Health Requirements

K-12 Admission

• Polio - 4 doses (3 doses OK if at least one is given on or after the 4th birthday).
• DTaP - 5 doses (4 doses OK if at least one is given on or after the 4th birthday, 3 doses OK if at least one dose of Tdap, DTaP, or DTP is given on or after the 7th birthday).
• Hepatitis B - 3 doses.
• Measles, Mumps, Rubella (MMR) - 2 doses given on or after the 1st birthday (two doses of measles, two doses of mumps, and one dose of rubella meet the requirement, either separately or combined).
• Varicella - 2 doses.
• Tdap (Grades 7th-12th) - 1 dose given on or after the 7th birthday.

7th Grade Advancement

• Tdap - 1 dose given on or after the 7th birthday.
• Varicella - 2 doses.

Personal Belief Waivers (effective since 2016)

Senate Bill (SB) 277:

• Will no longer permit immunization exemptions based on personal beliefs for children in child care, public and private schools;
• Will permit personal belief exemptions filed at a school or child care facility in California before January 1, 2016 to remain valid until a pupil reaches TK / kindergarten or 7th grade;
• Will not require immunization documentation for:
  • Students in home-based private schools.
  • Students enrolled in an independent study program who do not receive classroom-based instruction.
  • Access to special education and related services specified in an individualized education program.

Medical Exemptions

Beginning January 1 2021, all medical exemptions for schools and child care facilities must be submitted through the California Immunization Registry - Medical Exemption website (CAIR-ME) by physicians licensed in California. Schools and child care facilities may only accept new medical exemptions that are issued using CAIR-ME.

This change impacts medical exemptions for:

• New enrollments as of January 1, 2021.
• Students who transition to the next grade span (TK/K - 6th grade, 7th-12th grade).
• Students whose temporary medical exemption have expired.
• Medical exemptions that were revoked due to the issuing physician being a subject of disciplinary action.

In order to receive a medical exemption, parents must create a CAIR-ME account and log in to submit a request for a medical exemption. Next, the child's physician can complete the medical exemption in CAIR-ME and print a copy for the parents to give to the school or child care facility.

A medical exemption may be issued in CAIR-ME no more than 12 months before a child first enters a grade span (grade spans are birth-preschool, TK/K-6th, and 7th-12th).

Families who have a medical exemption due to a history of disease, for example from Varicella / Chickenpox, must also follow this process.

To request a medical exemption, please visit the CAIR-ME web page.

For Frequently Asked Questions on Medical Exemptions, please visit Shots for School web page.

For additional questions about submitting a request through CAIR-ME, please follow up with your child's physician. For questions about PAUSD Registration, please email Registration Services or call (650) 329-3707.

For information on where to get immunizations for your child in Santa Clara County, click here | Spanish.

What's DIFFERENT about the new immunization dose requirements for school (TK/K-12)?

Starting in the 2019-2020 school year, school immunization requirements will include 2 (rather than 1) doses of chickenpox vaccine at:

• TK/Kindergarten entry
• 7th grade advancement
• TK/K-12 admission or transfer
• 2 MMR doses and 3 Hepatitis B vaccine doses at admission or transfer for most K-12 students.

As these requirements reflect longstanding national recommendations, many children have already met these requirements.

What's DIFFERENT about the new immunization requirements for pre-kindergarten (child care or preschool)?

Starting July 1, 2019, immunization requirements include:

• Chickenpox vaccine is required at age 15 months and older (rather than age 18 months and older).
• Other required vaccine dose requirements remain the same.
• As children age into requirements, parents have 30 days to submit updated records showing the child has met the requirements. For example, when an already admitted child who is up-to-date on shots turns 18 months old, the parents have 30 days from the day the child turns 18 months old to submit records that the child has received the 4th dose of DTaP and 3rd dose of Hep B.

Do students admitted in previous school years have to meet the new requirements in the 2019-2020 school year?

If a child is considered an admission at any school at any date on or after July 1, 2019 (including transfer students), the child will need to meet the newer immunization requirements in effect at the time of admission.

If a child is advancing to 7th grade in the fall of 2019 or later, the child must meet the 7th grade requirements in effect at the time of entry into 7th grade (i.e., 1 dose of Tdap, 2 doses of chickenpox vaccine).

If a child has an expiring personal beliefs exemption prior to attending school on or after July 1, 2019, the child will need to meet all current immunization requirements.

For admissions on or after July 1, 2019, what is required for a medical exemption to a required immunization?

Starting July 1, 2019, a parent or guardian must submit a signed, written statement from a physician (MD or DO) licensed in California which states:

• The specific nature of the physical condition or medical circumstance of the child for which a licensed physician does not recommend immunization.
• Each specific required vaccine that is being exempted.
• Whether the medical exemption is permanent or temporary.
• If the exemption is temporary, an expiration date no more than 12 calendar months from the date of signing.

For admissions on or after January 1, 2021, what is required for a medical exemption to a required immunization?

Starting January 1, 2021:

• Medical exemptions can only be issued through the California Immunization Registry - Medical Exemption website (CAIR-ME) by physicians licensed in California.
• Schools and child care facilities may only accept from parents new medical exemptions that are issued using CAIR-ME.

Does a medical exemption filed for a child attending before January 1, 2021, need to meet the new requirements?

In some cases. A medical exemption filed previously remains valid until the earliest of:

• When the child is next considered to be an admission at a school or pre-kindergarten facility (applies to both temporary and permanent medical exemptions), or
• The expiration date specified in the medical exemption (applies to temporary medical exemptions), or
• Advancement to the next grade span (TK/K-6^th, 7^th-12^th).

May other practitioners, besides licensed physicians (MDs and DOs), provide a medical exemption to a required immunization?

No. Only a licensed Medical Doctor (MD) or Doctor of Osteopathic Medicine (DO) may provide a medical exemption.

To meet the chickenpox requirement for TK/K-12 admission or for advancement into 7th grade, may a school accept an immunization record that indicates a "history of chickenpox disease"?

No, this is not sufficient documentation to meet school requirements. A medical exemption may be used for a child who had chickenpox disease that was documented by a physician. Starting in 2021, new medical exemptions must be issued using CAIR-ME.

What are the requirements for students entering a home-based private school or independent study program and do not receive classroom-based instruction?

Students entering:

• A home-based private school or
• An independent study program and do not receive classroom-based instruction

are not subject to immunization requirements. Parents or guardians must provide records to the respective schools of any required immunizations received by these students.

Are students who are homeless or in foster care subject to the immunization requirements?

Yes. However, a student who is homeless or in foster care, when transferring into a new school, may be admitted immediately if the student arrives without immunization records. Schools should utilize their resources to make sure these students have received all required immunizations as soon as possible.

Are California schools and child care facilities required to report the immunization status of all pupils at selected ages and grades?

Yes. All California schools and child care facilities, whether public or private, are required to report to the California Department of Public Health and the local health department each year the immunization status of all pupils, without exceptions, admitted at specified ages or grade levels. (Citation: California Health and Safety Code Section 120375 and 17 CCR § 6075)

May schools and child care facilities share student immunization information with public health agencies?

Reporting of student immunization information to public health agencies is allowed by state and federal laws, including but not limited to

California laws:

• Chapters 1 (commencing with section 120325) and 2.5 (commencing with section 120440) of Part 2, of Division 105 of the Health and Safety Code

Federal laws:

• The Health Insurance Portability and Accountability Act of 1996 (HIPAA) (45 CFR Part 160 and Subparts A and E of Part 164), and
• The Family Educational Rights and Privacy Act (FERPA) (20 U.S.C. § 1232g; 34 CFR Part 99), which applies to educational agencies or institutions that receive funds from programs administered by the U.S. Department of Education.

Where may I find immunization coverage data for children in schools and child care facilities?

Data are posted at the following sites:

• Kindergarteners
• 7th Graders
• Children attending pre-Kindergarten facilities

As a 7th grader, to make sure your student is healthy at school, PAUSD will need to have the following documents in your student's record:

1. One dose of Tdap (Diphtheria, Tetanus, and Pertussis) given on or after the 7th birthday.
2. Two doses of Varicella.

Students who had a valid personal beliefs exemption filed before 2016 between Kindergarten and 6th grade need to meet the requirements listed for TK/K-12 as well as requirements for 7th grade.

These students will need documentation for the following immunizations:

1. Diphtheria, Tetanus, and Pertussis containing vaccine (DTaP, DTP, DT, Tdap, or Td) - 3 doses. One dose of Tdap vaccine given on or after the 7th birthday will meet the 7th grade requirement and count as one of the 3 doses required for students TK/K-12.
2. Polio (OPV or IPV) - 4 doses (3 doses ok if one given on or after the 2nd birthday)
3. MMR - 2 doses (or 2 doses of measles-containing vaccine and 1 dose of rubella vaccine)
4. Varicella - 2 doses

For information on where to get immunizations for your child in Santa Clara County, click here | Spanish.

Vaccination records or a letter from your child's physician can be delivered to Health Services

• By mail:
  Attn: Health Services
  25 Churchill Ave.
  Palo Alto, 94306
• By email: health@pausd.org
• By fax: (650) 833-4226
• Drop-Off:
  District Office Portable A
  25 Churchill Ave.
  Palo Alto, 94306
  Hours: 8 am - 4:45 pm (note - during summer, the District Office is closed on Fridays).

Tuberculosis (TB) Requirements

Students newly enrolling into a school in Santa Clara County are required to have their healthcare provider complete a TB Risk Assessment for School Entry form completed by a United States licensed health professional.

• TB skin or blood testing is only required if their healthcare provider identifies a risk factor for TB exposure on the TB Risk Assessment form.
• To be valid, documentation must show a TB risk assessment or tests was performed in the United States up to twelve months prior to registration for school.

For information on tuberculosis requirements and where to get a tuberculosis screening for your child in Santa Clara County, click here.

Oral Health Assessment KINDERGARTEN ONLY

A dental check-up is required by May 31st of Kindergarten or 1st grade for students who did not attend a California public school for Kindergarten.

• To be valid, the form must show the oral health examination was preformed no earlier than 12 months prior to the date of initial enrollment.
• For information on low-cost dental clinics, click here.
• For families with DentiCal, the following lists providers who accept DentiCal:
  1. Santa Clara County DentiCal Providers
  2. San Mateo County DentiCal Providers

Health Examination (CHDP Report) FIRST GRADE ONLY

California law requires a health assessment 18 months before or up to 90 days after enrolling in first grade.

Any student who is required to take medication during the school day may be assisted by a school nurse or designated school personnel if the school receives a completed "Medication Authorization Form" signed by a California licensed health care provider and the student's parent or guardian (EC 49423).

Upon written parent's consent and school nurse approval, a student may be allowed to carry and self-administer prescription auto-injectable epinephrine, prescription inhaled asthma medication, or medications and supplies prescribed for the management of diabetes. No other medications, except for emergency use, may be carried.* Students may be allowed to carry and self-administer these prescribed medications if the school receives a completed "Medication Authorization Form" and the "Student/Parent Consent to Carry and Self-Administer Medication" form and after approval by the school nurse.

*For approval to carry and self-administer other medications that are of a confidential nature, need urgent administration, or other reasons, please contact a district nurse. Exceptions to the above rule will be made on a case by case basis in consultation with the district nurse and student's physician. Contact a district nurse by email or call 650-833-4240.

Medication forms can be obtained from the school health office or printed from the links below.

No medication, including herbal remedies or other over-the-counter drugs, will be stored or dispensed at school without written authorization from the physician and parent. All medication permits must be renewed at the beginning of each school year before the medications can be on site. Medication must be supplied by the parent in the original container clearly labeled with student's name, medication, dosage and directions, or original over-the-counter container. Updated forms for the next school year must be signed after the current school year ends.

Your child's school will keep an accurate written record documenting that the medication was administered in the prescribed amount at the prescribed time.

In the event an emergency medication is administered, including but not limited to, epinephrine auto-injector, glucagon, and emergency anti-seizure medications, school staff will call the emergency 911 telephone number and the student’s parent/guardian. This shall not require the student to be transported to an emergency room. EMS protocol may require a parent/guardian to be present to avoid transport to the emergency room. If an emergency medication is administered, student will not remain at school or be transported by bus unless authorized by a district nurse.

Medication Authorization Forms

• Medication Authorization - General for School Hours, Field Trips, and Disasters - English | Spanish | Mandarin.
• Medication Authorization - Anaphylaxis - English | Spanish | Mandarin.
• Medication Authorization - Asthma - English | Spanish | Mandarin.
• Medication Authorization - Emergency Anti-Seizure - English | Spanish | Mandarin.
• Seizure Action Plan.

If your student has Type 1 Diabetes, Type 2 Diabetes, or a specialized health care procedure (i.e. Catheterization, Gastrostomy Tubes, etc.), please email Health Services or call 650-833-4240 for information on necessary forms and protocols.

If your child has a chronic health condition, asthma, seizures, or severe allergies (anaphylactic reaction), the health office at each school can help keep your child safe and healthy by completing the appropriate forms and returning the forms to your school office before school starts. This will help us prepare to care for your child. Please make sure that you ALWAYS keep your emergency card up to date.

• General Protocol for Anaphylactic Reaction
• Health and Education Information Form
• Lice Protocol
• Specialized Health Care Procedures Authorization (Spanish, Mandarin) i.e. Catheterizations, Gastrostomy tubes, etc.
• Sun Safety Protocol
• Type 1 Diabetes Protocol - if your child has diabetes please contact the Health Services Office at (650) 833-4240 to setup your child's Diabetes protocol.

The District Nurses and other qualified professionals conduct screenings at school sites. All students are screened at the grade levels listed below:

• Vision and Hearing: Grades TK, K, 2nd, 5th, and 8th.
• Color Vision: Grade 1.

Students may also be screened if the parent, teacher or school nurse suspect a vision or hearing problem and for special education assessments and as needed for district health initiatives. Those who fail the initial screening will be re-tested by the school nurse. Parents will be notified and referred for further follow-up only when a problem is identified (EC 49456, 49452.5).

Parents may submit a written request to the school principal for exemption from any of the above health screenings.

• Vaccine Schedule birth-6 years old (Spanish)
• Vaccine Schedule 7-18 years old (Spanish)
• DTaP Vaccine (Spanish)
• Flu Vaccine - Inactive (Spanish)
• Flu Vaccine - Live (Spanish)
• Hepatitis B Vaccine (Spanish)
• Hib Vaccine (Spanish)
• Polio Vaccine (Spanish)
• MMR Vaccine (Spanish)
• Tdap Vaccine (Spanish)
• Varicella - Chickenpox Vaccine (Spanish)

For the safety and protection of all, students should not attend school with any symptoms below and will be sent home for any of the following symptoms:

• Cold symptoms. Keep student home during period of productive cough and yellow or green nasal discharge.
• Fever of 100 degrees or higher. Students who have been ill with a fever need to be fever-free, without the use of medication, for 24 hours before returning to school.
• Eyes that are red, swollen, crusting or draining
• Untreated, draining ears or earache
• Diarrhea or Vomiting. Keep student home for 24 hours before returning to school.
• Severe nausea
• Severe sore throat
• Head lice
• Childhood communicable disease - contact the district nurse

If a student is at school with any of these symptoms, the parent/guardian will be called to pick up the student. Under certain circumstances, parents may be asked to consult a physician and to provide a written note from a doctor indicating that the student may return to school.

In the event that a case of pertussis, also known as whooping cough, is reported at any PAUSD school, the PAUSD nursing team works very closely with the Santa Clara County Department of Public Health to respond to and prevent cases of pertussis from spreading. The PAUSD nursing team uses the public health department's protocol to ensure the health and well- being of all PAUSD students. Please use the following resources to learn more about Pertussis and how to prevent it:

• California Department of Public Health - Pertussis (whooping cough)
• California Department of Public Health - Pertussis Quick Sheet / Spanish
• Centers for Disease Control and Prevention - About Pertussis
• Centers for Disease Control and Prevention - Diphtheria, Tetanus, and Pertussis Vaccine Recommendations
• Centers for Disease Control and Prevention - Tdap Vaccine Information Statement / Spanish / Chinese Traditional / Other Languages

Health Services Department

• Rosemarie Dowell, RN - Health Services Coordinator
• Sandra Jaimez Gutierrez - Health Services Administrative Assistant

District nurses

• Lorebelle Chang, RN
• TBD

Health technicians

• Alexandra Beltran, LVN - Ellen Fletcher Middle School
• Angel Luong, LVN - Frank S. Greene Middle School
• Carol Cannon, RN - Jane Lathrop Stanford Middle School
• Jennifer Kleckner, RN - Palo Alto High School
• Joanne Garlejo, LVN - Henry M. Gunn High School

Elementary nurse clinicians

• Lis Darner, RN
• Heather Kavanagh, RN
• Sherry Fowler, RN
• Valerie Scott, RN