Student Health (Home and Hospital)

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Home & Hospital Flow Chart


Parent makes request for Home/Hospital Services because the student has a condition that warrants being confined from school for a minimum of 10 consecutive days.

HOME/HOSPITAL APPLICATION (to be completed by parent/guardian)

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Completed application is returned to student's school.
School shall scan and send a copy to the school nurse.

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Nurse will contact doctor to complete the PHYSICIAN STATEMENT OF NEED form.

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Nurse will contact district administrator with acquired information.

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District administrator will contact site based Home & Hospital Coordinator with recommendation of approval or denial of Home & Hospital request.

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If student is eligible for Home & Hospital services, the team completes H&H school plan and parent/guardian assurances form.

  • Educator/s complete Home and Hospital Service Log While providing services and submits to district office monthly.

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If student is NOT eligible for Home & Hospital services, the team provides written notice of denial along with grievance procedures.

Home and Hospital Forms


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