3413P: Student Immunization and Life-Threatening Health Conditions

Proof of Immunization

Immediately upon enrollment in the district, the student's parent or legal guardian will obtain and provide the school with health care provider verified proof of immunizations. The following are considered medically verified immunization records:

• A Certificate of Immunization Status (CIS) printed from the Washington Immunization Information System or a CIS, provided by the Washington Department of Health, verified with a unique healthcare provider or clinic stamp, or handwritten provider signature
• Immunization records from a clinic or hospital electronic health record (EHR) with a unique healthcare provider, clinic, hospital stamp, or handwritten provider signature • Official certificate of immunization or immunization record from another state’s immunization registry
• Official lifetime immunization record from Washington or another state with a unique healthcare provider or clinic stamp, or handwritten provider signature
• An immigration form or lifetime immunization record from another country with a clinic or healthcare provider stamp, or handwritten provider signature

On or before the first day of school or child-care, attendance parents/guardians are required to provide proof of either, full immunization, a certificate of exemption, or the initiation of and compliance with a schedule of immunization for their child.

Children can enter and stay in school or childcare in conditional status if they are catching up on vaccines required to document immunity for school or child-care entry. Vaccine series doses are spread out among minimum intervals, so some children may have to wait for a period before finishing their vaccinations. Conditional status allows them to attend school or child-care while waiting for their next vaccine dose according to the national immunization catch-up schedule plus another 30 calendar days to turn in documentation of vaccination. If a student is catching up on multiple vaccines, conditional status continues in a similar manner until all the required vaccines are complete.

The parent/guardian must sign the Conditional Status statement on the Certificate of Immunization Status form. If the 30-day conditional period expires and documentation has not been given to the school or child-care, the student must be excluded from further attendance, per RCW 28A.210.120. Valid documentation includes medical records showing vaccination, evidence of immunity to the disease in question, or a completed certificate of exemption (COE) form.

In addition, a student may be excluded from school if a local health officer excludes them during an outbreak of a vaccine-preventable disease for which the student has not been fully immunized against that disease due to:

• Conditional status;
• Medical exemption;
• Religious exemption;
• Philosophical exemption; or
• Personal exemption.

Children of active-duty military parents or guardians must turn in documentation of immunization status on or before the first day of attendance. If they need additional vaccine doses to meet state requirements, they have 30 days from enrollment to do so.

Students experiencing homeless according to the McKinney-Vento Act (which may include migratory and refugee children) must be allowed to enroll, attend classes, and participate fully. These students cannot be excluded for being out of compliance with immunization requirements. The District Homeless Liaison should continue to help homeless students get immunizations, their immunization records, or an exemption.

Students in foster care must be allowed to enroll in school, even if they are missing paperwork, consistent with Every Student Succeeds Act.

Exemptions from Immunization

All exemptions will be processed and recorded on a Certificate of Exemption (COE) as provided by the Washington Department of Health.

Exemptions from one or more vaccines will be granted for medical reason upon certification by a physician that there is a medical reason for not administering the vaccine.

Exemptions for personal or religious reasons will be granted upon request of the parent or legal guardian. To request an exemption, a parent or guardian must submit a signed and dated COE that the parent/guardian has either a philosophical, personal, or religious objection to the immunization of the child. Forms must include a statement to be signed and dated by a health care practitioner stating that he or she provided the parent/guardian with information about the benefits and risks of immunization to the child. The form may be signed by a health care practitioner at any time prior to the enrollment of the child in a school or licensed day care. Photocopies of the signed form or a letter from the health care practitioner will be accepted in lieu of the original form.

According to state law, personal and philosophical exemptions may not be accepted for MMR vaccine.

Any parent or legal guardian who belongs to a church or religion that objects to the use of medical treatment and who exempts their child due to religious beliefs must complete a COE, but is not required to have the COE signed by a health care practitioner. If the parent or legal guardian has a religious objection to vaccinations but the beliefs or teachings of their church or religion allow for their child to be treated by medical professionals such as doctors or nurses, they must have a health care practitioner sign and date the COE.

Life-threatening Health Conditions

Prior to attendance at school, each child with a life-threatening health condition will present a medication or treatment order signed and dated by a healthcare provider to the school nurse addressing the condition. If a rescue medication is indicated, the parent or guardian will supply unexpired medication to the school as follows:

Prescription medication must be in original pharmacy container labeled with:

• Student name
• Medication name
• Strength of medication
• Dose
• Time of administration

Following submission of the medication or treatment order, an Individual Health Plan will be developed by a school nurse for parent/guardian review. Completed plans will be made available to school building staff who work with the student, transportation services, and nutrition services if applicable.

In addition to adhering to the requirements of each individual health care plan, the district will:

• Acquire necessary parent requests and instructions for treatment;
• Acquire monitoring and treatment orders from licensed health care providers prescribing within the scope of their licensed authority;
• Provide sufficient and secure storage for medical equipment and medication provided by the parent;
• Establish school rule/regulation exceptions necessary to accommodate students' needs related to their life-threatening health condition, as described in the individual health plan;
• Ensure the development of individual emergency plans
• Ensure the possession of legal documents for parent-designated adults to provide care, if needed for seizure disorders or diabetes; and
• Ensure each individual health plan is reviewed at least annually.

Exclusion From School

For Immunizations: If proof of immunization or a COE is not received upon the student's enrollment in school, the building administrator will provide written notice to the parents or guardians informing them of: 

• The immunization requirements;
• The potential denial of attendance by the student if any missing immunization(s) and/or documentation needed to complete proof of immunization is not provided within thirty (30) calendar days of the student’s first day of attendance;
• The procedural due process rights; and
• The immunization services that are available through the local health department and other public agencies.

If after conditional admittance status has elapsed, and proof of immunization or COE has not been presented to the school, following proper notification, the building administrator will exclude the student for noncompliance with the immunization laws in accordance with the following due process rights:

• Written notice to the parents, guardians or persons in loco parentis delivered to the parents in person, by mail, or by email;
• Notice of the applicable laws, including a copy of the laws and rules;
• Notice of immunization services that are available from or through the local health department and other public agencies; and
• The order that the student will be excluded from school immediately and until proof of immunization or exemption is provided.

For Life-threatening Health Conditions: Students who have a life-threatening health condition and no medication or treatment order presented to the school by the start of the first day of school will be excluded from school by the building administrator, or to the extent that the district can do so consistent with federal requirements for students with disabilities under the Individuals with Disabilities Education Act (IDEA) and Section 504 of the Rehabilitation Act of 1973, and according to the following due process rights:

• Written notice to the parents, guardians or persons in loco parentis delivered to the parents in person, by mail, or by email;
• Notice of the applicable laws, including a copy of the laws and rules; and
• The order that the student will be excluded from school immediately and until a medication and/or treatment order is presented

Students experiencing homeless according to the McKinney-Vento Act (which may include migratory and refugee children) must be allowed to enroll, attend classes, and participate fully. These students cannot be excluded for not having medical records, orders, or medication. The District Homeless Liaison should continue to help homeless students get orders and medications.

Students in foster care must be allowed to enroll in school, even if they are missing paperwork, consistent with Every Student Succeeds Act.

Appeal, Reconsideration, and Petition

Optional Conference with Principal

If a student and/or the parent/guardian disagree with the District’s decision to exclude the student, the student and/or parent/guardian may request an informal conference with the principal or designee to resolve the disagreement. The student and/or parent/guardian may request an informal conference orally or in writing.

The principal or designee must hold the conference within three (3) school business days after receiving the request, unless otherwise agreed to by the student and parent/guardian.

During the informal conference, the student and parent/guardian will have the opportunity to share the student’s perspective and explanation regarding the events that led to not being able to provide required immunization documentation, or medication or treatment order.

An informal conference will not limit the right of the student and/or parent/guardian to appeal the exclusion or petition for readmission.

Appeals

A student and/or the parent/guardian may appeal an exclusion to the Superintendent or designee orally or in writing. For exclusion, the request to appeal must be within three (3) school business days from when the District provided the student and parent/guardian with written notice.

Exclusion Appeal

For exclusions, the Superintendent or designee will provide the student and parent/guardian written notice in person, by mail, or by email, within one (1) school business day after receiving the appeal request, unless the parties agree to a different timeline. Written notice will include:

• The time, date, and location of the appeal hearing;
• The name(s) of the official(s) presiding over the appeal;
• The right of the student and parent/guardian to inspect the student’s education records;
• The right of the student and parent/guardian to inspect any documentary or physical evidence and a list of any witnesses that will be introduced at the hearing; and
• The rights of the student and parent/guardian to be represented by legal counsel; question witnesses; share the student’s perspective and explanation; and introduce relevant documentary, physical, or testimonial evidence.

Hearings

A hearing to appeal an exclusion is a quasi-judicial process exempt from the Open Public Meetings Act (OPMA). To protect the privacy of student(s) and others involved, the District will hold hearing without public notice and without public access unless the student(s) and/or the parent(s) or their counsel requests an open hearing. Regardless of whether the hearing is open or closed, the District will make reasonable efforts to comply with the Family Educational Rights and Privacy Act (FERPA) concerning confidentiality of student education records. 

For an exclusion, the District will hold an appeal hearing within two (2) school business days after the Superintendent or designee received the appeal request, unless the student and parent/guardian agree to another time.

The school Board has designated a Discipline Appeal Council (DAC) to hear and decide any appeals in this policy and procedure or to review and reconsider a District’s appeal decisions. All members of a Discipline Appeal Council must be knowledgeable about the rules in Chapter 392- 400 WAC and this policy and this procedure. The school Board may also designate the Superintendent or a hearing officer to hear and decide appeals. The presiding official(s) may not have been involved in the student’s behavioral violation or the decision to suspend or expel the student.

Upon request, the student and parent/guardian or their legal representative may inspect any documentary or physical evidence and list of any witnesses that the District will introduce at the appeal hearing. The District must make the information available as soon as reasonably possible, but no later than the end of the school business day before the appeal hearing. The District may also request to inspect any documentary or physical evidence and list of any witnesses that the student and parent/guardian intend to introduce at the appeal hearing. The student and parent/guardian must make this information available as soon as reasonably possible, but no later than the end of the school business day before the appeal hearing.

Upon request, the student and parent/guardian may review the student’s education records. The District will make the records available as soon as reasonably possible, but no later than the end of the school business day before the appeal hearing.

If a witness for the District cannot or does not appear at the appeal hearing, the presiding official(s) may excuse the witness’ nonappearance if the District establishes that:

• The District made a reasonable effort to produce the witness; and
• The witness’ failure to appear is excused by fear of reprisal or another compelling reason.

The District will record the appeal hearing by manual, electronic, or other type of recording device and upon request of the student or parent(s) provide them a copy of the recording.

For exclusion, the District will provide a written decision to the student and parent(s) in person, by mail, or by email within one (1) school business day after the appeal hearing. The written decision must include:

• The findings of fact;
• Whether the District will end the exclusion or what documentation, medication, or treatment orders are still required for the student to attend school.

The school district will retain records for at least three years on a child who is excluded from school under this chapter. The record must include the child's name, address, and date of exclusion.

School Reassignment

Students with medically fragile conditions face daily the possibility of a life-threatening emergency requiring the skill and judgment of a professional nurse. These students require a full- time nurse in the building, meaning the nurse is scheduled to be on the school site and “is quickly and easily available and the patient (student) has been assessed by the licensed registered nurse prior to the delegation of the duties to any caregiver” (WAC 246-840- 010(11)(c)). To ensure the safety and wellbeing of the student, the student may need to be transferred to a school site where full-time nursing staff is provided if full-time nursing not available at the student’s attendance area school.

Examples of students who may need reassignment to a school where a full-time nurse is available include, but are not limited to:

• Severe seizure disorder with multiple daily seizures or seizure medication that can only be administered by a nurse
• Unstable and/or newly diagnosed student with diabetes or a student who cannot perform blood sugar monitoring and/or insulin injection themselves
• Severe asthma
• Sterile procedures
• Tracheostomy with frequent and/or unpredictable suctioning

For these students, an Individual Health Plan (IHP) with or without 504 Plan will be developed by a school nurse in conjunction with parent and the student’s health care provider. Distribution of the IHP will include all relevant school personnel in contact with these students.

Upon notification (receipt of information) of student’s Medically Fragile Health Condition the school nurse at student’s attendance area school creates an IHP utilizing data from physician, parent/guardian, and student. Professional assessment process by the school nurse is utilized to create an IHP and to assess possible reassignment due to health needs of student.

Attendance area school nurse contacts administrator of their site, school nurse and administrator of proposed reassignment school site, Director of Health Services, and student’s parents/guardians to plan a meeting to review and discuss the need for reassignment.

The meeting will be conducted expediently and at site convenient for all participants. Review of all gathered information, IHP, parent/guardian input, nurse input, and administrator input will be completed, and a decision made regarding need for reassignment. Transportation needs will be addressed during this meeting.

Upon decision for reassignment to a school site with full-time nursing services, the reassignment school site nurse will take over review and modification of the IHP to reflect reassignment.

Transportation will be notified of student transfer and bus service needs. All students reassigned are eligible for District transportation unless they are within walking distance to the school. If parents chose to transport, they will be reimbursed for travel from the Bellevue School District.

Any siblings who apply for transfer to attend with their siblings at reassignment school site may apply to ride the bus if there is room on the bus.

If a student no longer needs licensed nursing support but the parent/guardian elects to have student remain at the reassignment school, the parent/guardian will then be responsible for transportation to the site; it will not be provided by the Bellevue School District.

Any student or parent/guardian who disagrees with a District reassignment for health needs to a school other than student home attendance school, may appeal the assignment to the Superintendent or his/her Designee.

A student’s status and need for continued full-time nursing support will be evaluated yearly or anytime during the school year at the request of parent/guardian, school nurse, health care provider, or building administrator.

If the student’s status changes and it is determined by the professional judgment of the school nurse in conjunction with the health care provider and parents/guardian that full-time nursing services are no longer medically necessary, the student may then be returned to the attendance area school. If the parent requests that the student remain at the reassignment school site after licensed school nursing services are no longer needed, that situation will be evaluated individually by the reassignment school site administrator. District transportation will no longer be provided if student remains at reassignment school site.