ENROLLMENT RELEASES Questions? Please don`t hesitate to

 ENROLLMENT RELEASES Below you’ll find a list of releases that are included in this packet. Please be sure to sign, as indicated, and return prior to your child’s enrollment date. You may fax them to (208) 267‐3232 or scan and e‐mail to [email protected]. •
•
•
•
•
•
•
•
Nursing Communication Document Dental Forms Pharmacy Release Aquatic Activity Consent & Release Boundary Community Hospital Form Bill Lane Transport Services Release AAIS Transport Services Release Schweitzer Mountain Learning Center and Rental Releases •
•
•
•
Privacy Practices (Please note that pages 1 through 8 are for your review – please return only the signature page.) ACT Application for Extended Time SAT College Board Application for Extended Time Student Policy Packet (This is for your review – please return only signature page. Your child also receives a copy of this policy.)
Please be sure to also send the following documents to us: □ Academic transcript and/or current grades, progress report (if not already submitted) □ Copy of medical insurance card (both front and back please) □ Copy of dental insurance card (if applicable) □ Copy of immunization record □ Copy of most recent physical and lab test results □ Student identification (i.e. – driver’s license, passport photo page, or school identification card) □ Copy of parents’ driver’s license □ Copy of birth certificate □ Copy of divorce and custody/visitation agreement (if applicable) □ Passport (please bring upon admission if available) Also, please be sure you have submitted both Part I and II of our application, both can be found on our web site at bouldercreekacademy.com. Questions? Please don’t hesitate to contact Admissions Coordinator Diane Grey at: (877) 348‐0840, Ext. 4017 ▪ [email protected] Dear Parent or Guardian, We are pleased you have chosen Boulder Creek Academy. The nursing staff welcomes the opportunity to work with you and your child. Please feel free to contact us at any time with questions or concerns. This is an outline of the requirements needed at enrollment and throughout your child’s stay with us. Please take a moment to review and complete the check lists so that we can better assist you and your family. PHYSICALS A current physical is required within 30days of enrollment date. If your child was in a wilderness program setting, it could be from any time during the wilderness stay. Our Medical Director is Dr. Ligeia Reinhardt, located here in Bonners Ferry, Idaho. Please alert our nursing department of any issues that need to be addressed. □ Yes, physical is current and a copy is included. □ No, please schedule a physical. □ I also need the doctor to address the following: _____________________________ _______________________________________________________________________ Physicals will need to be done on an annual basis from the date of the last exam; our nursing staff will inform you when it is due and give you the opportunity to schedule it at home or have it done here locally with Dr. Reinhardt. LAB WORK All students are required by the state of Idaho to have lab work completed. The panel of labs that needs to be done is as follows: CBC, BMP, TSH‐r, VDRL, HIV, Hepatitis A/B, UA, Pregnancy test, Lipid panel, Hepatic function, RPR, and Chlamydia test (if your child went to a wilderness program, they only require a couple of the above labs). Our local hospital provides this UHS panel at a less expensive cost than if these tests were to be done individually. □ Yes, labs are complete. □ No, please schedule the lab work as required. Labs will be ordered on an as‐needed basis. If you child is on psychotropic or seizure medications it may be necessary every six months or sooner with medication changes. IMUNIZATION RECORDS We need a copy of the current Immunization Record on your child. We will review the records to ensure compliance with Idaho’s School Immunization requirements. We will schedule your child to be updated if any of the below are not current. □ Yes, Tetanus booster has been done within 5 years □ No, please schedule □ Yes, Hepatitis B series is complete (3 injections) □ No, please schedule □ Yes, TB skin test has recently been performed and is negative □ No, please schedule DENTAL We need documentation of the last dental exam and cleaning; it needs to be within a six month period. Our local dentist will send you paperwork to fill out to determine your child’s ongoing needs; a follow up appointment will then be scheduled. You will be notified by the dentist of any restorations that are necessary and give your approval prior to care being provided. It is the same for any orthodontic care that is needed. □ My child needs a dental appt in _________________________ (timeline) □ My child needs an orthodontic follow up in ________________ (timeline) Follow up dental exams and cleanings will be scheduled depending on your child’s needs and/or insurance coverage. MEDICATIONS It is the responsibility of the nursing staff to ensure your child’s medication safety, and ordering medications and refills. Our nursing staff cannot take medication orders from a physician outside of their state of practice, therefore all students on psychotropic, antidepressant, ADHD, or mood stabilizing medications will see Dr. Alan Unis (Child Psychiatrist) or Dr. Ligeia Reinhardt (MD, Medical Director). It is important for us to know what medications your child has been on in the past and why it was discontinued. Please provide a medication history with the name, dose, reason for stopping the medication, and time frame of when the medication was taken. __________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________ Dr. Alan Unis will see your child in the first few weeks after they arrive at the school. You will have a phone conference with the doctor on the same day. He will then be the primary physician for management of any psychiatric medications for your child. Dr. Unis visits our campus on a regular basis to follow the progress of students. The nursing and clinical staff work very closely with him for medication management and continuity of care. Nursing staff will contact you when a change in medication is recommended by the doctor, for your approval of the change. All other medications will be managed by Dr. Ligeia Reinhardt. ALTERNATIVE / NON‐TRADITIONAL MEDICINES We sometimes receive requests by various Alternative Medicine Practitioners across the country. We provide only traditional evidenced‐based medicine. Alternative or non‐traditional medicines cannot be honored unless it has been assessed as medically sound and may complement allopathic medicine ordered by our local physician. That includes all supplements other than a multivitamin and/or a Vitamin C for once‐a‐day use. If you would like your child to have additional supplements, please let nursing staff know and we will make an appointment for your child with Dr. Reinhardt to be evaluated for medical need. Power bars, protein bars, and body‐building products are discouraged and cannot be managed by the Nursing Department. EYE EXAMS For those that need it, eye exams are scheduled annually. Please provide documentation of the last appointment so that we can schedule accordingly. Extra glasses and/or contacts that you provide can be stored in the nursing office for safe keeping. ASTHMA If your child has asthma issues now or in the past, please let nursing staff know the specifics. It is recommended you bring two inhalers with you upon admission, even if it has been a long time since an asthma attack. Our climate is very unpredictable and students are expected to be more physically active the first few weeks of enrollment. These could set off an attack and we want to be prepared. □ Yes, my child does have asthma □ current □ in the past Effective treatment has been ________________________________________________ □ No issues with asthma SPECIAL DIETARY NEEDS Let us know of any special dietary needs your child has so that we may review for accommodation through our Dietary Department Again, please feel free to contact nursing staff with any issues that arise, we are available seven days a week. The nursing staff is responsible for the scheduling of all medical appointments. To ensure the quickest response be sure to include all of the nurses in your emails. Phone: (208) 267‐2873 ▪ Fax: (208) 267‐1302 Linda Manley, RN ACLS,APLS,TNCC,PEN Nursing Staff [email protected] Chinna McKechnie, RN, ACLS Nursing Staff [email protected] Marlene Stanley, LPN Nursing Staff [email protected]
PLEASE SIGN HERE:
Student Name: ______________________________________________ Birthdate: _________________
Parent/Guardian name:___________________________Signature____________________Date: _______