5600.3: Physical Examination, Visual Evaluation, Immunization, and Inspection

I. Physical Examination and Visual Evaluation. Prior to the entrance of any student into kindergarten and the seventh grade or, in the case of a transfer from out of state, to any other grade in any District school, the parents or guardian must submit written evidence of a physical examination of the student by a physician, physician assistant, or advanced practice registered nurse.

A. The physical examination must have been performed within six (6) months of the date of enrollment. Either a completed, signed and dated physical exam report, or a printed or typewritten form signed by a qualified examiner indicating that a physical examination was administered on a specific date within the previous six (6) month period for the named student, constitutes sufficient evidence of compliance.

B. The cost of such physical examination is to be borne by the parents or guardian of each child examined.

C. No physical examination shall be required of any student whose parents or guardian objects thereto in writing.

D. All kindergartners and out of state transfer students will be required to submit written evidence of a visual evaluation by a physician, physician assistant, advanced practice registered nurse, or optometrist within six (6) months prior to admission. The visual evaluation shall consist of testing for amblyopia, strabismus, and internal and external eye health, with testing sufficient to determine visual acuity. A visual evaluation report that is signed and dated by a qualified examiner and including at a minimum the specific required tests, constitutes sufficient evidence of compliance. No such visual evaluation shall be required of any child whose parent or guardian objects in writing. The cost of such visual evaluation shall be borne by the parent or guardian of each child who is examined.

II. Immunization. All students by law are required to be protected by immunization against measles, mumps, rubella, varicella (chicken pox), poliomyelitis, diphtheria, pertussis, tetanus, Haemophilus influenza type b (Hib), Hepatitis B, and and invasive pneumococcal disease (for students 2-5 years of age), prior to enrollment and in accordance with the immunization standards prescribed in Title 173, Nebraska Administrative Code, Chapter 3-008.

A. Any student who does not comply with this provision shall not be permitted to continue in school until the student complies unless the student falls within the two (2) exceptions contained in this Rule.

B. Unless exempted by state law, the cost of such immunization shall be borne by the parents or guardian of each student who is immunized or by the Department of Health and Human Services for those students whose parents or guardian are unable to meet such cost.

C. Immunization shall not be required for enrollment if either of the following is submitted to the District:

1. A statement signed by a physician, physician assistant, or advanced practice registered nurse stating that, in the health care provider's opinion, the immunizations required would be injurious to the health and well-being of the student or any member of the student's family or household; or

2. A notarized affidavit signed by the student or, if the student is a minor, by a legally authorized representative of the student, stating that the immunization conflicts with the tenets and practice of a recognized religious denomination of which the student is an adherent or member or that immunization conflicts with the personal and sincerely followed religious beliefs of the student.

3. The physician's statement or affidavit shall be kept in the student's file.

D. A student may be provisionally enrolled in the District in the following circumstances:

1. The student has begun the immunizations required by state law and the student is receiving the necessary immunizations as rapidly as is medically feasible and in accordance with the requirements of Title 173, Nebraska Administrative Code, Chapter 3-010.02; or

2. The student is the child or legal ward of an active member of any of the military services of the United States or of his or her spouse, and the student is enrolling in the District following residence in another state or in a foreign country, and the parents or guardian of the student provide the District with a signed written statement certifying that the student has completed the immunizations required by state law. The student’s parents or guardian must thereafter provide the District with written evidence that the student has completed the immunizations required by state law, and if such written evidence is not provided to the District within sixty (60) days of the date of the provisional enrollment, then the student shall not thereafter be permitted to continue in school until such written evidence of compliance is provided.

III. Required Evidence of Immunization. For the purposes of compliance with the immunization requirements of state law, the student’s parents or guardian shall be required to present to the District the following evidence of immunization:

A. An immunization history containing the name of the vaccine, the month and year of administration (the month, day, and year for MMR vaccine), the name of the health practitioner, the agency where the immunization was obtained, and the signature of the physician, parent, guardian, or of such other person maintaining the immunization history of the student, verifying that the student has received these vaccines; or

B. Laboratory evidence of circulating antibodies for measles, mumps, or rubella shall constitute evidence of immunity against those diseases provided the following information is supplied: name of laboratory, name of test, test result, test date, signature of laboratory technician performing the test or of the laboratory director, and date of signature.

C. For purposes of compliance with this Rule, clinical history of measles, mumps, or rubella without laboratory or epidemiologic confirmation does not constitute evidence of immunity. Epidemiologic confirmation of a diagnosis means that the clinical history of measles, mumps, or rubella is corroborated by association with laboratory proven case(s) and that such epidemiologic case(s) have been reported to and counted by the Department of Health and Human Services.

IV. Health Screenings. Students in District schools must be screened periodically for vision, hearing, and dental health. In addition, the Department of Health and Human Services prescribes height and weight measurement for the purpose of monitoring weight/height status at intervals for all students.

A. If such health screening indicates a need for further evaluation and the necessity of professional attendance, the District shall notify the parents or guardian in writing and explain the necessity for further evaluation and professional attendance for such student.

B. A student is not required to submit to health screenings if the student’s parents or guardian provide a written statement signed by a physician, physician assistant, or advanced practice registered nurse attesting that the student underwent the required hearing, vision, and/or dental screening within the last six (6) months. For height and weight screenings, the written statement must object to such screening and be signed and dated by the student’s parents or guardian and be submitted before each time such screening is conducted.

C. The District's health screenings shall be conducted during the first quarter of each school year for students then in attendance. Thereafter, as students enter the District during the year, such health screenings shall be made immediately upon their entrance.

V. Parental Notification and Opportunity to Opt out of Participation. Pursuant to the Protection of Pupil Rights Amendment, 20 U.S.C. §1232h, the District shall provide reasonable notice at the beginning of the school year, directly to the parents and guardians of students enrolled in District schools, of the specific or approximate dates of any non-emergency invasive physical examination or screening that is required as a condition of attendance and administered by the District and scheduled in advance, and which is not necessary to protect the immediate health and safety of the student or other students.

A. An invasive physical examination is any medical examination that involves the exposure of private body parts, or any act during such an examination which includes incision, insertion, or injection into the body, but does not include a hearing, vision, dental, or scoliosis screening, or any physical examination or screening permitted or required by state law.

B. Parents, guardians, and students who are eighteen (18) years old or emancipated under state law, may opt out of participation in any such invasive physical examination by providing the District with a signed written statement which declines participation in any such invasive physical examination.

VI. Physical Examinations for Student Athletes. Students participating in activities sponsored by the Nebraska Schools Activities Association, athletics, cheerleading, or dance team, shall obtain a physical examination by a physician after May 1st, and shall submit the same to the District prior to participation.

A. The requirement of the obtaining and submission of a physical examination will be in force each year a student participates in student athletics.

B. Student athletes must also be covered by accident insurance prior to participation on any team. Student athletes are eligible to purchase insurance made available by the District.

VII. Definitions.

A. Student Athletics. Student athletics shall mean extracurricular school sponsored competitive interscholastic sports.

B. Physician. Physician shall mean individuals who are licensed by the Department of Health and Human Services Regulation and Licensure as:

1. Medical Doctors (M.D.) who practice medicine and/or surgery; or

2. Osteopathic Physicians (D.O.) who are also authorized to prescribe medications.

C. Advanced practice registered nurse. Advanced practice registered nurse shall mean individuals who are licensed and practicing under and in accordance with the Advanced Practice Registered Nurse Act.

D. Physician assistant. Physician assistant shall mean individuals who are licensed under Neb. Rev. Stat. §§ 38-2046 through 38-2055 to perform medical services under the supervision of a licensed physician.