of required vaccine.  The appointment date shall serve as the suspension date. If the parent/guardian fails to keep the scheduled appointment, and suspension shall continue until acceptable immunization status is attained.
The following outlines the New Hampshire School Immunization Requirements for 2023-2024

Vaccinations and Requirements

Vaccinations Requirements
Diphtheria, Tetanus, and Pertussis
6 years and under: 4 or 5 doses with the last dose given on or after the 4th birthday

7 years and older: 3, 4, or 5 doses with the last dose given on or after the 4th birthday

Grades 7-12: 1 dose of Tdap is required for entry into 7th grade
Grades K-8: 3 or 4 doses with the last dose given on or after the 4th birthday and the last 2 doses separated by 6 months or more.

Grades 9-12: 3 doses, with the last dose given on or after the 4th birthday OR 4 doses regardless of age at administration.
Hepatitis B
Grades K-12: 3 doses at acceptable intervals
Measles, Mumps and Rubella, MMR
Grades K-12: 2 doses; the first dose must be administered on or after the 1st birthday
Varicella (Chicken Pox)
Grades K-11: 2 doses with the first dose administered on or after the 1st birthday OR laboratory confirmation of immunity.

Grade 12: 2 doses with the first dose administered on or after the 1st birthday OR laboratory confirmation of immunity OR history of chickenpox disease.


All medications are to be administered or assisted with under the supervision of the school nurse, designated UAP (Unlicensed Assistive Personnel), or principal as prescribed. Over the counter medications will be administered as recommended by the manufacturer unless the student’s physician, APRN, PA, or dentist has provided different
instructions. (JLCD).
Parent/guardian authorization is required for all medication administered to a student during the school day. In addition to parent/guardian authorization, for any prescription medication from a licensed physician, APRN, PA or dentist, there must be written documentation from the prescriber which specifies the student, medication, dose, route, time, frequency, and purpose. The school day includes any day, afternoon, or evening hours when the student is attending a school or other school sponsored activity. Medications must be renewed each school with the appropriate documentation. 

A parent/guardian or designated responsible adult shall deliver all medications to the school nurse. The medication must be in the original pharmacy container. The label shall include the student’s name, dose of medication, route, and time of administration, and any specific instructions regarding administration. Over the counter medications are to be in their original manufacturer’s container.
Students may carry and self-administer epinephrine auto injectors and asthma inhalers with authorization in writing of both the parent/guardian and the prescriber (RSA 200:42-200:47). Any student who has to use an epinephrine auto injector shall obtain help from the nearest supervising adult. A call to 911 will activate emergency services for further care of the student. The nurse may delegate authority to students with diabetes to self-carry and self-administer glucose tabs and insulin with parent/guardian and prescriber authorization. Glucagon for injection will be provided for the health office in order to ensure a rapid response for a diabetic emergency. Student 504 plans are to state any accommodations needed to ensure the safety of the student and that medical needs are met. Students shall not possess any medication, with the exceptions of epinephrine, inhalers, or diabetes medications. Students shall not share any medication.

Health Screening

Height, weight, vision, hearing, and spinal (scoliosis) screenings may be done for certain grades by the Nurse, according to the recommendations of the National Association of School Nurses (NASN), to determine if a child needs to be referred to a specialist for a thorough evaluation. If a parent/guardian prefers that their child NOT be screened at school, please notify the Nurse in writing, if a parent has any concerns about the growth and development of a child, the Nurse will gladly screen your child sooner, upon your request.

Dental Services

There is a school based preventive dental program for children in grades K-3.  The Cheshire Health Foundation and the United Way, along with community groups and concerned citizens, fund this program, called “Cheshire Smiles”. Our School Nurse will be facilitating this initiative with the Cheshire Smiles Coordinator.

Exclusion Criteria

Students shall not be excluded from school because of illness unless the student exhibits signs or symptoms of illness preventing him or her from participating comfortably in school activities or the illness results in greater care needed than the staff can provide without compromising the health and safety of the other students.  A student may be excluded from school when he/she exhibits symptoms of a contagious or communicable illness. The following outlines some of the criteria for which a student may be excluded from school.
Exclusion Criteria Documentation Reportable to the Department of Health
No exclusion necessary.  
Per the AAP, “Pinkeye is similar to the common cold, for which exclusion is not recommended.  The best method for preventing it is good hand hygiene.”
N/A Not reportable
  • Defined as 3 or more loose or watery stools not associated with changes in diet that occur in a 24-hour period.

  • Exclude students in grades K-5 with diarrhea until symptoms are resolved for 24 hours or more, or medical evaluation indicates that inclusion is acceptable.

  • Exclusion for students in grades 6-8 is not mandatory unless:
    1. Diarrhea is caused by E.coli, Salmonella, or Shigella, or
    2. Students are determined to be contributing to the spread of illness in the school setting.

  • Exclude any students with uncontrolled diarrhea or stools that contain blood or mucus until symptoms are resolved or medical evaluation indicates that  inclusion is acceptable.

  • Exclusion is not required if a student is known to have these symptoms for a non-infectious condition (i.e. Crohn's Disease, IBS).

  • Exclusion is not required if diarrheal symptoms persist after completion of effective antimicrobial therapy.
N/A … unless one of the bulleted criteria applies, in which case a medical note from a consulting healthcare provider is required. Reportable within 72 hours only if diagnosed a Reportable Disease as outlined by NH DHHS (i.e. E. coli, Salmonella, Shigella, Giardia, Campylobacter)

  • Fever in school is defined as a temperature greater than 100.4⁰F.
Exclude for fever, accompanied by behavior changes or other signs and symptoms of illness (such as sore throat, rash, vomiting, nausea, diarrhea, irritability, earache, confusion).
If the excluding fever was less than 100.4⁰ F, and the student has no signs or symptoms of illness, (s) he may return to school the next day.
If the excluding fever was 100.4⁰ F or greater, and the student has signs or symptoms of illness, (s) he should remain home for an additional day.
Not reportable
Pediculosis (Head Lice)
Infestation of head lice is defined as: 
  • The presence of live, crawling lice visualized on the direct inspection of the scalp, and/or
  • The presence of nits (eggs) that appear to be ¼ inch from the scalp.
Students identified with head lice may be allowed to remain at school until the end of the school day, with limitations placed upon activities that cause head-to-head contact.
Exclusion for head lice shall begin at the end of the school day and remain until after the first treatment with an appropriate lice removal product.
The school does not have a “No-Nit Policy”.
Parent note documenting treatment with an appropriate lice removal product identified in literature as having pediculicidal activity, plus evidence of no live-crawling lice on student’s scalp. 
Not reportable
Pertussis (whooping cough)
Exclude until completion of 5 days of appropriate antimicrobial therapy.  
Medical note documenting diagnosis, plus completion of 5 days of antimicrobial therapy (unless ≥21 days post cough onset at diagnosis.) Report within 24 hours of diagnosis or suspicion of diagnosis.
Tinea (ringworm)

  • Ringworm of the scalp (tinea capitis):  Exclude students in grades K-5 at the end of the school day until oral antifungal treatment is initiated.
  • Ringworm of the body (tinea corporis):  If lesions cannot be adequately covered, exclude students in grades K-5 at the end of the school day until oral or topical antifungal treatment is initiated.
  • Exclusion for tinea capitis or tinea corporis is not mandatory for students in grades 6-8 unless a student is determined to be contributing to the spread of illness in the school setting or meets other exclusion criteria outlined above.
Medical note documenting diagnosis and initiation of oral and/or topical antifungal therapy. Not reportable

Exclude until after appropriate scabicidal treatment has been completed (usually overnight). 
Medical note documenting diagnosis and parent/guardian note documenting completion of therapy. Not reportable
Streptococcal pharyngitis (strep throat)
Exclude until afebrile and at least 24 hours after treatment has been initiated.
Medical note documenting diagnosis and parent/guardian note indicating initiation of treatment and report of afebrile status. Not reportable
Varicella (chicken pox)

  • Exclude typical Varicella until all lesions have dried and crusted (usually 6 days after the onset of rash.)

Children with mild or breakthrough Varicella disease (typically seen in previously immunized children) may not exhibit vesicles or crusting of lesions. These students should be excluded from school until lesions fade away and no new lesions appear.
Exclude for 5-7 days, return after lesions dry and scab over.
Parent note indicating lesions are fading/resolving.
Report within 24 hours of diagnosis or suspicion of diagnosis.
Unimmunized School Children:
Students without documentation of immunity or natural disease must be excluded if exposed to:
  • measles
  • mumps
  • rubella
  • varicella (chicken pox)
NH DHHS says that during an outbreak of a communicable disease for which immunization is required, children exempted shall not attend the school or childcare agency threatened by the communicable disease. The NH DHHS will provide guidance on an individual basis regarding when a student who is immunocompromised and/or unimmunized may return to school following an exposure to one of these conditions.
Anybody who meets any of the following criteria should be excluded:
  • Any new or unexplained symptoms of COVID-19  (fever/chills, cough, shortness of breath or difficulty breathing, sore throat, runny nose or nasal congestion, muscle or body aches, fatigue, headache, new loss of taste or smell, nausea or vomiting, diarrhea), even if symptoms are mild or symptoms of Multisystem Inflammatory Syndrome (MIS-C) which include fever, abdominal pain, vomiting, diarrhea, neck pain, rash, bloodshot eyes, feeling extra tired.

  • Close contact with someone who is suspected or confirmed to have COVID-19 in the prior 14 days.

  • Reports a travel-related risk factor as identified in daily screening questions.
Symptomatic students or staff can be allowed to return to school when one of the following two conditions is met:
  1. Person receives an approved COVID-19 test that is negative, AND the person’s symptoms are improving and they are fever-free for at least 24 hours off any fever-reducing medications. Approved tests include:  A PCR-based molecular test Quidel Sofia antigen testing is conducted within 5 days of symptom onset

  2. Person has met CDC criteria for ending home isolation (i.e., if the person is not tested, they are managed assuming they have COVID-19).
If a student has close contact with someone confirmed to have COVID-19 in the prior 14 days or has a travel-related risk, they are required to complete self-quarantine at home for 14 days from the last known exposure.
Report within 24 hours of diagnosis or suspicion of diagnosis.