DEPARTMENT OF EDUCATION
Office of the Secretary
FINAL
ORDER
815 Health Examinations and Screening
I. SUMMARY OF THE EVIDENCE AND INFORMATION SUBMITTED
Pursuant to 14 Del.C. §§122(b)(2) and 406A, the Delaware Department of Education ("Department") developed amendments to 14 DE Admin. Code 815 Health Examinations and Screening. The regulation sets forth the requirements for health examinations and screenings for students seeking to enroll or enrolled in Delaware public schools. The proposed amendments include adding a definition of oral health screening to Section 2.0 and adding subsection 4.4, which concerns oral health screenings. The proposed amendments are consistent with H.S. 1 for H.B. 83 of the 152nd General Assembly, which was signed into law on August 3, 2023 and effective for the 2024-2025 school year. In addition, the proposed amendments include adding Section 1.0, which specifies the statutory authority for and content of the regulation; revising Section 2.0; and clarifying subsection 4.3, which concerns lead screenings; and striking requirements that pertained to the 2021-2022 school year.
Notice of the proposed regulation was published in the Delaware Register of Regulations on June 1, 2024. No written comments were received for this regulation.
II. FINDINGS OF FACTS
The Secretary finds that it is appropriate to amend 14 DE Admin. Code 815 Health Examinations and Screening to set forth the requirements for health examinations and screenings for students seeking to enroll or enrolled in Delaware public schools. The proposed amendments include adding a definition of oral health screening to Section 2.0 and adding subsection 4.4, which concerns oral health screenings. The proposed amendments are consistent with H.S. 1 for H.B. 83 of the 152nd General Assembly, which was signed into law on August 3, 2023 and effective for the 2024-2025 school year. In addition, the proposed amendments include adding Section 1.0, which specifies the statutory authority for and content of the regulation; revising Section 2.0; and clarifying subsection 4.3, which concerns lead screenings; and striking requirements that pertained to the 2021-2022 school year.
III. ASSESSMENT OF IMPACT
Pursuant to 29 Del. C. §10118(b)(3) this regulation has no impact on the achievement of the State's greenhouse gas emissions reduction targets or the State's resiliency to climate change. Such assessment is not practical for this regulation.
IV. DECISION TO AMEND THE REGULATION
For the foregoing reasons, the Secretary concludes that it is appropriate to amend 14 DE Admin. Code 815 Health Examinations and Screening. Therefore, pursuant to 14 Del.C. §122, 14 DE Admin. 815 Health Examinations and Screening attached hereto as Exhibit "A" is hereby amended.
V. TEXT AND CITATION
The text of 14 DE Admin. Code 815 Health Examinations and Screening amended hereby shall be in the form attached hereto as Exhibit "A", and said regulation shall be cited as 14 DE Admin. 815 Health Examinations and Screening in the Administrative Code of Regulations for the Department of Education.
VI. EFFECTIVE DATE OF ORDER
The actions hereinabove referred to were taken by the Secretary pursuant to 14 Del.C. §122 on July 8, 2024. The effective date of this Order shall be ten (10) days from the date this Order is published in the Delaware Register of Regulations.
IT IS SO ORDERED the 1st day of August 2024.
Department of Education
Mark A. Holodick, Ed.D., Secretary of Education
Approved this 1st day of August 2024.
815 Health Examinations and Screening
Pursuant to 14 Del.C. §§122(b)(2) and 406A, this regulation sets forth the health examination and screening requirements for students seeking to enroll or enrolled in Delaware public schools.
The following words and terms, when used in this regulation, have the following meaning unless the context clearly indicates otherwise:
"Delaware School Health Examination Form" means the age-appropriate form developed by the Delaware Department of Education or a substantially similar form for documenting information from the parent, guardian or relative caregiver, and healthcare provider on the student's health status.
"Delaware Interscholastic Athletic Association (DIAA) Pre-Participation Physical Evaluation Form" means the form approved by the DIAA.
“Health Examination examination” means the medical examination done by a Healthcare Provider healthcare provider to determine health status and conditions.
"Healthcare Provider provider" means a currently licensed physician, advanced practice nurse, nurse practitioner, or physician's assistant.
“Lead Screening screening” means a capillary blood lead test, including where a drop of blood is taken from a finger or heel of the foot (16 Del.C. Ch. 26 §2601(b)(5)).
"Local Education Agency" or "LEA" means a public board of education or other public authority legally constituted within Delaware for either administrative control or direction of, or to perform a service function for, public elementary or secondary schools in a school district, or for a combination of school districts. The term includes an educational service agency and any other public institution or agency having administrative control and direction of a public elementary school or secondary school.
"Oral health screening" means the screening done by a dental hygienist or dentist coordinated with the school by the Bureau of Oral Health and Dental Services.
“School Enterer enterer” means any child between birth and twenty (20) 20 years inclusive enrolling and attending a Delaware public school district or public school for the first time, including but not limited to, foreign exchange students, immigrants, students from other states or territories, and children entering from non-public schools.
“Screenings” “Screening” or “screenings” means the vision, hearing, and postural gait screening gait, lead, and oral health screenings performed by the school nurse or other qualified healthcare professional, as provided in this regulation.
2.1 3.1 All public school students shall have two (2) 2 health examinations, as provided in this section, that have been administered by a healthcare provider.
2.1.1 3.1.1 The first health examination shall have been done within the two (2) 2 years prior to enrollment into a Delaware public school.
2.1.1.1 Within thirty (30) 30 calendar days after enrollment, any public school student who has not complied with the health examination requirement shall have received the health examination or shall have a documented appointment with a healthcare provider for the health examination. If this documentation is not provided within this thirty (30) 30 calendar days, the student shall be excluded from school until this documentation is received.
2.1.2 3.1.2 The second required health examination shall be done within the two (2) 2 years prior to entry into grade 9.
2.1.2.1 Within thirty (30) 30 calendar days after entry, any grade 9 student who has not complied with the second health examination requirement shall have received the health examination or shall have a documented appointment with a healthcare provider for the health examination. If this documentation is not provided within these thirty (30) 30 calendar days, the student shall be excluded from school until this documentation is received.
2.1.3 3.1.3 Notwithstanding subsections 2.1.1.1 and 2.1.2.1 3.1.1 and 3.1.2, all students must meet the requirements under 14 DE Admin. Code 804 Immunizations.
2.1.4 3.1.4 The requirement for the health examination may be waived for students whose parent, guardian or relative caregiver as defined in 14 Del.C. §202(f), or the student if 18 years or older, or an unaccompanied homeless youth (as defined by 42 USC §11434a) presents a written declaration acknowledged before a notary public, that because of individual religious beliefs, they reject the concept of health examinations.
2.1.5 3.1.5 Notwithstanding the above, a second health examination shall not be required if the first health examination is within two (2) 2 years of entering Grade grade 9.
2.1.6 3.1.6 The Delaware School Health Examination Form or the DIAA Delaware Interscholastic Athletic Association Pre-Participation Physical Evaluation Form may be used as documentation of the health examination. For the purpose of this regulation, the "Delaware School Health Examination Form" means the age-appropriate form developed by the Delaware Department of Education or a substantially similar form for documenting information from the parent, guardian or relative caregiver, and healthcare provider on the student's health status. In addition, a district or charter school may accept a health examination or evaluation documentation on a form which includes, at a minimum, health history, immunizations, results of medical tests and screenings, medical diagnoses, prescribed medications and treatments, and healthcare plans.
2.1.7 3.1.7 The school nurse shall record all findings within the student’s electronic health record (see 14 DE Admin. Code 811) and maintain the original copy in the child’s medical file.
Non regulatory note: See 14 DE Admin. Code 1008.3 and 14 DE Admin. Code 1009.3 1034 DIAA Health and Safety Requirements for physical or health examination requirements associated with participation in interscholastic sports.
3.1 4.1 Vision and Hearing Screening
3.1.1 4.1.1 Each public school student in kindergarten and in grades 2, 4, 7 and grades 9 or 10 shall receive both a vision screening and a hearing screening by January 15th of each school year. For the 2021-2022 school year only, the required screenings shall be completed by April 15, 2022 and not required to be completed by January 15, 2022.
3.1.1.1 4.1.1.1 In addition to the screening requirements in subsection 3.1.1 4.1.1, screening shall also be provided to school enterers, students referred by a teacher or an administrator, and students considered for special education.
3.1.1.1.1 4.1.1.2 Driver education students shall have a vision screening within one (1) 1 year of their in-car driving hours.
3.1.2 4.1.2 The school nurse shall record the results of the vision and hearing screenings within the student’s electronic health record (see 14 DE Admin. Code 811) and shall notify the parent, guardian or relative caregiver as defined in 14 Del.C. §202(f), or the student if 18 years or older, or an unaccompanied homeless youth (as defined by 42 USC §11434a) if the student has a suspected problem.
3.2 4.2 Postural and Gait Screening
3.2.1 4.2.1 Each public school student in grades 5 through 9 shall receive a postural and gait screening by December 15th of each school year. For the 2021-2022 school year only, the required screening shall be completed by February 15, 2022 and not required to be completed by December 15, 2021.
3.2.2 4.2.2 The school nurse shall record the findings of the postural and gait screening within the student’s electronic health record (see 14 DE Admin. Code 811) and shall notify the parents, guardian or relative caregiver as defined in 14 Del.C. §202(f), or the student if 18 years or older, or an unaccompanied homeless youth (as defined by 42 USC §11434a) if a suspected deviation has been detected.
3.2.2.1 If a suspected deviation is detected, the school nurse shall refer the student for further evaluation through an on-site follow up evaluation or a referral to the student’s healthcare provider.
3.3 4.3 Lead Screening
3.3.1 4.3.1 School enterers at kindergarten or at age 5 or prior, shall be required to provide documentation of lead screening as per 16 Del.C. Ch. 26 §2603.
3.3.1.1 For school enterers in kindergarten, documentation of lead screening shall be provided within sixty (60) Except in the case of enrollment in kindergarten, the screen may be done 60 calendar days of the date of enrollment. Failure to provide the required documentation shall result in the child's exclusion from school until the documentation is provided.
3.3.1.2 Exemption from this requirement may be granted for religious exemptions, per 16 Del.C. §2603.
3.3.1.3 The Childhood Lead Poisoning Prevention Act, 16 Del.C. Ch. 26, requires all healthcare providers to order lead screening for children at or around the age of 12 months.
3.3.1.4 For school year 2021-2022, children entering first grade, who did not provide documentation of the results of lead screening when enrolling in kindergarten for the 2020-2021 school year, shall provide such documentation within sixty (60) calendar days of the date of the beginning of the 2021-2022 school year. Failure to provide the required documentation shall result in the child’s exclusion from school until documentation is provided.
3.3.2 4.3.2 The school nurse shall document the lead screening within the student’s electronic health record. See 14 DE Admin. Code 811.
Non-regulatory note: The Childhood Lead Poisoning Prevention Act, 16 Del.C. Ch. 26, requires healthcare providers to order lead screening for children at or around 12 and 24 months of age. A child is not required to undergo the screening if the child's parent or guardian objects on the grounds that the screening conflicts with the parent's or guardian's religious beliefs. 16 Del.C. §2602(e).
4.4 Oral Health Screening
4.4.1 Beginning with the 2024-2025 school year, and for each school year thereafter subject to 14 Del.C. §4123(f), each school, through the Bureau of Oral Health and Dental Services shall provide an oral health screening to each student enrolled in kindergarten by the last student attendance day of the school year.
4.4.2 The school shall record the results of the oral health screening within the student's electronic health record.
4.4.3 If a student fails the oral health screening, the school shall notify the student's parent, guardian, or relative caregiver.
Non-regulatory note: Pursuant to 14 Del.C. §4123(e), the Bureau of Oral Health and Dental Services is required to inform a parent or guardian of each student's oral health status by sending home, with the student, a copy of the dental screening results and to refer students who need a dental referral or restorative care to a dentist.
If the student is at risk of exclusion because of not meeting the health examinations or immunization documentation requirements, the school nurse may contact the previous Delaware public school nurse to obtain health examinations and immunization records.
5.1 6.1 School districts and charter schools shall ensure that policies concerning immunization, guardianship and birth certificates do not create barriers to the school enrollment and participation of identified special populations.
6.2 Special consideration should be given to the following populations:
5.1.1 6.2.1 Homeless Children and Youth - The federal McKinney-Vento Homeless Assistance Act, 42 USC §11301 et seq., requires immediate enrollment and entry to school, even if students are unable to produce immunization or other medical records. The Delaware public school nurse and the LEA Homeless Education Liaison at the enrolling school shall work together to obtain the necessary immunization records as soon as possible. If a student has not had immunizations, the school nurse and LEA Homeless Education Liaison shall assist homeless children and youth in meeting the immunization requirements.
5.1.2 6.2.2 Youth in Foster Care – The federal Elementary and Secondary Education Act of 1965, Section 1111(g)(1)(E) requires that when a determination is made that it is not the best interest of a youth in foster care to remain in the school of origin, the child is immediately enrolled in a new school, even if the child is unable to produce records normally required for enrollment. The enrolling school shall immediately contact the school last attended by any such child to obtain relevant academic and other records. The school nurse and LEA foster care liaison at the enrolling school shall work together to obtain the necessary immunization records as soon as possible.
5.1.3 6.2.3 Military-Connected Youth - In accordance with the provisions of 14 Del.C. Ch. 1, Subchapter III-A Interstate Compact on Education For Children of Military Families (MIC3) and its enabling regulation, a school enterer or secondary school student who is subject to MIC3 shall be allowed thirty (30) 30 calendar days from the date of enrollment or within such time as is reasonably determined under the rules promulgated by the Interstate Commission, to obtain or to initiate a series of immunizations required by this regulation. The Delaware public school nurse of the enrolling school shall work with the parent or guardian of the school enterer to obtain the necessary immunization records as soon as possible.
