These Regulations are promulgated pursuant to the authority conferred under R.I. Gen. Laws §§ 16-21-7(a) and 23-1-18(4), and are established for the purpose of adopting prevailing standards pertaining to school health programs.

A.These Regulations hereby adopt and incorporate the Rhode Island Health Education Framework: Health Literacy for All Students (2010) standards by reference, not including any further editions or amendments thereof and only to the extent that the provisions therein are not inconsistent with these Regulations.

B.These Regulations hereby adopt and incorporate the RIDE Comprehensive Health Instructional Outcomes (2015) by reference, not including any further editions or amendments thereof and only to the extent that the provisions therein are not inconsistent with these Regulations.

C.These Regulations hereby adopt and incorporate the Rhode Island Physical Education Framework standards (2003) by reference, not including any further editions or amendments thereof and only to the extent that the provisions therein are not inconsistent with these Regulations.

D.These Regulations hereby adopt and incorporate the Substance Abuse and Mental Health Services Administration (SAMHSA) National Registry of Evidence Based Programs and Practices (2014), by reference, not including any further editions or amendments thereof and only to the extent that the provisions therein are not inconsistent with these Regulations.

E.These Regulations hereby adopt and incorporate the Occupational Safety and Health Administration (OSHA) Toxic and Hazardous Substances Standard - 29 C.F.R. Parts 1910-1450 (2012) by reference, not including any further editions or amendments thereof and only to the extent that the provisions therein are not inconsistent with these Regulations.

F.These Regulations hereby adopt and incorporate the American Speech-Language-Hearing Association Guidelines for Audiology Service Provision in and for Schools (2002) by reference, not including any further editions or amendments thereof and only to the extent that the provisions therein are not inconsistent with these Regulations.

G.These Regulations hereby adopt and incorporate the American National Standards Institute Specifications for Audiometers Standards (2010) by reference, not including any further editions or amendments thereof and only to the extent that the provisions therein are not inconsistent with these Regulations.

H.These Regulations hereby adopt and incorporate the Occupational Safety and Health Administration Occupational Noise Exposure Standard, 29 C.F.R. § 1910.95(c) (2008) by reference, not including any further editions or amendments thereof and only to the extent that the provisions therein are not inconsistent with this Part.

I.These Regulations hereby adopt and incorporate the Scoliosis Research Society Screening for Early Detection for Idiopathic Scoliosis in Adolescents standards (2015) by reference, not including any further editions or amendments thereof and only to the extent that the provisions therein are not inconsistent with these Regulations.

J.These Regulations hereby adopt and incorporate the U.S. Consumer Product Safety Commission Standards for public playground safety (2010) by reference, not including any further editions or amendments thereof and only to the extent that the provisions therein are not inconsistent with these Regulations.

K.These Regulations hereby adopt and incorporate the Uniform Federal Accessibility Standards (2004) by reference, not including any further editions or amendments thereof and only to the extent that the provisions therein are not inconsistent with these Regulations.

L.These Regulations hereby adopt and incorporate the National Center for Children's Vision and Eye Health's Vision Screening Recommendations (2019) by reference, not including any further editions or amendments thereof and only to the extent that the provisions therein are not inconsistent with these Regulations.

A.Wherever used in these Rules and Regulations the terms listed below shall be construed as follows:

1.“Administrative head of school” means the person with the greatest responsibility for the care and supervision of a public-school district or community as defined in § 4.3(A)(10) of this Part, or a non-public school (e.g. headmaster, principal, superintendent).

2."Anaphylaxis" means a potentially fatal, acute allergic reaction to a substance (such as stinging insects, foods and medications) that is induced by an exposure to the substance. Manifestations of anaphylaxis may be cutaneous (such as hives, itchiness, swelling), cardiorespiratory (swelling of tongue, throat, wheezing, difficulty breathing, low blood pressure), central nervous system (lethargy, coma) and others.

3."Audiologist" means an individual licensed in this State in accordance with Part 40-05-33 of this Title, Speech Pathologists and Audiologists.

4."Audiometric aide" means an individual registered in this State in accordance with Part 40-05-33 of this Title, Speech Pathologists and Audiologists.

5."Bullying and cyber-bullying", as used in this Part, are defined by R.I. Gen. Laws § 16-21-33.

6."Certified health educator" means an individual who is certified by the Rhode Island Department of Education (RIDE) in accordance with 200-RICR-20-20-, Regulations Governing the Certification of Educators in Rhode Island.

7."Certified school nurse" means an individual who is licensed as a professional (registered) nurse in this State pursuant to R.I. Gen. Laws Chapter 5-34 and is certified by RIDE as an All Grades Registered School Nurse and is not eligible to serve as a teacher of record in accordance with 200-RICR-20-20-1, Regulations Governing the Certification of Educators in Rhode Island.

8."Certified school nurse-teacher" means an individual who is licensed as a professional (registered) nurse in this State pursuant to R.I. Gen. Laws Chapter 5-34 and is certified by RIDE as an All Grades School Nurse-Teacher and as a Health Teacher in accordance with 200-RICR-20-20-, Regulations Governing the Certification of Educators in Rhode Island.

9."Community" means any city, town or regional school district established pursuant to State law and/or DCYF and any school operated by RIDE; provided, however, that the Department for Children, Youth and Families shall not have those administrative responsibilities and obligations as set forth in R.I. Gen. Laws Chapter 16-2 ("Education").

10.“Comprehensive school health program” means a school health program consisting of health education, health services and a healthful school environment, approved by the State Commissioner of Elementary and Secondary Education and the Director of Health in accordance with R.I. Gen. Laws § 16-21-7.

11.“Competitive foods” means all foods and beverages other than meals reimbursed under the National School Lunch Act (42 U.S.C. § 1751 et seq.), 200-RICR-20-25-4, Regulations Governing Nutritional Requirements for Reimbursable Meals and Competitive Foods and Beverages; Limitations on Competitive Foods and Beverages at Meal Time and the Child Nutrition Act of 1966 (42 U.S.C.§ 1771 et seq.) available for sale to students on the school campus during the school day.

12."Confidential health care information" means all information relating to a patient's health care history, diagnosis, condition, treatment or evaluation obtained from a health care provider who has treated the patient.

13."Controlled substance" means a drug, substance, or immediate precursor in schedules I-V of R.I. Gen. Laws § 21-28-1.02.

14.“Dating partner” means any person involved in an intimate association with another, primarily characterized by the expectation of affectionate involvement, whether casual, serious, or long-term.

15.“Dating violence” means a pattern of behavior wherein a person uses threats of, or uses, physical, sexual, verbal or emotional abuse to control his/her dating partner.

16."Dental hygienist", means a person with a license to practice dental hygiene in this State under the provisions R.I. Gen. Laws § 5-31.1-1.

a.Public health dental hygienist, as used in this Part means any practicing registered dental hygienist who may perform dental hygiene procedures in a public health setting under the provisions of R.I. Gen. Laws § 5-31.1-39.

17."Dentist", as used in this Part, means a person with a license to practice dentistry in this State under the provisions of R.I. Gen. Laws § 5-31.1-1.

18.“DCYF” means the Rhode Island Department of Children, Youth and Families.

19."Education record" means those records that are:

a.Directly related to a student; and

b.Maintained by an educational agency or institution or by a party acting for the agency or institution.

20."Emergency" means a medical or psychological condition where the absence of immediate intervention could reasonably be expected to result in placing the student's health (or another student's health) in serious jeopardy; serious impairment to bodily or psychological functions; or serious dysfunction of any bodily organ or part.

21.“Emergency care plan” or “ECP” means a set of procedural guidelines that provides specific directions about what to do in an emergency. A student with special health care needs may have both an ECP and an individualized health care plan (IHCP). The ECP may be formulated as part of the IHCP. As used in this Part, “emergency care plan (ECP)” shall have the same meaning as “emergency health care plan (EHCP).”

22."Epinephrine auto-injectors" means any device that is used for the automatic injection of epinephrine into the human body to prevent or treat anaphylaxis.

23."Eye care provider" means an individual licensed in the Rhode Island to practice optometry or medicine (i.e., ophthalmology) pursuant to the provisions of R.I. Gen. Laws Chapter 5-35.1.

24."Follow-up" means the contact with a student’s parent as defined in this Part, and/or service provider to verify receipt of services, provide clarification and determine the need for additional assistance.

25.“Governing body” means the body or board or committee or individual, or the designated agent(s) or designee(s) of the aforementioned responsible for, or who has control over, the administration of any elementary or secondary school, public or non-public, in the State of Rhode Island.

26."Hazardous chemical" means a chemical for which there is statistically significant evidence based on at least one (1) study conducted in accordance with established scientific principles that acute or chronic health effects may occur in exposed persons. The term "health hazard" includes chemicals that are carcinogens, toxic or highly toxic agents, reproductive toxins, irritants, corrosives, sensitizers, hepatotoxins, nephrotoxins, neurotoxins, agents that act on the hematopoietic systems, and agents that damage the lungs, skin, eyes, or mucous membranes.

27."Health" means the quality of a person's physical, psychological, and sociological functioning that enables him/her to deal effectively with self and others in a variety of situations.

28."Health care provider/agency" means any person/agency licensed by this State to provide or otherwise lawfully able to provide health care services, including, but not limited to, a physician, chiropractor, hospital, intermediate care facility or other health care facility, dentist, dental hygienist, nurse, physician assistant, nurse practitioner, optometrist, podiatrist, pharmacist, physical therapist, psychiatric/clinical social worker, mental health counselor, or psychologist and any officer, employee or agent of that provider acting in the course and scope of his/her employment or agency related to or supportive of health services.

29."Health education" means comprehensive sequential kindergarten through grade twelve (K through 12) instruction that builds a foundation of health knowledge, develops the motivation and skills required of students to cope with challenges to health and provides learning opportunities designed to favorably influence health attitudes, practices and behavior that will impact lifestyles, educational performance and achievements and long range health outcomes and is in accordance with the requirements of § 4.5(D) of this Part.

30."Hearing impairment" means an impairment in hearing, whether permanent or fluctuating, that affects a student's educational performance.

31.“Individualized health care plan” or “IHCP” means a comprehensive plan for care of children with special health care needs developed by the school nurse in collaboration with the student, parents/guardians, school staff, community, and health care provider(s), as appropriate.

32.“Individualized health services” means services provided to individual students who attend school within the community which are specific to the health needs of the individual student, such as medication administration, and are not included in the health examination/screenings, record keeping and reporting requirements described in § 4.9.1(B) of this Part.

33."Laboratory" means a facility where the laboratory use of hazardous chemicals occurs. It is a place where relatively small quantities of hazardous chemicals are used on a non-production basis.

34."Mandated instructional health outcomes" means statements which indicate what health knowledge and skills students should have at the completion of a specific health unit.

35.“Medically accurate” means verified or supported by research conducted in compliance with accepted scientific methods and published in peer-reviewed journals, where appropriate, and recognized as accurate and objective by professional organizations and agencies with expertise in the relevant field, such as the federal Centers for Disease Control and Prevention.

36.“Medical marijuana” means as defined in § 230-RICR-80-05-1.1(A)(27) and can only be purchased from a licensed compassion center.

37."Medication" means any FDA-approved substance regarded as effective for the use for which it is designed in bringing about the recovery, maintenance or restoration of health, or the normal functioning of the body.

38.“OSHA” means the Occupational Safety and Health Administration.

39."Parent" means a natural parent, a legal guardian, or an individual acting as a parent in the absence of a parent or a legal guardian.

40."Physician" means an individual licensed in the United States to practice allopathic or osteopathic medicine pursuant to the provisions of R.I. Gen. Laws Chapter 5-37.

a.Chiropractic physicians licensed under the provisions of R.I. Gen. Laws Chapter 5-30 are entitled to the same services of the laboratories of RIDOH and other institutions, and shall be subject to the same duties and liabilities, and are entitled to the same rights and privileges in their professional calling pertaining to public health which may be imposed or given by law or Regulations upon or to physicians qualified to practice medicine by R.I. Gen. Laws § 5-37-2; provided, however, that chiropractic physicians shall not write prescriptions for drugs for internal medication nor practice major surgery.

41.“Population-based health services” means services provided to all students attending school within the community which are not focused on the individual health needs of the particular student but are provided to all students as part of the health examination/screenings, record keeping, and reporting requirements described in § 4.9.1(B) of this Part.

42."Prescription" means an order for medication signed by a licensed practitioner with prescriptive authority or transmitted by the practitioner to a pharmacist by telephone, facsimile, or other means of communication and recorded in writing by the pharmacist.

43."Record" means any information recorded in any way, including, but not limited to, handwriting, print, tape, electronic storage, computer diskette, film, microfilm, and microfiche.

44.“RIDE” means the Rhode Island Department of Elementary and Secondary Education.

45.“RIDOH” means the Rhode Island Department of Health.

46."School campus" means all areas of the property under the jurisdiction of the school that are accessible to students during the school day.

47."School" means all public or privately supported schools for students in grades Kindergarten (K) through 12 in Rhode Island. In addition, a preschool program operated by or within an approved school (per the requirements of § 4.4(A) of this Part) shall be considered a "school" for the purposes of this Part.

48."School nurse" means a certified school nurse teacher as defined in § 4.3 of this Part, or a certified school nurse as defined in § 4.3 of this Part.

49."School personnel" means all persons employed directly by the school or under contract to the school.

50."Scoliosis screening" means screening for detection of an abnormal curvature of the spine, as defined by current American Academy of Orthopaedic Surgeons and Scoliosis Research Society standards.

51."Self-administration of medication” means that the student uses the medication with parental authorization in the manner directed by the health care provider, and by following the age appropriate instructions on the medication label, without additional assistance or direction.

52."Self-carry" means that the student carries medication on his/her person, if self-administration of the medication is necessary.

53."Speech or language impairment" means a disorder in articulation, language, voice and/or fluency that adversely affects the student's educational performance. A speech and language impairment may range in severity from mild to severe; it may be developmental or acquired. A speech and language impairment may be the result of a primary disabling condition or it may be secondary to other disabling conditions. A dialect is a variation of a symbol system used by a group of individuals that reflects and is determined by shared regional, social or cultural/ethnic factors and is not considered to be a disorder of speech.

54."Speech/language pathology" includes identification of students with speech or language impairments; diagnosis and appraisal of specific speech or language impairments; referral for medical or other professional attention necessary for the habilitation of speech or language impairments; provision of speech and language services for the habilitation or prevention of communicative impairments; and counseling and guidance of parents, children and teachers regarding speech and language impairments.

55."Speech/language pathologist" means a professional who identifies, assesses, diagnoses, prevents, and treats speech, voice, language, communication, and swallowing disorders.

a."Certified speech/language pathologist" means a speech/language pathologist certified by RIDE in accordance with 200-RICR-20-20-1, Regulations Governing the Certification of Educators in Rhode Island to perform speech-language pathology services for the public-school system.

b."Licensed speech/language pathologist" means a speech/language pathologist licensed by the Rhode Island Board of Examiners in Speech Pathology and Audiology to perform speech-language pathology services in all settings outside the public-school system.

56."Speech/language pathology aide" means an individual registered in this State in accordance with Part 40-05-33 of this Title, Speech Pathologists and Audiologists.

57."Student" means any individual who is or has been enrolled at an educational agency or institution and regarding whom the agency or institution maintains educational records.

58."Vision screening," as used in this Part, means a limited series of tests to identify individuals who may have a vision or eye health problem.

59."Visual impairments" include:

a."Partial sight" means a visual acuity ranging from 20/70 to 20/200 in the better eye after refraction, or a significant loss of fields of vision in both eyes as a result of, but not limited to, hemeralopia, glaucoma, retinitis pigmentosa, retinoschisis, or diabetes retinopathy that, with correction, affects a student's educational performance.

b."Blindness" means a visual acuity ranging from a central visual acuity of 20/200 or less in the better eye after refraction, or a peripheral field of vision that subtends an angle no greater than twenty (20) degrees that, even with correction, affects a student's educational performance.

A.All schools, as defined in § 4.3(A)(48) of this Part, that are approved pursuant to R.I. Gen. Laws §§ 16-19-1 and 16-19-2 are required to have a comprehensive school health program approved by RIDE and RIDOH in accordance with R.I. Gen. Laws § 16-21-7.

B.A comprehensive school health program as defined in § 4.3(A)(11) of this Part, consists of three (3) components:

1.Health education;

2.Health services; and

3.A healthful school environment.

a.All schools that sell or distribute competitive foods and beverages as defined in § 4.3 must do so in accordance with the provisions of R.I. Gen. Laws §§ 16-21-7(c) and (d); and pursuant to 200-RICR-20-25-4, Regulations Governing Nutritional Requirements for Reimbursable Meals and Competitive Foods and Beverages; Limitations on Competitive Foods and Beverages at Meal Time.

b.The prohibition on advertising unhealthy food and beverages is pursuant to R.I. Gen. Laws § 16-21-7.1.

4.The health education program (curriculum and personnel) for non-public schools must be consistent with the provisions of § 4.5(A) of this Part.

C.The administrative head of school(s) is responsible for the comprehensive school health program and is required to:

1.Develop a manual of procedures (protocols) governing health education, health services and a healthful school environment. This manual must be available at the Superintendent's office and at each school. Procedures must address the statutory and regulatory requirements of this Part and include provisions pertaining to, but not limited to, the following:

a.Students and/or employees infected with HIV/AIDS or hepatitis;

b.Substance abuse;

c.The use of alcohol and tobacco products on school premises and at authorized school activities;

d.Suicidal behavior;

e.The prevention and management of injuries and violent behaviors for the protection and safety of students on school premises and at authorized school activities; and

f.Provisions regarding the three (3) statutory waivers for exemption of a student from health education curricula pursuant to R.I. Gen. Laws §§ 16-22-18(c) sexuality and family life; 16-22-17(c) HIV/AIDS; and 16-21-7(a) the characteristics, symptoms or treatment of disease.

2.Provide an adequate number of personnel for a comprehensive school health program in accordance with the statutory requirements and the requirements of this Part. Required personnel include no less than a school physician, dentist, certified health educator and a school nurse.

a.Non-public schools may employ registered nurses licensed in Rhode Island pursuant to R.I. Gen. Laws Chapter 5-34, to provide individualized health services, but not to provide population-based health services and other requirements of the school health program as described in this Part.

3.Designate an individual(s) or committee to be accountable for the comprehensive school health program. The name of the individual(s) must be included in the annual school health report as required in § 4.4(C)(4) of this Part.

4.Submit an annual school health report to RIDE pertaining to the comprehensive school health program no later than sixty (60) days from a date established by RIDE. The report should be prepared with input from district school improvement teams when appropriate.

D.No requirement of this Part shall be construed as requiring a school nurse or other licensed health care provider to act in a manner contrary to the provisions of the laws and Regulations governing the practice of their profession.

E.Nothing in this Part is meant to preclude any student or the parents of any student from pursuing their rights to appropriate educational services and accommodations guaranteed by Federal and State laws.

4.4.1Child Abuse/Neglect Reporting; Reporting of Sexual Abuse of a Child in an Educational Program

A.Any person who has reasonable cause to know or suspect that any child has been abused or neglected, as defined in R.I. Gen. Laws § 40-11-2, or has been the victim of sexual abuse by another child is required to transfer that information to DCYF in accordance with the requirements of R.I. Gen. Laws § 40-11-3.

B.Any person who has reasonable cause to know or suspect that any child has been the victim of sexual abuse by an employee, agent, contractor or volunteer of an educational program as defined in R.I. Gen. Laws § 40-11-2, is required to transfer that information to DCYF in accordance with the requirements of R.I. Gen. Laws § 40-11-3.3.

C.The school's protocol for reporting child abuse or neglect and sexual abuse shall specify the responsibilities of all school personnel related to child abuse or neglect and sexual abuse, such as identification, reporting, multidisciplinary cooperation, in-service training, and public awareness.

D.Pursuant to R.I. Gen. Laws § 16-21-36, all schools are required to post the DCYF child abuse hotline telephone number available on DCYF's Child Protective Services website.

4.4.2Health and Wellness Subcommittee

The school committee for each school district is required to establish a district-wide coordinated school health and wellness subcommittee in accordance with the requirements of R.I. Gen. Laws § 16-21-28.

4.4.3Free-Play Recess

All schools are required to provide daily, at least twenty (20) consecutive minutes of unstructured free-play recess for students in elementary grades Kindergarten through six (6) in accordance with R.I. Gen. Laws § 16-22-4.2.

A.Health education is required for grades K through twelve (12) in all schools. The health education program (curriculum and personnel) of non-public schools will be approved by RIDE if deemed substantially equivalent.

B.Pursuant to the provisions of R.I. Gen. Laws § 16-1-5(14), RIDE in conjunction with RIDOH will provide guidance and technical assistance in the development and adoption of school health education curricula.

C.The administrative head of school(s) is required to designate a certified health educator to administer the health education program.

D.Pursuant to the RIDE certification requirements in 200-RICR-20-20-, Regulations Governing the Certification of Educators in Rhode Island and the provisions of this Part, teachers providing health education shall consist of:

1.At the secondary level: certified school nurse-teachers, health and physical education teachers or health educators, all of whom must hold appropriate certification as health educators in accordance with the 200-RICR-20-20-1, Regulations Governing the Certification of Educators in Rhode Island.

2.At the elementary level: certified school nurse-teachers, health and physical education teachers or health educators, all of whom must hold appropriate certification as health educators in accordance with the 200-RICR-20-20-1, Regulations Governing the Certification of Educators in Rhode Island, or any certified elementary teacher.

E.Health education instruction must comply with the Comprehensive Health Instructional Outcomes incorporated at § 4.2(B) of this Part, which conforms to the statutory provisions of R.I. Gen. Laws § 35-4-18, the curriculum requirements of RIDE, and other statutory and regulatory requirements of this Part.

F.Health education instruction and materials must be age-appropriate for use with students of all races, genders, sexual orientations, ethnic and cultural backgrounds, and students with disabilities.

G.All students in K through twelve (12) attending schools, are required to receive instruction in health and physical education as prescribed and approved by RIDE, for periods which shall average at least twenty (20) minutes in each school day in accordance with the provisions of R.I. Gen. Laws §§ 16-22-4 and 16-1-5(14).

1.Recess, free play, and after-school activities shall not be construed as physical education.

2.Exemption from the requirements of § 4.5(G) of this Part is pursuant to R.I. Gen. Laws § 16-100-3(d).

H.No non-public instruction will be approved by any school committee for the purposes of R.I. Gen. Laws Chapter 16-19 as substantially equivalent to that required by law for a student attending a public school in the same city and/or town unless instruction in health and physical education similar to that required in public schools is given.

I.Planned and ongoing in-service programs are required to update health educators and other relevant personnel in their knowledge of health and teaching skills, and to obtain their input regarding health curriculum, assessment and improvement. These must be consistent with the provisions of R.I. Gen. Laws §§ 35-4-18, 16-1-5(14), 16-22-12, 16-22-14, and 16-22-24 pertaining to substance abuse, alcohol, suicide prevention and mental health services, teen dating violence, and such other relevant laws.

J.Provisions must be made for participation by representatives from parent groups, community agencies, professional organizations, health agencies, business, educational institutions and other groups, to actively involve them in the planning and the implementation of the health education program.

K.Teaching methods and learning materials must be consistent with the mandated health instructional outcomes of § 4.7 of this Part, and available to health educators and students in the classroom.

A.The health education curriculum must:

1.Be sequential and comprehensive for K through twelve (12);

2.Be medically accurate;

3.Be aligned with the standards in the Rhode Island Health Education Framework;

4.Include standards-based goals, objectives, examples of teaching and learning strategies and materials, and assessment;

5.Address the mandated health instructional outcomes in § 4.7 of this Part; and

6.Be developmentally appropriate so that all students can achieve high standards.

B.A curriculum team consisting of representatives from the school district teaching and administrative staff, parents, and community members including health professionals must periodically review and revise, as necessary, the health education curriculum. The health education curriculum of each school district must be available for review by RIDE upon request.

A.Pursuant to R.I. Gen. Laws § 16-22-4, the health education curriculum must be based on the Rhode Island Health Education Framework: Health Literacy for All Students standards and consistent with the mandated health instructional outcomes incorporated at §§ 4.2(A) and (B) of this Part, and must be evidence-based. These outcomes must pertain to no less than the following required content area topics appropriate to grade or developmental level:

1.Alcohol, Tobacco and Other Substance Abuse: the causes, effects, treatment and prevention of the use of tobacco and abuse of alcohol and other drugs, including but not limited to information that mixing opioids and alcohol can cause accidental death, pursuant to R.I. Gen. Laws §§ 16-22-3, 16-22-4, 16-22-12, 16-1-5(14), and 35-4-18;

2.Cardiopulmonary Resuscitation (CPR): the procedures and proper techniques for CPR, automated external defibrillator (AED), and the Heimlich Maneuver, pursuant to R.I. Gen. Laws §§ 16-22-15 and 16-22-16;

3.Child Abuse: the signs, symptoms and resources available for assistance;

4.Community Health: the significance of the relationship between the individual and the community, and the impact that individual health has on the community’s health within a framework of geographical, social, cultural, and political factors;

5.Consumer Health: the factors involved in decision-making, selecting, evaluating, accessing and utilizing health information, products and services;

6.Environmental Health: environmental factors that affect the health of individuals and society, strategies to minimize the negative effects of the environment on the community and its members, and the importance of protecting and improving all aspects of the environment;

7.Family Life and Sexuality: responsibilities of family membership and adulthood, issues related to reproduction, abstinence, dating and dating violence, marriage, parenthood, information about sexually transmitted diseases, the law and meaning of consent, sexuality and sexual orientation, as part of comprehensive sexuality education pursuant to R.I. Gen. Laws § 16-22-18.

8.HIV (Human Immunodeficiency Virus)/AIDS (Acquired Immune Deficiency Syndrome): the causes, effects, treatment, and prevention, pursuant to R.I. Gen. Laws § 16-22-17.

9.Human Growth and Development: growth and development as a process of natural progression influenced by heredity, environment, culture, and other factors and which encompasses the continuum from conception to death;

10.Mental Health: the emotional, behavioral, and social factors that influence both mental and physical health;

11.Nutrition: the role of nutrition in the promotion and maintenance of good health;

12.Physiology and Hygiene: the basic structure and functions of the human body systems, health habits, and sanitary practices for the preservation of health, pursuant to R.I. Gen. Laws § 16-22-3;

13.Physical Activity: the relationship of physical activity to health and physical fitness;

14.Prevention and Control of Disease: the causes, effects, treatment, and prevention of chronic and communicable diseases, with exclusion of instruction thereof pursuant to R.I. Gen. Laws § 16-21-7(a).

15.Safety and Injury Prevention: the causes, effects, treatment, and prevention of behaviors that can result in unintentional or intentional injury; and:

a.Suicide Prevention: the causes, effects, and treatment of behaviors related to suicide, and information that mixing opioids and alcohol can cause accidental death, pursuant to R.I. Gen. Laws §§ 16-22-4 and 16-22-14.

b.Teen Dating Violence (grades seven (7) through twelve (12)): defining dating violence, recognizing dating violence warning signs and characteristics of healthy relationships, as stipulated in R.I. Gen. Laws § 16-22-24, and as defined in this Part.

(1)Students must be provided with the school district’s dating violence policy in accordance with R.I. Gen. Laws § 16-21-30(c).

(2)Upon written request to the school principal, and within a reasonable period after the request is made, a parent or legal guardian of a student less than eighteen (18) years of age must be permitted to examine the dating violence education program instruction materials at the school in which the student is enrolled.

A.The physical education curriculum must:

1.Be sequential and comprehensive for grades K through twelve (12);

2.Be aligned with the Rhode Island Physical Education Framework standards incorporated at § 4.2(C) of this Part;

3.Include standards-based goals, objectives, examples of teaching and learning strategies and materials, and assessment; and

4.Be developmentally appropriate so that all students can achieve high standards.

B.A curriculum team consisting of representatives from the school district teaching and administrative staff, parents, and community members must periodically review and revise, as necessary, the physical education curriculum.

C.The physical education curriculum of each school district must be available for review by RIDE upon request.

4.9.1Population-Based Health Services

A.In accordance with R.I. Gen. Laws § 16-21-9, each community is required to provide adequate and appropriate personnel to conduct mandated population-based health services, as described in this Part, for all students attending schools within its geographical boundaries.

B.Population-based services must include no less than the following components:

1.Health examinations and screenings in accordance with §§ 4.12 through 4.16 of this Part;

2.Record keeping requirements in accordance with §§ 4.17 through 4.21 of this Part;

3.Reporting and managing any school-based communicable, environmental, or occupational disease, as directed by a physician and in accordance with Part 30-05-1 of this Title, Reporting and Testing of Infectious, Environmental and Occupational Diseases.

4.9.2Individualized Health Services

A.Each school must provide adequate and appropriate personnel and/or equipment to provide individualized health services to all students enrolled in the school. At a minimum, the services must include those ordered by a physician, such as medication administration.

1.All personnel providing individualized health services to students must be licensed and/or certified in Rhode Island in accordance with all applicable State laws and Regulations.

4.9.3Students Assisted by Medical Technology and Special Health Care Needs

A.Pursuant to the provisions of R.I. Gen. Laws § 23-13-26, school nurses who provide direct care for technology-dependent students must develop individualized health care plans (IHCPs) for such students and provide care accordingly.

B.All students assisted by medical technology and/or with other specialized health care needs, who are currently enrolled in grades K through twelve(12); entering Kindergarten; or currently attending or entering a public school-sponsored preschool, must have as part of their permanent school health record, an individualized health care plan (IHCP) and/or an emergency care plan (ECP/EHCP), as necessary and/or appropriate to ensure health, safety, and learning for the student while at school or at school-sponsored activities. The plan must include, but not be limited to the following:

1.A description of all services that will be provided to the student, including those services related to school-sponsored transportation and off-site school-sponsored activities;

2.Persons responsible for providing each service and a description of service(s) provided in school or at school-sponsored activities;

3.Qualifications of the person(s) providing services;

4.Training requirements for person(s) providing services and focus of responsibility for providing training;

5.Supervision of person(s) providing services.

C.All school personnel who may be involved in the care of a student assisted by medical technology must be informed of the IHCP and ECP/EHCP, on a need-to-know basis.

D.The IHCP and ECP/EHCP must be developed by the school nurse in collaboration with the medical provider, parent or guardian, student (when appropriate), principal, and other school staff, as appropriate. It must be signed by the school nurse, parent/guardian, and student (when appropriate).

E.The IHCP and ECP/EHCP must be developed in addition to an Individualized Education Plan (IEP) or a 504 Plan, when appropriate. The IEP or 504 Plan may serve as the IHCP or ECP/EHCP if it meets all the requirements stated in this Part.

The administrative head of school(s) with the advice and consent of the school committee of each community, school district or appropriate non-public school authority (e.g., superintendent, headmaster or principal) is required to arrange for the appointment of all school health personnel necessary to implement the health services requirements described in this Part, pursuant to the requirements of R.I. Gen. Laws Chapter 16-21.

4.10.1School Physician

A.Qualifications and general duties of the school physician include the following:

1.Must be licensed to practice allopathic or osteopathic medicine in Rhode Island in accordance with R.I. Gen. Laws Chapter 5-37.

2.Must be qualified by training and experience to assume the role of a school health physician consultant (e.g., develops school health protocols, provides in-service training for school nurses) and/or primary care provider (e.g., performs physicals, examines outbreak cases) for a wide range of comprehensive school health services.

3.Must have knowledge of all State and local laws, Regulations and protocols pertaining to schools.

4.Must ensure implementation of all such laws, Regulations and protocols in collaboration with the school’s administrative authorities and school health personnel.

5.Must have a contract with the school system defining mutually agreed upon expectations and objectives.

6.Must provide a regular report, a minimum of one (1) per year, on consultation and/or direct service activities provided.

7.At least annually, must review and approve school health service plans, protocols, and programs (except those developed and provided by the school dentist[s]) including but not limited to:

a.Delivery of school health services and screenings;

b.Consultations;

c.Furnishing information on health-related matters;

d.Review of standing orders, protocols and procedures; and

e.Reporting and management of infectious diseases and outbreaks, in accordance with Part 30-05-1 of this Title, Reporting and Testing of Infectious, Environmental and Occupational Diseases and RIDOH recommendations related to infection control in the school environment.

4.10.2Certified School Nurse-Teachers and Certified School Nurses

A.Qualifications and general duties of the school nurse include the following:

1.Must be licensed as a professional (registered) nurse pursuant to R.I. Gen. Laws Chapter 5-34 and certified by RIDE as a certified school nurse or as a certified school nurse-teacher pursuant to 200-RICR-20-20-1, Regulations Governing the Certification of Educators in Rhode Island..

2.Must provide population-based health services to students in public and non-public schools in the community.

3.Must provide individualized health services to all public-school students in the community.

a.This requirement shall not be construed as prohibiting certified school nurse-teachers or certified school nurses from providing individualized health services to students in non-public schools.

B.Exemption from Certified School Nurse Requirement

1.Non-public schools are authorized to employ registered nurses licensed in Rhode Island pursuant to R.I. Gen. Laws Chapter 5-34 who are not certified by RIDE for the purpose of providing individualized health services, including dispensing medications, to students in the non-public school setting.

2.Registered nurses may not provide the population-based health services and other requirements of the school health program as described in this Part.

4.10.3Dentist/Public Health Dental Hygienist/Dental Hygienist

A.Qualifications

1.The school dentist(s)/public health dental hygienist/dental hygienist for a community must be licensed to practice dentistry/dental hygiene, respectively, in Rhode Island in accordance with R.I. Gen. Laws Chapter 5-31.1, and have at least three (3) years of clinical experience as specified in R.I. Gen. Laws § 16-21-9.

a.Public health hygienists performing the dental screenings pursuant to the provisions of R.I. Gen. Laws § 16-21-9 must do so in accordance with R.I. Gen. Laws § 5-31.1-39.

b.Dental hygienists performing the dental screenings pursuant to the provisions of R.I. Gen. Laws § 16-21-9 must do so under the general supervision as defined in Part 40-05-2 of this Title, Dentists, Dental Hygienists, and Dental Assistants, of the dentist liable and responsible under the contract with the community.

B.General Duties

1.The school dentist, public health hygienist, or dental hygienist as specified in § 4.10.3(A)(1)(b) of this Part may perform any of the required dental screenings of students.

2.Each dentist must also examine students referred by the administrator, school nurse, or physician for suspected dental disease.

3.The school dentist, public health hygienist and dental hygienist, when applicable, must be qualified by virtue of training and experience to assume the role of a school health dental consultant (e.g., develops school health protocols, provides in-service training for school nurses or dental hygienists) and/or service provider in accordance with Part 40-05-2 of this Title, Dentists, Dental Hygienists and Dental Assistants.

4.The school dentist, public health hygienist and dental hygienist, when applicable, must have knowledge of all relevant State and local laws, Regulations and protocols affecting schools, and must participate actively to ensure implementation of all such laws, Regulations and protocols in collaboration with the school’s administrative authorities and school health personnel.

5.The school dentist or public health hygienist must establish a contract with the school system defining mutually agreed upon expectations and objectives and the dentist, public health hygienist and/or dental hygienist, when applicable, must provide a regular report, (a minimum of one (1) per year),on consultation and/or direct service activities rendered to the school system.

6.Referrals of students screened by the school dentist, public health hygienist and dental hygienist, must be made in accordance with the provisions of R.I. Gen. Laws § 16-21-9(c).

a.Referrals by a dentist, public health hygienist or a dental hygienist to non-profit dental programs that provide oral health services on a reduced or sliding fee scale basis are exempt from the provisions of § 4.10.3(B)(6) of this Part.

4.11.1Health Examination Requirements

A.General health examinations must be a complete, age-appropriate medical history and physical examination, assessing the health and well-being of the student and evaluating any challenges to the student's success in school and school-related activities.

B.These general health examinations must be conducted by the student's primary care physician, a physician's assistant under the physician's supervision, or a certified registered nurse practitioner.

C.Every student who has not been previously enrolled in a school in this State is required to have a health examination completed. This health examination may be performed in the twelve (12) months preceding the date of school entry, but if not, it must be completed within six (6) months of school entry.

D.A second (2^nd) general health examination and health clearance is required upon entry to the seventh (7^th) grade. This health examination may be performed during the sixth (6^th) grade, but no later than six (6) months after entry into the seventh (7^th) grade.

E.A third (3^rd) health examination is required upon entry to the twelfth (12^th) grade. This health examination must be performed after the student turns sixteen (16) years of age, and no later than six (6) months after the student enters the twelfth (12^th) grade.

F.If there is no evidence that the required health examination has been performed, the school must make provisions for the health examination by the end of the school year in which it is required.

1.No student shall be excluded from school for failure to provide documentation of completion of a health examination.

G.For students suspected or identified as having special health needs, referrals by a school nurse must be made as specified in this Part or in 200-RICR-20-30-6, Regulations Governing the Education of Children with Disabilities.

H.Each school system may require additional health examinations, to ensure the mental and physical health of each student to participate in classroom, athletic, or special activities sponsored or conducted by the school.

4.11.2Health Examination Documentation & Follow-up

A.Written or electronic documentation of the health examination results is acceptable and must be in a standardized format with one (1) copy available from RIDOH or any format that captures the same required fields of information.

1.Documentation of the health examination results must be included in the student's cumulative school health record.

B.A care plan for health problems must be developed by the school nurse in conjunction with the parent, student, and other appropriate health care providers as defined in § 4.3 of this Part.

A.Pursuant to R.I. Gen. Laws § 23-24.6-8, evidence that students under six (6) years of age have been screened for lead poisoning is required in accordance with guidelines established under R.I. Gen. Laws § 23-24.6-7.

1.A statement on a school health form signed by a healthcare provider is sufficient to comply with this requirement.

B.The lead screening entry requirement does not apply if a parent signs a statement indicating that lead screening is contrary to their religious beliefs.

4.13.1General Vision Screening Requirements

A.Pursuant to R.I. Gen Laws §§ 16-21-14 and 16-21-14.1, vision screening is required for all students upon entry to school, and in preschool programs operated by public school districts, and first (1^st), second (2^nd), third (3^rd), fourth (4^th), fifth (5^th), seventh (7^th) and ninth (9^th) grades.

B.If evidence is presented to the school physician or school nurse that an eye examination was completed within the preceding twelve (12) months of the initial screening by the student's ophthalmologist, optometrist, pediatric ophthalmologist, pediatric optometrist or primary care provider, the student may be exempt from this screening requirement for that school year.

C.A school must screen vision using evidence-based, optotype-based screening, or evidence-based, instrument-based screening, depending on the age of the student in accordance with the National Center for Children’s Vision and Eye Health's Vision Screening Recommendations (https://nationalcenter.preventblindness.org/vision-screening-recommendations) incorporated by reference at § 4.2(L) of this Part.

1.Certain students who have a higher rate of vision problems should bypass vision screening in accordance with the National Center for Children’s Vision and Eye Health's Vision Screening Recommendations and be referred directly to an eye specialist for a comprehensive examination. The school nurse may determine which children should be referred directly.

D.It is recommended that vision screening occur early in the school year. Preschool and kindergarten screening must be completed within thirty (30) administrative days of the start of school.

E.Vision screening outside of the grade level required for screening must occur upon referral from teachers, parents/caregivers, or with presentation of signs or symptoms of a vision problem.

F.Students transferring to a school without record of previous vision screening must be screened.

G.When a trained, unlicensed individual, or individuals from an outside entity, conducts the initial screening, the school nurse must rescreen the student before making a referral.

1.Rescreening for all vision tools, except instrument-based screening, will occur as soon as possible, but no later than six (6) months following the initial screen.

H.Students who do not pass vision screening must be referred to their parents/caregivers and provided with a referral form to bring to their health care provider or eye specialist.

I.Periodic reporting of vision screening results to RIDE and/or RIDOH may be required.

4.13.2 Distance Visual Acuity

A.Students in preschool, kindergarten, and grades one (1) through five (5), seven (7), and nine (9) must be screened for distance visual acuity.

B.For those students required to wear prescription glasses, screening must occur with student wearing glasses.

C.Screening tools recommended for preschool and kindergarten (and grade one (1) if students cannot identify letters in random sequence) are:

1.LEA SYMBOLS® chart (illuminated preferred, critical line screening permissible; five (5) foot and ten (10) foot charts or booklets are permissible); and

2.HOTV chart (illuminated preferred, critical line screening is permissible;

3.Computer-based screening programs using either HOTV or LEA SYMBOLS® optotypes.

D.Screening tools recommended for students in grades one (1) (if students can identify letters in random sequence) and grades two (2) through five (5), seven (7), and nine (9) are:

1.Sloan Letters chart (illuminated preferred if using nine inch by fourteen inch (9"x14") charts, charts exceeding nine inches by fourteen inches (9"x14") are permissible);

2.Computer-based screening programs using Sloan Letters.

E.Instrument-Based Screening may be used as an alternative to distance visual acuity screening for:

1.Children ages three (3), four (4), and five (5) years

2.Children ages six (6) years and older when children cannot participate in optotype-based vision screening.

3.If conducting instrument-based screening, record pass or refer.

4.13.3Near Visual Acuity

A.Students in preschool, kindergarten, and grades one (1) through five (5), seven (7), and nine (9) must be screened for near visual acuity.

B.For those students required to wear prescription glasses, screening should occur with student wearing glasses.

4.13.4Referral Requirements

A.Referral of students to qualified vision professionals, such as an ophthalmologist, optometrist, pediatric ophthalmologist, or pediatric optometrist, must occur in the following circumstances:

1.Age three (3) years, unable to correctly identify at least three (3) of five (5) optotypes on 20/50 line with each eye individually if using threshold method.

2.Ages four (4) and five (5) years, unable to correctly identify three (3) of five (5) optotypes on the 20/40 line with each eye individually if using threshold method.

3.Ages six (6) years and older, unable to correctly identify at least three (3) of five (5) optotypes on the 20/32 line with each eye individually if using threshold method.

4.Refer students who have a two (2) line difference between the eyes, even in the passing lines (e.g., 20/20 and 20/32), if using threshold method.

5.If using threshold screening, record the visual acuity value for each eye.

6.If using critical line screening, use the age line per the chart manufacturer’s instructions and record pass or refer.

B.The school nurse will follow up with the parents/caregivers of students referred to determine the outcome of the referral.

C.The school nurse will follow up with students referred for further evaluation by an eye care provider (pediatric ophthalmologist, pediatric optometrist, ophthalmologist, or optometrist) to ensure treatment plans are implemented at school, if necessary.

4.13.5Stereoacuity Screening

A.Stereoacuity screening – to determine how well eyes work together – is optional and if used for students in preschool, kindergarten, and grades one (1) through five (5), seven (7), and nine (9), will be used in conjunction with optotype-type based screening, but not instrument-based screening.

B.Preschool Assessment of Stereopsis with a Smile (PASS) II is the recommended tool for stereoacuity screening with all students. Manufacturer's instructions must be followed for use of any tools used for stereoacuity screening.

4.13.6Color Vision Deficiency Screening

A.Color Vision Deficiency Screening is optional. If such screenings are conducted, recommended age for use is in preschool, kindergarten, and upon entry to the school.

B.Books with pseudoisochromatic plates should be used. Options include:

1.HRR Standard Pseudoisochromatic Test, 4^th Edition;

2.Good-Lite ColorCheck Complete Vision Screener; and

3.Waggoner Color Vision Testing Made Easy.

C.Manufacturer's instructions must be followed for use of any tools used for color vision deficiency screening.

4.13.7Personnel & Training Requirements

A.The school vision screening must be conducted by a formally trained school nurse, trained in the administration of these tools to ensure uniformity across procedures.

B.Trained volunteers or other school personnel who are directly supervised on-site by a school nurse may be utilized in the vision screening program.

4.13.8Follow-up & Documentation Requirements

A.A student who does not pass vision screening must be rescreened on a different day and as soon as possible but no longer than six (6) months before the parents/caregivers are notified of the results of the screening.

1.Students who fail the screening criteria set must be re-screened by the school nurse.

2.Parents of students who fail to meet the minimal visual requirements on the second screening must be notified in accordance with the requirements of § 4.19 of this Part in order to arrange for a comprehensive vision examination by an eye care provider.

B.If the corrected visual acuity of the student is found to be in the range of 20/70 – 20/200 in the better eye after an eye examination, the school nurse in charge of the screening must, within thirty (30) days, report the result of the eye examination to the administrator of the Division of Services for the Blind and to the Special Education Supervisor, indicating that specialized services may be indicated.

1.Students identified with a visual impairment must be referred for specialized services and follow-up in accordance with the provisions of the 200-RICR-20-30-6, Regulations Governing the Education of Children with Disabilities.

C.A student's vision screening results must be recorded in the "Vision Screening" section of the school health record.

4.14.1General Hearing Screening Requirements

A.Students in preschool programs operated by public school districts, and all students in kindergarten, first (1^st), second (2^nd), and third (3^rd) grades and any student(s) new to a school without a prior record of a hearing screening must be given a hearing screening test by a properly trained and qualified person in accordance with the guidelines of the American Speech-Language-Hearing Association (ASHA) incorporated at § 4.2(G) of this Part.

B.Students who failed the hearing screening tests in previous years, repeat a grade, have a history of hearing difficulty or pathology, are enrolled in curricular or extracurricular activities where there is exposure to noise levels that meet or exceed current Occupational Safety and Health Administration (OSHA) standards incorporated at § 4.2(I) of this Part, or are suspected by school personnel of a hearing loss must be screened as often as is necessary.

C.The "passing" criteria for the hearing screening test shall be in accordance with the guidelines of the American Speech-Language-Hearing Association (ASHA) incorporated at § 4.2(G) of this Part.

D.The screening must consist of an initial Otoacoustics Emission hearing test. Students who fail the initial screen must be re-screened within four (4) weeks with tympanometry and pure tone in accordance with the American Speech/Language and Hearing guidelines incorporated at § 4.2(G) of this Part.

E.Any student who provides documentation from a parent that a hearing screening test has been performed in accordance with § 4.14.1(A) of this Part is exempt from this screening requirement.

1.In the absence of this documentation from the parent, the school is required to make provisions for the screening.

4.14.2Equipment

All equipment utilized in the hearing screenings must be calibrated according to the American National Standards Institute Specifications for Audiometers incorporated at § 4.2(H) of this Part.

4.14.3Personnel Requirements

A.A school nurse is responsible for coordinating the requirements of this section.

B.Personnel who may perform the screening requirements of this section include: an audiologist, speech language pathologist, school nurse, audiometric aide under the supervision of a licensed audiologist, or a speech/language pathology assistant under the supervision of a certified speech language pathologist.

C.Any supporting personnel utilized by an audiologist/speech language pathologist in the hearing screening program must meet the requirements in Part 40-05-33 of this Title, Speech Pathologists and Audiologists.

4.14.4Follow-up & Documentation Requirements

A.The parent of a student who does not meet the "passing" criteria of the hearing screening must be notified, in accordance with the requirements of § 4.14.3(B) of this Part, and recommended to obtain a comprehensive audiological evaluation and/or medical follow-up with the student’s primary care provider.

B.Students identified with a potentially educationally-significant hearing impairment must be referred by the school nurse for in-school supportive accommodations, Teacher Support Team, or other educational services, as appropriate or as specified in 200-RICR-20-30-6, Regulations Governing the Education of Children with Disabilities.

C.The hearing status of students referred for further evaluation must be confirmed and noted by the school nurse within three (3) months of the initial referral.

D.A student's hearing screening results must be entered into the school health record by the school nurse, or the person performing the screening. At a minimum, the following components must be noted in the record:

1.Date screening completed;

2.Screening results;

3.Follow-up plan, as indicated.

4.15.1General Speech/Language Requirements

A.Every elementary school student who has not been previously screened for speech/language impairments must be screened for speech and language impairments by a trained and qualified person as described in § 4.15.2 of this Part. Any student may be screened on an “as needed” basis.

1.For those students who have been previously screened, results of said screening must be transferred to each new school in accordance with the requirements of § 4.18.2 of this Part.

B.Any student who has never been previously enrolled in a Rhode Island school who provides documentation from a parent that a speech screening has been performed by a certified and/or licensed speech language pathologist must be exempt from this screening requirement.

1.In the absence of this documentation from the parent, the school must make provisions for the screening.

C.A speech/language screening must consist of an assessment of the following:

1.Articulation;

2.Voice characteristics;

3.Fluency (e.g., stuttering) and;

4.Receptive/expressive language skills.

4.15.2Personnel Requirements

A.A certified speech language pathologist certified by RIDE in accordance with 200-RICR-20-20-, Regulations Governing the Certification of Educators in Rhode Island is responsible for implementing the requirements of § 4.15.1 of this Part.

B.Any support personnel (e.g., a speech/language pathology assistant) utilized by a speech/language pathologist must meet the training and supervision requirements outlined in Part 40-05-33 of this Title, Speech Pathologists and Audiologists.

4.15.3Instruments

A.A school's speech screening program may be conducted utilizing commercially available kindergarten/elementary school level screening instruments.

B.In developing techniques for screening students ages eight (8) and above, informal items may be adapted from available tests. This informal screening would not provide standardized procedures but would yield an acceptable method of screening to determine the need for further testing.

4.15.4Follow-up and Documentation Requirements

A.A student who does not pass the speech/language screening must be referred immediately for a comprehensive speech/language evaluation. The parent of any student who does not pass the speech screening must be notified of the findings, in accordance with the requirements of § 4.19 of this Part.

B.The speech language pathologist or the school nurse must enter the results into the student's school health record.

1.The following components must be noted in the record:

a.Date screening completed;

b.Screening results (i.e., pass/fail); and

c.Follow-up plan for a student who does not pass.

4.16.1General Scoliosis Screening Requirements

A.Annual scoliosis screening, conducted by a school nurse, is required for students in grades six (6) through eight (8) pursuant to R.I. Gen. Laws § 16-21-10.

B.No school-based scoliosis screening shall be conducted before students are introduced to the nature of the condition, its effects, and the nature of the scoliosis screening procedure.

C.The screening of male and female students must be conducted separately and individually. A private, well-lit screening area should be available.

D.The parent of any student may have the scoliosis screening conducted by a private physician.

E.If these results are made available to the local school department, the student will be exempt from the scoliosis screening requirement.

F.The screening is not required of any student whose parents object on the grounds that the test conflicts with their religious beliefs.

4.16.2Follow-up and Documentation Requirements

A.The school nurse is responsible for notifying the parent of any student who is found to have positive signs or symptoms of scoliosis, based on standards published by the American Academy of Orthopedic Surgeons or the Scoliosis Research Society incorporated at § 4.2(E) of this Part, in order to arrange for further evaluation or treatment, as indicated.

B.A student's scoliosis screening results must be documented in the student health record.

4.17.1General Dental Health Screening Requirements

A.Every student who has not been previously enrolled in a public or non-public school in this State must be given a dental screening by a licensed dentist, licensed dental hygienist, or a licensed public health dental hygienist with at least three (3) years of clinical experience.

1.Thereafter, every student must be given an annual dental screening by a licensed dentist, dental hygienist, or a licensed public health dental hygienist through the fifth (5^th) grade and must be screened at least once between the sixth (6^th) and tenth (10^th) grades.

a.Provided, however, that dental screenings for students in kindergarten, third (3^rd) and ninth (9^th) grades must be performed by a licensed dentist or licensed public health dental hygienist.

b.Dental hygienists performing the dental screenings pursuant to the provisions of this section must do so under the general supervision of the dentist liable and responsible under the contract with the community as required under R.I. Gen. Laws § 16-21-9(b).

c.Public health dental hygienists performing the dental screenings pursuant to the provisions of R.I. Gen. Laws § 16-21-9 must do so in accordance within the collaborative agreement guidelines between the public health dental hygienist and a licensed dentist, or an authorized facility. (For a definition of “general” supervision or “collaborative agreement”, see Part 40-05-2 of this Title, Dentists, Dental Hygienists and Dental Assistants.

2.Schools are required to report to RIDOH annually, aggregate screening results on grades K, three (3), and six (6) (if 6^th grade is screened).

B.Students who are screened by private dentists/dental hygienists and who provide written documentation containing information outlined by RIDOH of the screening being performed at the intervals prescribed by § 4.17.1(A)(1) of this Part are exempt from the requirements of this section and may elect not to be screened.

C.To screen for hard tissue disease (tooth decay), soft tissue disease (gum disease) and urgent treatment need, the school dental screening must consist of a non-invasive inspection of the student's mouth using the RIDOH standardized screening form.

D.Equipment to perform the screening requirements must include: a mirror, tongue depressor, a light source, and non-latex disposable gloves.

E.The initial dental screening preferably should be conducted by the student’s family dentist/dental hygienist within the six (6) months preceding the date of school entry, and the succeeding screenings should be conducted by him/her at any time during the school year (including vacations) for which the screening is required.

1.Screening results must be documented in writing using the RIDOH standardized form and submitted to the school for all grades and to the RIDOH Oral Health Program upon screening completion for grades K and three (3), or as indicated by the RIDOH.

2.The RIDOH standardized form is available to all schools via the RIDOH website.

4.17.2Follow-up and Documentation Requirements

A.When a school dental screening has revealed that a dental problem may exist, the parent must be notified in writing, using the RIDOH standardized form, so that a dental visit may be arranged.

B.A student's dental screening results must be documented on the school health record.

C.Each community must provide to parents or custodians of students who require professional or skilled treatment, a current list of both dental practices in the community which accept patients insured by Medical Assistance and/or RIte Care and dental practices which provide services on a sliding scale basis to uninsured individuals.

A.The school nurse is responsible for the complete, cumulative school health record for each student at the school in which the student is enrolled. The health record must include:

1.Immunization status;

2.Health history, including chronic conditions and treatment plan;

3.Screening results and necessary follow-up;

4.Health examination reports;

5.Documentation of traumatic injuries and episodes of sudden illness referred for emergency health care (see also requirements in “First Aid and Emergencies" § 4.21 of this Part);

6.For a student with documented anaphylaxis, the parental authorization of a student's treatment for allergies and the physician's order to administer an epinephrine auto-injector must be entered into the student's health record.

7.Documentation of any nursing assessments completed;

8.Documentation of any consultations with school personnel, students, parents, or health care providers related to a student's health problem(s), recommendations made, and any known results;

9.Documentation of the health care provider's orders, if any, and parental permission to administer medication or medical treatment in school by the school nurse.

B.The student's cumulative health record is confidential and subject to the provisions of R.I. Gen. Laws Chapter 5-37.3, ("Confidentiality of Health Care Information Act"), and other applicable State and Federal laws and Rules and Regulations.

C.The record must be stored in an appropriately secured location with convenient access by the school nurse and must be used only in connection with the provision of treatment to the student.

D.Appropriate steps must be taken for the protection of all student health records, including the provisions for the following:

1.Securing records at all times, including confidentiality safeguards for electronic records;

2.Establishing, documenting and enforcing protocols and procedures consistent with the confidentiality requirements of R.I. Gen. Laws Chapter 5-37.3 and this Part;

3.Training school personnel who handle student school health records in security objectives and techniques.

E.The record must be maintained by the school for a minimum of five (5) years after the student turns eighteen (18) years of age or five (5) years after the student leaves the school district.

4.18.1Confidentiality

A.Any school personnel, including health care providers, who maintain cumulative school health records containing confidential health care information are responsible for ensuring full confidentiality of this information as provided in R.I. Gen. Laws § 5-37.3-4 ("Confidentiality of Health Care Information Act") and other applicable State and Federal laws and Rules and Regulations.

B.Any school personnel, including health care providers, who release confidential health care information from cumulative school health records in accordance with R.I. Gen. Laws § 5-37.3-4 ("Confidentiality of Health Care Information Act") and other applicable State and Federal laws and Rules and Regulations, must document each release in the cumulative school health records by indicating the following:

1.The date of release;

2.A description of the information released;

3.The name(s) of the person(s) to whom the information was released;

4.The reason for the release of information.

C.Violations Pertaining to Confidentiality: Any person suspected of violating the Health Care Information Act must be reported to the Attorney General's Office for prosecution and any subsequent penalties, in accordance with statutory provisions.

4.18.2Transfer of Health Records

A.Whenever a student transfers to another school building or school system in or out of Rhode Island, the original, a copy, or electronic version of the complete, cumulative school health record must be transferred at the same time to the health personnel of the school building or school system to which the student is transferring.

B.This record must be sent in a manner consistent with the provisions of the Health Insurance Portability and Accountability Act (Pub. Law 104-191) to a health care professional authorized to receive confidential health care information at the new school or handed to the parent, as appropriate.

C.A copy of the record (or the original) must be maintained by the community for a minimum of five (5) years after the student turns eighteen (18) years of age or five (5) years after the student leaves the school district.

A.Parents and/or guardians must be notified, according to established local school district procedures, of any suspected deviation from normal or usual health found as a result of a screening test (e.g., vision screening), health examination, and/or school personnel observation, in accordance with all applicable State and/or Federal laws and Regulations.

B.Each school district must develop procedures or protocols for documenting and implementing a follow-up and referral plan for students identified as needing additional services.

A.In accordance with the Rules and Regulations pertaining to Part 30-05-1 of this Title, Reporting and Testing of Infectious, Environmental and Occupational Diseases, the basic responsibility for reporting infectious, environmental and occupational diseases lies with:

1.Physicians licensed in accordance with R.I. Gen. Laws Chapter 5-37 who are attending the case or suspected case;

2.Laboratories;

3.Other authorized health professionals working under the auspices of a physician; and

4.Other health care professionals authorized by law or Regulation to practice independently (e.g., registered nurse practitioners).

5.In the school setting, this requirement encompasses school nurses directed by a physician to report in accordance with the regulatory requirements cited above.

6.Licensed health care facilities that operate school-based health clinics must report communicable, environmental and occupational diseases in accordance with the Rules and Regulations for the Licensing of Organized Ambulatory Care Facilities and Part 30-05-1 of this Title, Reporting and Testing of Infectious, Environmental and Occupational Diseases.

B.In accordance with Part 30-05-1 of this Title, Reporting and Testing of Infectious, Environmental and Occupational Diseases, any health care provider (e.g., school physicians, school nurses, school dentists/dental hygienist) having knowledge of any outbreak or undue prevalence of infectious or parasitic disease or infestation (based upon his/her professional judgment), whether listed in this Part or not, must promptly report the facts to RIDOH. Exotic diseases and unusual group expressions of illness that may be of public health concern should also be reported immediately.

A.Each school must have written protocols and standing orders available in the event of injuries and acute illnesses, including anaphylaxis and cardiac arrest.

B.Protocols and standing orders must be prepared, dated, signed, reviewed and updated, as appropriate, but at least on an annual basis by the school physician(s).

C.Protocols must also be reviewed annually by all school personnel designated by the school principal (or other designated school authority), who might be involved in managing an emergency in a school, including anaphylaxis, prior to the arrival of more fully trained persons.

D.No requirement in this Part shall be construed as prohibiting the issuance of a standing order by a school physician for the administration of an epinephrine auto-injector by a school nurse to a student who has not been previously medically identified for the prevention or treatment of anaphylaxis. This standing order must be reviewed in accordance with § 4.21(B) of this Part.

4.21.1Basic First Aid Training

A.In-service basic first aid training must be provided for school personnel who might be involved in managing an injury or other medical emergency.

B.Personnel must be identified by the school principal, or other designated school authority, and listed in the emergency protocol described in §§ 4.21(B) through (D) of this Part.

C.First aid subjects to be covered must include, but not be limited to: control of major bleeding, use of universal/standard precautions, management of ocular trauma and emergencies, management of burns, diabetes-related signs and symptoms, accessing the "911" emergency medical system, proper application and removal of disposable gloves and equipment, and movement and transportation of an injured person.

D.No less than one (1) hour of basic first aid training or current certification for the allotted term of said certification in basic first aid by a nationally recognized organization shall be required of school personnel designated by the school administrator during every school year.

E.The school principal, or other authorized school personnel, must maintain a record-keeping system documenting that the basic first aid training (as required under § 4.21.1(D) of this Part) has been provided to all designated school personnel.

F.The training must be delivered by a school nurse, or other designated instructor, utilizing a training curriculum that adheres to standards established by a nationally-recognized body.

G.Students engaged in potentially hazardous tasks (including, but not limited to, activities during normal school hours in science laboratories, industrial arts, physical education, and family/consumer science classes) should be directly supervised by teachers or instructors who are trained in the administration of basic first aid, and who have posted and discussed safety rules with the students.

4.21.2Cardiopulmonary Resuscitation Training

A.At all times, during normal school hours and at on-site school-sponsored activities, each school must have available at least one (1) person other than the school nurse who is trained, competent and responsible for the administration of basic first aid, child/adult cardiopulmonary resuscitation (CPR), including emergency procedures for obstructed airways (choking) and drowning, and administration of the epinephrine auto-injector.

B.Requirements for automated external defibrillators (AEDs) in high schools and middle schools are pursuant to R.I. Gen Laws § 16.21-33.1(b).

4.21.3Anaphylaxis Training

Training must be provided for school personnel who might administer an epinephrine auto-injector in a case of anaphylaxis. Subjects to be covered must include, but not be limited to,: signs and symptoms of anaphylactic shock, proper epinephrine auto-injector administration, adverse reactions, accessing the "911" emergency medical system, and preparation for movement and transport of the student.

4.21.4Response to and Treatment for Anaphylaxis

A.To prevent or treat a case of anaphylaxis (as defined in § 4.3(A)(2) of this Part), the school nurse or trained school personnel must administer the epinephrine auto-injector to an identified student. School nurses must administer the epinephrine auto-injector in accordance with standard nursing practice.

B.In the event of a suspected case of anaphylaxis, school personnel may administer the emergency protocol, including an epinephrine auto-injector to a medically identified student when authorized by a parent/guardian and when ordered by a physician or other licensed prescriber.

C.School health programs must develop and adopt a procedure for addressing incidents of anaphylaxis and the use of the epinephrine auto-injector on previously medically identified students. Such procedures must pertain to no less than the requirements described in this Part and must include the following:

1.Parents must provide a physician's or other licensed prescriber's order, parent authorization, and filled prescription(s) such as, the epinephrine auto-injector(s)) notifying the school of the student's allergy and the need to administer the epinephrine auto-injector in a case of anaphylaxis.

2.School administrators must communicate the required medical information from the parent to the appropriate school personnel, including the school nurse, teachers, food service workers, and school bus drivers and bus monitors.

3.The school physician must review these procedures on an annual basis.

4.Such procedures must stipulate that the epinephrine auto-injector be used only on the student for whom it was prescribed, in accordance with the provisions of R.I. Gen. Laws Chapter 21-28.2.

5.Such procedures must provide for the development of an individualized emergency care plan for a student at risk for anaphylaxis.

6.Procedures for accessing the community's emergency medical system, also known as, "911".

D.Students who are treated for anaphylaxis at the school must be transported by a licensed ambulance/rescue service promptly to an acute care hospital for medical evaluation and follow-up.

E.If appropriate, a student identified as being at risk for anaphylaxis should carry the epinephrine auto-injector at all times. If this is not appropriate, the epinephrine auto-injector must, if necessary for the student’s safety, as determined by the physician, or other licensed prescriber, be available in the classroom, cafeteria, physical education facility, health room and/or other areas where the epinephrine auto-injector is most likely to be used. Reasonable provisions must be made for the availability, safekeeping and security of the epinephrine auto-injector. The school must develop protocols and procedures related to the availability, safekeeping and security of the epinephrine auto-injector.

F.School personnel who have been trained in accordance with §§ 4.21.1, 4.21.2, and/or 4.21.3 of this Part are authorized to administer the epinephrine auto-injector to an identified student. If trained school personnel are not available, any willing person may administer the epinephrine auto-injector to a medically identified student. None of the requirements of this Part shall preclude the self-administration of an epinephrine auto-injector by a medically identified student.

G.In accordance with R. I. Gen Laws § 16-21-22(e), school districts may permit schools to maintain epinephrine auto-injectors for emergency first aid to students who experience allergic reactions.

4.21.5Good Samaritan Provisions

School personnel who voluntarily assist persons suffering from anaphylaxis are immune from liability for ordinary negligence in accordance with R. I. Gen Laws §§ 9-1-27.1 and 16-21-22(d).

4.21.6Food Allergy Management

A.Schools that have students with peanut/tree nut allergies are required to post a notice in accordance with R.I. Gen Laws § 16-21-31.

B.In all public and non-public elementary, middle or junior high schools, the school authority shall develop a policy designed to provide a safe environment for students with peanut/tree nut allergies pursuant to R.I. Gen Laws § 16-21-32.

C.Students with peanut/tree nut allergies, must have an IHCP and EHCP developed in accordance with R.I. Gen Laws § 16-21-32 prior to entry into school or immediately thereafter for students diagnosed with an allergy.

D.In addition to the requirements of R.I. Gen Laws § 16-21-32, the IHCP and EHCP must be part of the student’s permanent record, include both preventative measures to help avoid accidental exposure to allergens, and emergency measures in case of exposure. Additional measures shall include:

1.Educating school personnel, students, and families about food allergies; and,

2.Implementing protocols around cleaning surfaces touched by food products, washing of hands after eating, etc.

E.The EHCP must be consistent with applicable provisions contained in this Part, including, but not limited to, training, communication, plan review, Good Samaritan protections in accordance with R.I. Gen Laws § 9-1-27.1, and follow-up and documentation.

F.All school personnel who may be involved in the care of a student who has been diagnosed with a peanut/tree nut allergy must be informed of the IHCP and the EHCP, as appropriate.

4.21.7Follow-up & Documentation Requirements

A.Following a traumatic injury, an episode of anaphylaxis, or other emergency, a written report must be completed and filed in the student health record and verbal notification made to the student's parents as soon as possible by the school principal or designee.

B.Following a minor injury, the school nurse, or other appropriate school authority, must make a notation of the minor injury in a log book maintained by the school specifically for this purpose. At a minimum, the following items must be noted:

1.Date and time of injury;

2.Location where injury occurred;

3.Chief complaint;

4.Treatment administered;

5.Disposition (e.g., back to class);

6.Signature of responder.

C.For each student, emergency information must be documented and updated on an annual basis. Such emergency information must include no less than the following:

1.Name and telephone number of the student's parent and additional contact person(s) in the event of an emergency;

2.Name and telephone number of the student’s primary care provider;

3.Health insurance (optional);

4.Known allergies (including drug, food, insect bite and chemical allergies);

5.Medical conditions that may need attention, such as, past surgeries, heart problems, seizure disorders, nosebleeds, or diabetes;

6.Current, routine prescription medications and authorized OTC medications.

D.Protocols or procedures shall be developed to require an individualized emergency care plan for a student at risk for anaphylaxis, asthmatic conditions and/or any other medical emergencies, as defined in § 4.3 of this Part.

4.21.8Concussions/Head Injuries in Recreational and/or Athletic Competition

A.A youth athlete who is suspected of sustaining a concussion or head injury in a practice or game related to recreational and/or athletic competition must be removed from that practice or competition at that time.

B.A youth athlete who has been removed from play may not return to play until the athlete is evaluated by a licensed physician and until the athlete receives written clearance to return to play from that licensed physician.

C.A report of a concussion or head injury and written clearance to return to play should be logged in the student’s health record.

D.All coaches, trainers and volunteers involved in youth recreational and/or athletic competition must complete a training course, and a refresher course annually thereafter, in concussions and traumatic brain injuries.

E.All school nurses must complete a training course and an annual refresher course in concussions and traumatic brain injuries.

F.School districts and schools are required to use training materials of the US Center for Disease Control and Prevention entitled "Heads Up: Concussion in High School Sports/Concussion in Youth Sports" or materials substantially equivalent.

4.21.9Opioid-related Drug Overdose in School Settings

A.All public and private elementary, middle, junior, and high schools must develop policies and procedures for the provision and maintenance of a supply of opioid antagonists (Naloxone) in the school setting to treat suspected opioid overdose in accordance with R.I. Gen. Laws. § 16-21-35.

1.School nurses and other school personnel are immune from liability for ordinary negligence for acts or omissions relating to the use of the opioid antagonist in accordance with R.I. Gen. Laws § 16-21-35.

A.Each school district must develop a policy or protocol that allows students who are diagnosed with diabetes to self-manage their disease whenever possible. The policy or protocol must be developed in collaboration with licensed health care providers, parents, students, school nurses and administrators, as appropriate.

B.Such policy or protocol must require no less than the following:

1.Developing an individualized health care plan (IHCP) and an emergency care plan (ECP/EHCP);

2.Permitting self-testing in the classroom or other appropriate place(s) on the school campus or at school-sponsored activities, as designated in the IHCP;

3.Permitting healthy snacks in the classroom or other appropriate place(s) on the school campus or at school-sponsored activities, as designated in the IHCP;

4.Permitting bathroom and water fountain privileges in the classroom or other appropriate place(s) on the school campus or at school-sponsored activities as designated in the IHCP,

5.Ensuring the accompaniment of a symptomatic student to a health area by a designated adult, per the IHCP and the ECP/EHCP, unless such action puts the student at increased health risk.

C.The student’s IHCP and EHCP must be part of their permanent school health record and be developed by the school nurse in collaboration with the student’s health care provider, the parents/guardians of the student, and the student (if appropriate).

4.22.1Glucagon Administration

A.As part of the ECP/EHCP, a parent or legal guardian may authorize school employees (or those employed on behalf of the school), for when there is no school nurse immediately available, to administer glucagon on such student in case of an emergency, while at school or school-sponsored activities.

1.A parent or legal guardian must provide a diabetes management plan or physician's order, signed by the student's health care provider, that prescribes the care and assistance needed by the student including glucagon administration.

2.The glucagon must be kept in a conspicuous place, readily available, but with reasonable provisions made for the safekeeping and security of the glucagon, so that the security of the medication will not be compromised.

3.Glucagon administration training may be provided by a licensed physician, physician assistant, advanced practiced registered nurse, or registered nurse, however in no case shall school nurses be required to provide the training.

a.The school administration shall allow properly trained staff to voluntarily assist with the emergency administration of glucagon when authorized by a parent or legal guardian.

b.A school employee, including administrative staff, shall not be subject to penalty or disciplinary action for refusing to be trained in glucagon administration.

c.The training and supervision of personnel, other than the school nurse, who provide emergency medical assistance to students under this section, shall be governed by performance standards and guidelines developed by the Rhode Island Department of Health, in conjunction with the American Diabetes Association, and the Rhode Island Chapter of the American Academy of Pediatrics. Such personnel shall be authorized to provide such assistance only upon successful completion of glucagon administration training.

4.No school teacher, school administrator, school health care personnel, person employed on behalf of the school, any other school personnel, nor any local educational authority shall be liable for civil damages which may result from acts or omissions in use of glucagon which may constitute ordinary negligence. This immunity does not apply to acts or omissions constituting gross negligence or willful or wanton conduct.

B.All school personnel who may be involved in the care of a student who has been diagnosed with diabetes must be informed of the IHCP and the ECP/EHCP, as appropriate.

4.23.1Requirements for All Medical Marijuana Administration to Students

A.Every school authority must develop protocols or procedures authorizing parents, parents’ designees, legal guardians, and school nurses in accordance with § 4.23.2 of this Part, to administer medical marijuana to a student while the student is on school campus. The protocols or procedures must include, at a minimum, the following:

1.A requirement that the student be authorized to engage in use of medical marijuana pursuant to R.I. Gen. Laws § 21-28.6.

2.An established written process for verifying the student's medical marijuana cardholder registration and ongoing medical marijuana cardholder authorization status.

3.Written instructions for medical marijuana administration that includes:

a.The signature of the certifying physician, advanced practice nurse practitioner, or physician assistant;

b.The student’s debilitating medical condition;

c.The dose of medical marijuana, including the amount of CBD and/or THC (where applicable) per dose;

d.Minimum interval between dosage; and

e.Possible side effects to be included in the student’s IHCP.

4.A requirement that all medical marijuana products utilized under § 4.23 of this Part shall only be obtained from a Rhode Island licensed compassion center. All medical marijuana products utilized must be labeled with the following information:

a.The student’s name;

b.The student’s date of birth;

c.Dosage;

d.Ingredients of product.

5.Documentation of each dose of medical marijuana administered to a student. Documentation must include:

a.Date and time;

b.Dosage;

c.Route of administration; and

d.The signature of the parent, parents’ designees, legal guardian, or school nurse who is administering the medical marijuana.

e.In the event the dosage is not administered as dictated by the instructions required under § 4.23.1(A)(2) of this Part, the reason(s) therefore must be noted.

6.Prohibition on administering medical marijuana to a student by smoking or other form of inhalation.

7.Identification of locations on the school campus where medical marijuana may be administered.

8.A written and signed statement from the student's parent or legal guardian releasing the school, and employees and volunteers of the school, from liability, except in cases of willful or wanton conduct or disregard of the criteria of the IHCP.

9.Prohibition of students handling or self-administering medical marijuana on the school campus.

10.Prohibition of student possession, use, distribution, or sale of marijuana that is inconsistent with the provisions of § 4.23 of this Part and R.I. Gen. Laws §§ 16-21-16 and 16-21-21.1.

11.A requirement that a student who is authorized to use medical marijuana shall not be considered under the influence of marijuana and not penalized pursuant to R.I. Gen. Laws §§ 16-21-16 and 16-21-21.1.

B.The provisions of § 4.23 of this Part do not apply during the time a student is engaged in a school-sponsored trip or activity outside the state of Rhode Island.

C.The school may not discipline or otherwise discriminate against a student who is administered medical marijuana and may not deny the student's eligibility to attend school solely because the student requires the administration of medical marijuana.

D.§ 4.23 of this Part does not apply to FDA-approved cannabinoid medications.

E.A school is exempt from implementing the provisions of § 4.23 of this Part if the school can reasonably demonstrate that it would lose Federal funding as a result of the implementation of the provisions of § 4.23 of this Part.

4.23.2Administration of Medical Marijuana by a School Nurse

A.Pursuant to R.I. Gen. Laws § 21-28.6-4(n), a school nurse may administer medical marijuana to a student. Administration of medical marijuana to students by school nurses must follow all requirements of § 4.23.1 of this Part. Additionally:

1.All medical marijuana to be administered by the school nurse must be kept in a secured cabinet designated by the school.

2.No school nurse shall be subject to disciplinary action by the applicable Rhode Island professional licensing board solely for following an appropriate written certification to administer medical marijuana.

3.Nothing in this Part requires a school nurse to administer medical marijuana to a student, provided that the school nurse’s decision not to administer medical marijuana applies to all students authorized to use medical marijuana.

a.School’s whose school nurse refuses to administer medical marijuana shall make arrangements for the student to receive his or her medical marijuana during the school day.

4.23.3Administration of Medical Marijuana by Parents, Parents’ Designees, and Legal Guardians

A.Administration of medical marijuana to students by parents, parents’ designees, and legal guardians must follow all requirements of § 4.23.1 of this Part. Additionally:

1.Any medical marijuana taken onto the school campus by the parent, parents’ designee, or legal guardian must be either:

a.Consumed/utilized in its entirety by the student; or

b.The excess medical marijuana which is not consumed/utilized by the student must be removed in its entirety from the school campus, with the exception of any disposable packaging which no longer contains medical marijuana.

A.Each school district or authority must develop protocols or procedures related to medication administration in schools that include, at a minimum, the following provisions:

1.A school nurse must administer medication(s) to student(s) within the public school setting except as provided in §§ 4.21.4(F), 4.22.1, 4.24.3, 4.24.4, or 4.24.5 of this Part. The school nurse must be licensed in Rhode Island in accordance with the requirements of R.I. Gen. Laws Chapter 5-34. He or she must also be certified in accordance with the provisions of R.I. Gen. Laws § 16-21-8.

a.All medications, including prescription and over-the-counter (OTC), must be administered only in accordance with a written order from a licensed health care prescriber, except as provided in §§ 4.21.4(F), 4.22.1, 4.24.3, 4.24.4, or 4.24.5 of this Part. All medications must be administered in keeping with safe standards of health care practice and in accordance with all applicable State and Federal laws and Regulations.

2.A school nurse or other registered nurse must administer medication to student(s) in a non-public school except as provided in §§ 4.21.4(F), 4.22.1, 4.24.3, 4.24.4, or 4.24.5 of this Part. Such a registered nurse must be licensed in Rhode Island in accordance with the requirements of R.I. Gen. Laws Chapter 5-34.

3.No lay person, other than a parent, may administer medication to a student in the school setting. Exceptions: §§ 4.21.4(F) and 4.22.1 of this Part (related to the administration of epinephrine and glucagon).

4.24.1Provisions Related to Nurse Administration

A.Each dose of medication administered by a school nurse or other registered nurse must be documented. Documentation must include: date, time, dosage, route of administration and the signature of the school nurse or other registered nurse administering the medication or supervising the student in self-administration. In the event a dosage is not administered as ordered, the reason(s) therefore must be noted.

B.All medications to be administered by the school nurse or other registered nurse, as provided in this Part, must be kept in a secured cabinet.

C.A licensed provider's (with prescriptive privileges) order must be obtained and verified by the school nurse or other registered nurse for all medications to be administered by the school nurse or registered nurse, including school physician standing orders. Verbal orders to the nurse and facsimile transmissions may be accepted. Verbal orders must be followed up by a written order from the licensed prescriber within three (3) working days. Upon receipt, the orders must be confirmed with the parent by the nurse.

D.For prescription medications, all parent authorizations and licensed provider’s orders must be renewed no less than annually by the school nurse or other registered nurse.

4.24.2Controlled Substances

Except as provided in § 4.2.5 of this Part, no controlled substance is permitted to be in the possession of or administered by anyone other than a school nurse, other registered nurse, licensed prescriber, or parent of the child for whom the medications have been prescribed. A student may deliver his/her own medication to school in accordance with protocols or procedures developed by the school but may not self-administer the controlled substance while on school property.

4.24.3Self-Carry and Self-Administration of Medication

A.All school districts or school authorities must develop protocols or procedures to permit students to self-carry and/or self-administer prescription medication if the student, parent, school nurse or registered nurse, and licensed prescribing health care provider enter into a written agreement that specifies the conditions under which the prescription medication must be self-carried and/or self-administered. The school principal must be informed of the existence of said agreement.

1.School districts or school authorities may develop protocols or procedures to permit students to self-carry and/or self-administer medication that does not require a licensed prescriber’s note. In developing such protocols or procedures, school districts or school authorities must give consideration to such factors as the age of the child, the duration of the need for the medication, and the ability of the child to self-administer.

B.The protocols or procedures related to student self-administration of medication must include provisions for the following:

1.All medication must be stored in its original prescription or manufacturer-labeled container.

2.For prescription medication, a licensed health care prescriber’s written order is required.

C.A student is prohibited from sharing, transferring, or in any way diverting his/her own medication(s) to any other person.

4.24.4Inhalers

A.Each school district must develop a procedure to allow students to carry and use prescription inhalers while in school or at a school sanctioned function or event, when prescribed by a licensed healthcare provider with prescriptive privileges. Students who carry inhalers must provide the school with medical documentation that the inhaler has been legitimately prescribed and that the child needs to self-carry due to a medical condition. No child shall be disciplined for failure to provide such documentation in advance.

1.No school teacher, school administrator, or school health personnel, or any other school personnel will be liable for civil damages which may result from acts or omissions in the use of prescription inhalers by children which may constitute ordinary negligence. This immunity does not apply to acts or omissions constituting gross negligence or willful or wanton conduct.

4.24.5Medication Administration at Off-site School-sponsored Activities

A.Each school district or non-public school authority must develop a procedure or protocol to allow students to self-carry and self-administer a day’s supply of medication for each day off-site, including a controlled substance, during an off-site school-sponsored activity.

1.The medication must be supplied by the parent with a parent’s written authorization for use of the medication during the off-site school-sponsored activity and must be stored and transported in its original prescription-labeled container (in the case of a prescription medication) or its manufacturer-labeled container (in the case of a non-prescription medication).

2.In the case of a prescription medication, a licensed health care prescriber’s written order must be provided, if it is not already on file in the school.

3.A student is prohibited from sharing, transferring, or in any way diverting his/her own medication(s) to any other person.

Pursuant to Part 30-05-3 of this Title, Immunization and Communicable Disease Testing in Preschool, School, Colleges or Universities, all schools in Rhode Island must adopt, at a minimum, the standards for immunization and communicable disease testing described therein.

A.Pursuant to R.I. Gen. Laws § 16-21-3, the State Building Codes Standards Committee, the State Fire Marshall, the State Health Department, and the Department of Labor and Training, Division of Occupational Safety shall determine whether the school buildings in the several cities and towns or on State property conform to appropriate State and Federal laws and Regulations within their respective jurisdiction.

1.Furthermore, it shall be the responsibility of each local Fire Chief, local Building Inspector, the Director of the State Department of Health, and the Director of the State Labor and Training Department to determine and notify each local school superintendent or non-public school official by August 1 of each year as to whether the public and non-public nursery, elementary and secondary school buildings conform to appropriate State and Federal laws and Regulations within their respective jurisdiction.

2.In the case of those schools on State property, it shall be the responsibility of the State Building Commissioner, the State Fire Marshall, the Director of the State Department of Health, and the Department of Labor and Training to notify the department director responsible for the operation of the school as to whether these schools conform to appropriate State and Federal laws and Regulations.

B.Pursuant to R.I. Gen. Laws § 16-21-3.1, it shall be the responsibility of the school administrator, the non-public school official, in the case of State operated schools, the responsibility of the director of the State operated school, to ensure that schools are not opened until notification is received from the aforementioned agencies that the schools are in compliance with their respective codes.

1.Neglect by any superintendent, non-public school official, or director of any State operated school to comply with the statutory provisions of § 4.26(B) of this Part shall be subject to the sanction as set forth in R.I. Gen. Laws § 16-21-3.1.

4.27.1General Requirements

A.All new construction or the alteration, extension, or modification of an existing building(s) is subject to all applicable Federal, State and local laws, codes, Regulations, and ordinances, including but not limited to the following regulatory provisions enforced by the specific agency:

1.IBC-1 State Building Code, et al, R.I. Gen. Laws Chapter 23-27.3, R.I. State Building Code Standards Committee;

2.The Uniform Federal Accessibility Standards (UFAS) incorporated at § 4.2(L) of this Part and State accessibility for persons with disability standards:

a.R.I. Gen. Laws § 37-8-15, “Access for People with Disabilities”;

b.The Federal Rehabilitation Act of 1973, as amended, (29 U.S.C. § 791 et seq.) § 504, 34 C.F.R. Part 104, Program Accessibility for Persons with Disabilities and the Americans with Disabilities Act of 1990 (42 U.S.C. § 12101 et seq.), 28 C.F.R. Parts 35 and 36, Accessibility for Persons with Disabilities in Public Entities and Public Accommodations;

c.R.I. Gen. Laws § 42-26-13 Open Meetings-Accessibility for Persons with Disabilities; 510-RICR-00-00-17, RISBC-17 Public Meetings Accessibility Standard;

3.Construction, Division of Occupational Safety, Rhode Island Department of Labor and Training, incorporated at § 4.2(I) of this Part;

4.R.I. Gen. Laws § 16-21-5.1, "Carbon monoxide detectors required in school buildings;

5.§ 450-RICR-00-00-7.1.10 of the Fire Safety Code Board of Appeal and Review's Fire Safety Code; and,

6.200-RICR-20-05-4, Rhode Island School Construction Regulations

7.Such other applicable statutory and regulatory provisions.

B.All architectural plans for school construction, renovations, or conversions must be submitted to the appropriate staff at RIDE, the Governor’s Commission on Disabilities, the State Building Commissioner and all other State or local agencies as appropriate prior to construction for review for compliance with all applicable Federal, State and local laws, codes, Regulations and ordinances.

1.All architectural plans for new school construction, submitted for approval must include provisions for a health room that includes, at a minimum, a private toilet, hand washing facilities, a private area for consultation, and a waiting area.

A.All existing structures must comply with all applicable Federal, State and local laws, codes, Regulations, and ordinances including but not limited to the following regulatory requirements enforced by the specified agency:

1.510-RICR-00-00-13, Standards for Existing Schools, through the local building officials or the State Building Commissioner;

2.Where applicable, the Federal and State accessibility for persons with disability standards:

a.R.I. Gen. Laws § 37-8-15, “Access for People with Disabilities”;

b.The Federal Rehabilitation Act of 1973, as amended, (29 U.S.C. § 791 et seq.) § 504, 34 C.F.R. Part 104, Program Accessibility for Persons with Disabilities and the Americans with Disabilities Act of 1990 (42 U.S.C. § 12101 et seq.), C.F.R. Parts 35 and 36, Accessibility for Persons with Disabilities in Public Entities and Public Accommodations;

c.R.I. Gen. Laws § 42-26-13 Open Meetings--Accessibility for Persons with Disabilities; 510-RICR-00-00-17, RISBC-17 Public Meetings Accessibility Standard

3.R.I. Gen. Laws Chapter 23-24.9, "Mercury Reduction and Education Act;"

4.29 C.F.R. Parts 1910 and 1926, Construction, Division of Occupational Safety, R.I. Department of Labor and Training;

5.R.I. Gen. Laws § 16-21-5.1, "Carbon monoxide detectors required in school buildings;

6.R.I. Gen. Laws Chapter 23-28.12 and § 7, Chapters 1 through 8 and Chapters 24 through 43 of 450-RICR-00-00-7, RI Fire Code ; and,

7.Such other applicable statutory or regulatory requirements.

All school buildings are subject to the provisions of R.I. Gen. Laws § 23-25-37 for the notification and application of pesticides.

All school buildings are subject to the provisions of R.I. Gen. Laws Chapter 23-24.5 and Part 50-15-1 of this Title, Asbestos Control.

All schools serving children under the age of six (6) years (e.g., kindergartens, day care sites) are subject to the provisions of R.I. Gen. Laws Chapter 23-24.6 and Part 50-15-3 of this Title, Lead Poisoning Prevention.

All school buildings are subject to the provisions of R.I. Gen. Laws Chapter 23-61 and Part 50-15-2 of this Title, Radon Control.

Any school that utilizes latex gloves must do so in accordance with the provisions of Subchapter 15 Part 3 of this Chapter, Use of Latex Gloves by Health Care Workers, in Licensed Health Care Facilities, and by Other Persons, Firms, or Corporations Licensed or Registered by the Department.

A.Food service in all schools, including food service facilities, must comply with the following statutory and regulatory provisions relating to food protection including, but not limited to:

1.R.I. Gen. Laws Chapter 21-27 and § 23-1-31;

2.Part 50-10-1 of this Title, Rhode Island Food Code;

3.Part 50-10-2 of this Title, Certification of Managers in Food Safety.

B.No less than one (1) person certified as a manager in food safety within each school must be designated as the person in charge to supervise all food preparation personnel to ensure food safety in accordance with Part 50-10-1 of this Title, Rhode Island Food Code.

C.In accordance with Part 50-10-1 of this Title, Rhode Island Food Code, each school serving hot potentially hazardous foods must have a written plan for assessing, monitoring, and controlling foodborne disease hazards within the facility. The plan must include, but not be limited to, monitoring of food temperatures at the shipping and receiving end for satellite feeding operations and a plan for the restriction and exclusion of ill personnel.

A.Schools must have a designated health room(s) to be utilized for health services. The room(s) must be equipped with no less than the following accommodations:

1.Within the health room:

a.Hand washing facilities, including warm (not to exceed one hundred twenty degrees Fahrenheit (120° F) [forty-nine degrees Celsius (49° C)]) and cold running water, soap dispensers and soap (liquid or powdered), and either disposable towels or a heated-air hand drying device;

b.A cot or other suitable area for reclining, with accommodations for privacy;

c.All supplies necessary for the disposal of biohazardous waste, including but not limited to, a sharps container that must be managed in accordance with the requirements of 250-RICR-140-15-1, Rhode Island Department of Environmental Management Medical Waste Regulations;

d.A secure medication storage area, including a locked storage site for controlled substances;

e.A telephone;

2.Either within or adjacent to the health room:

a.A toilet;

b.A secure refrigerator for exclusive use of medications and health supplies (e.g., ice packs);

c.A secure cabinet for medical record storage;

d.An area for students to comfortably await services;

3.Either within or accessible to the health room on the same floor of the building:

a.A private area for consultations that ensures that confidentiality is maintained.

4.The minimum lighting level for the health room must be fifty foot (50’) candles.

A.The premises of each school must include an appropriate number of hand washing facilities, toilets, and drinking fountains for all students and school personnel and must be maintained in a working and sanitary condition as determined by RIDOH and in accordance with the most recent version of the Code of Federal Regulations of the Division of Occupational Safety, R.I. Department of Labor and Training.

1.Hand washing facilities: In addition, hand washing facilities must have cold and warm (not to exceed one hundred twenty degrees Fahrenheit (120° F) [forty-nine degrees Celsius (49° C)]) running water and be stocked at all times with soap dispensers and soap (liquid or powdered) and either disposable towels or a heated-air hand drying device. An adequate number of alcohol-based personal hand washing stations for students and teachers must also be available within school premises in accordance with Executive Order 07-01.

2.Toilets: At a minimum, the following ratios of toilets must be accessible to students:

3.Showers: In those schools where shower facilities are in use, they must be properly cleaned and maintained and supplied with cold and warm (not to exceed one hundred twenty degrees Fahrenheit (120° F) [forty-nine degrees Celsius (49° C)]) running water.

4.All sanitation facilities must be accessible to persons with disabilities in accordance with all applicable local, State and Federal laws and Regulations.

Each school must maintain a comprehensive list of all solutions, compounds and other products used in and around the school for cleaning and maintenance. This list must include, but not be limited to, cleaning products used in all parts of the school, lawn care products used on school campus, and products used to maintain facilities such as swimming pools. The list must be kept in a readily accessible location, such as the school administrative office, be updated regularly and provided to any individual upon request.

Swimming pools are subject to the statutory provisions of R.I. Gen. Laws Chapter 23-22 and any other applicable law relating to Part 50-05-4 of this Title, Licensing Aquatic Venues.

A.Each school building must be furnished with an adequate supply of potable water in accordance with Part 50-05-1 of this Title, Public Drinking Water.

1.Potable water must be supplied to all food service areas, lavatories, janitorial and shower areas.

2.An adequate supply of potable drinking water must be available for consumption through a sufficient number of well-maintained and accessible sources and in accordance with 510-RICR-00-00-3, RISBC-3 Rhode Island Plumbing Code.

B.A community water system must be used as the source of supply where available.

1.Where a community water system is unavailable the water supply system utilized by the school must meet the requirements of R.I. Gen. Laws Chapters 46-13, 23-65, and Part 50-05-6 of this Title, Drinking Water State Revolving Fund.

C.All proposed schools that meet the definition of a public water system pursuant to Part 50-05-1 of this Title, Public Drinking Water, or proposed alterations to existing public water systems in schools must be approved by RIDOH.

School buildings, school campus, and all facilities used by a school, are subject to the provisions of R.I. Gen. Laws Chapters 23-20.9 entitled “Smoking in Schools” and Chapter 23-20.10 the “Public Health and Workplace Safety Act”.

4.40.1Violations and Penalties

In accordance with R.I. Gen. Laws Chapter 23-20.10 if an employer violates the provisions of the statute, civil penalties will be levied in accordance with R.I. Gen. Laws §§ 23-20.10-10 and 23-20.10-14.

4.41.1School Safety Assessments

The school district of each city, town, and regional school department is required to conduct an assessment every three (3) years to examine the safety of each school building in accordance with R.I. Gen Laws § 16-21-23(a).

4.41.2School Safety Teams

The school committee or superintendent of each city, town, and regional school department is required to appoint a school safety team and a school crisis response team in accordance with R.I. Gen. Laws §§ 16-21-23(b) through (c).

4.41.3School Safety Plans

A.In accordance with R.I. Gen. Laws § 16-21-23(b), the school committee of each city, town, and regional school department is required to adopt a comprehensive school safety plan that addresses preparedness, response and recovery and meets the policy and procedure requirements in R.I. Gen. Laws § 16-21-24.

1.The school safety plan must include best practices and relevant provisions of the current State model plan as published by RIDE including:

a.Guidance for communicating threats of violence or harm to the specifically identifiable student(s) and/or school personnel who are the subject of said threats by individuals or groups.

b.Standards for determining those threats of violence or harm that meet the threshold of seriousness and reasonableness so that communication of said threats to specifically identifiable students and/or school personnel is justified;

2.The school safety plan must include written policies for the establishment of threat assessment teams, completion of an emergency action plan and submission of the all hazards site safety survey report in accordance with the requirements of R.I. Gen. Laws § 16-21-23.

3.The school committee is required to review and update the school safety plans by November 1 of each year in accordance with R.I. Gen. Laws § 16-21-25.

4.41.4Statewide Bullying Policy

In accordance with R.I. Gen. Laws §§ 16-21-33 and 16-21-34, any form or degree of bullying at school is prohibited. All school districts, charter schools, career and technical schools, approved private day or residential schools and collaborative schools must adopt a policy pursuant to 200-RICR-30-10-2, Safe School Act – Statewide Bullying Policy and 200-RICR-30-10-1, Regulations Governing Protections for Students Rights to be Free from Discrimination on the Basis of Sex, Gender, Sexual Orientation, Gender Identity or Gender Expression.

A.All schools are required to have policies prohibiting possession of firearms and other weapons and imposing penalties for such possession in conformity with R.I. Gen. Laws § 16-21-18 and the “Gun Free Schools Act,” 20 U.S.C. § 8921 et seq.

1.All school districts must ensure the discipline policies regarding incidents of students in possession of weapons are imposed on a case-by-case basis.

A.All schools are required to have policies regarding possession of alcohol and other drugs and must have on-going prevention activities and programs as supported by the “Safe and Drug-Free Schools and Communities Act,” 20 U.S.C. § 7101 et seq.

1.All school districts must ensure that the discipline policies regarding incidents of students in possession of alcohol or drugs are imposed on a case-by-case basis.

A.All recreation facilities and areas, including gymnasiums, playgrounds, and athletic fields must be maintained and operated in a safe manner, including, at a minimum, the following provisions:

1.Playground surfaces and equipment must demonstrate compliance with all applicable guidelines of the most recent version of the Handbook for Public Playground Safety issued by the U.S. Consumer Products Safety Commission incorporated at § 4.2(B) of this Part.

B.In accordance with 36 C.F.R. Part 1191, recreational facilities, athletic fields and playgrounds must be accessible to persons with disabilities.

C.Adequate, convenient, and well-maintained changing areas and facilities must be provided for secondary school students, as needed.

A.Each school is required to develop written procedures or protocols to reduce the risk of motor vehicle injuries and exposure to motor vehicle exhaust fumes among students. These procedures must be reviewed annually by school representatives and local police authorities and must address no less than the following issues:

1.Arrival and departure areas for busses, private automobiles, bicyclists, and pedestrians;

2.Parking and idling locations for motor vehicles, including busses;

3.Signage and crosswalks;

4.Traffic flow on and adjacent to school campus; and,

5.Emergency procedures.

Each public school and district is subject to the provisions of R.I. Gen. Laws Chapter 16-7.1, requiring all public schools and districts to provide an annual asset protection plan to the Commissioner of RIDE.

A.Pursuant to the provisions of R.I. Gen. Laws § 16-5-30, the Commissioner of RIDE may for violation or neglect of law or for violation or neglect of Rules and Regulations in pursuance of law by any city or town or city or town officer or school committee, order the General Treasurer to withhold the payment of any portion of the public money that has been or may be apportioned to the city or town.

B.The General Treasurer upon the receipt in writing of the order shall hold the public money due the city or town until such time as the Commissioner by writing requests the withheld funds for the purposes of eliminating the violation or neglect of law or Regulation that caused the order to be issued, or the Commissioner of RIDE shall notify the Treasurer that the city or town has complied with the order as the Department shall make in the premises, in which case payment shall be made to the town forthwith.

C.The Council on Elementary and Secondary Education shall report to the General Assembly annually all infractions of school law which shall be brought to its attention, with a record of such action as the Department shall have taken in each instance.

A.Special purpose areas of school facilities that must include, but not be limited to, the cafeteria, home economics laboratory, industrial arts and vocational laboratories, art rooms, and science laboratories must be in compliance with the following provisions:

1.Rhode Island Department of Labor and Training "OSHA Regulations 1910" Occupational Safety and Health Standards, as filed with the Secretary of State pursuant to R.I. Gen. Laws Chapter 28-20;

2.29 C.F.R. Part 1200, General Industry Standards 1910. Hazardous Communication that requires employers to maintain in the workplace copies of the required material safety data sheets for each hazardous chemical, and must ensure that they are readily accessible during each work shift to employees when they are in their work area(s), and to provide training in accordance with State and Federal Regulations.

3.Rhode Island Department of Labor and Training "OSHA Regulations 1926": Safety and Health Regulations for Construction, as filed with the Secretary of State pursuant to R.I. Gen. Laws Chapter 28-20;

4.R.I. Gen. Laws § 16-7-24, entitled “Minimum Appropriation by a Community for Approved School Expenses”;

5.Rhode Island Council on Elementary and Secondary Education’s Basic Education Program (BEP) 200-RICR-20-10-1.

4.48.1Chemical Hygiene Plan

A.For the purposes of this Part, the protective measures required for employees pursuant to 29 C.F.R. Part 1450, as incorporated by reference in § 4.2(A) of this Part, must extend to students.

B.Any school engaged in the laboratory use of hazardous chemicals as defined in this Part must develop and implement a written chemical hygiene plan that sets forth procedures, equipment, personal protective equipment, and work practices that are capable of protecting employees and students from the health hazards presented by hazardous chemicals used in that particular school setting in accordance with the requirements of 29 C.F.R. Part 1450, as incorporated by reference in § 4.2(A) of this Part. Said plan must also include a section regarding the purchase, storage, and disposal of potentially hazardous chemicals and the training of staff and students on their use.

C.School personnel (e.g., art teachers, shop teachers, classroom teachers, maintenance staff) must ensure compliance with 29 C.F.R. Part 1200, as incorporated by reference in § 4.2(A) of this Part, for those areas under their control or supervision. Safety data sheets for all chemicals stored, handled or used in those areas must be reviewed with the school’s chemical hygiene officer to ensure that the chemicals are appropriately managed in accordance with school’s chemical hygiene plan.

D.The written chemical hygiene plan required by this Part must include a prohibition on the use of the chemicals listed below.

1.State-approved career and technical education programs, as governed by 200-RICR-20-10-3, Regulations Governing Career and Technical Education in Rhode Island, shall be exempt from the chemical prohibition of § 4.2(A) of this Part, but must maintain a safe and healthy environment where risks are minimized through education, training, administrative and engineering controls, personal protective equipment, proper work practices, and the use of the safest available materials and products, in accordance with current occupational and environmental standards and Regulations.

‎