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  • Protocols

    Each Specialized Physical Healthcare Service (SPHCS) or protocol has a specific authorization form posted under the protocol guidelines.

     

 
A. Specialized Health Care Services:
   (1)  Form 2023/2024
         Form 2024/2025
   (2)  Guidelines
 
 
 
 
E. For a protocol or SPHCS that is not listed on the standardized specialized physical health care services, please download the Generic Authorization Form (English)
 
 
 
 
        Assistive Personnel
  1. DNS Training Logs are submitted at: Submit Training Logs
  2. All submitted training logs (Student Specific, General, and Supervisor Checklist) are housed on SharePoint: Access Submitted Training Logs

JOB AID: Downloading Training Records from SharePoint

Student Specific Training Log

Contact your Nursing Coordinator if:

  • You can’t access the Training Log SharePoint Link

  • A training log needs to be marked as an error (provide explanation)

K.   Review of Support Services Due to Health Needs - Complete for Student with Protocol Before the IEP Meeting
 

 

Guidelines

Solu-Cortef Protocol Guidelines (1/2024)

 

Authorization Form for Emergency Medication for Adrenal Insufficiency and Student Emergency Care Plan

English

Spanish

 

Related Forms and Information:

Solu-Cortef Checklist (1/2024)

 

 

 
Protocols Guidelines: 
 
 
 
                       Attachment B - Anaphylaxis Guidelines
                       Attachment C - Letter Template
                       Attachment D - Special Diet Form.
                       *****For the most recent version of the Special Diet form, click here.
 
 
 
Authorization Form:English/Spanish (2/2023)
 
 
 
 
a. Clean Catheterization Guidelines (3/2019)
   Authorization Form for Clean Catheterization (2/2023): English/Spanish
 
    Authorization Form for Clean Self-Catheterization with Assistance (2/2023) English/Spanish
 
 c. Clean Self-Catheterization Guidelines (3/2019)
   Authorization Form for Clean Self-Catherization (2/2023) English/Spanish
  
d. Sterile Catheterization Guidelines (3/2019)
   Authorization Form for Sterile Catheterization (2/2023) English/Spanish
 
e. Training Videos Link
  1. MALE CATHETERIZATION
  2. FEMALE CATHETERIZATION
 
Guidelines:
 
2. Baqsimi(Glucagon Nasal Spray/Severe Hypoglycemia) (12/2021)
3. Glucagon Injection(Severe Hypoglycemia) (3/2019)
    Glucagon Training Video
 
 
 
Authorization Forms:
 
 
 
Other Related Forms and Information:
c.  Diabetes Protocol Log, 4/2024 

For LAUSD Food Services Web Page for Menu click here; for carbohydrate count click here.

 

 

 Epinephrine for Schools Resource Page

Gastrostomy
 
    Authorization Form (2/2023): English/Spanish
 
    Authorization Form (2/2023): English/Spanish
 
    Authorization Form (2/2023): English/Spanish
 
d. Training Videos Link
  1. GASTROSTOMY TUBE FEEDING BOLUS METHOD
  2. GASTROSTOMY TUBE REPLACEMENT
 
 
Jejunostomy
 
 Authorization Form (3/2023): English/Spanish
 
 
Protocol Related Form:  Special Diet Form
 
 
 
 

 

LifeVac Protocol, March 2023

Authorization Form: EMERGENCY TREATMENT OF CHOKING LIFEVAC® DEVICE

 

 

 
Mechanical Nebulizer Guidelines (3/2019)
 
Authorization Form with the Parent Section (2/2023): English/Spanish
 
 
 
Mechanical Ventilation Guidelines (3/2019)
 Authorization Form for Mechanical Ventilation (2/2023): English/Spanish
 
Other Related Forms/Information 
 
 

 

Ostomy Care (3/2019)

Authorization Form (2/2023): English/Spanish
 
 
 

Oxygen Therapy  - Guidelines (3/2019)

Pulse Oximetry - Guidelines (1/2024)

 
Authorization Form for Pulse Oximetry and/or Oxygen (1/2024): 

 

 
 

 

Pulse Oximetry - Guidelines (1/2024)

Oxygen Therapy  - Guidelines (3/2019)

 
Authorization Form for Pulse Oximetry and/or Oxygen (1/2024): 

 

 
Protocols:

    Authorization Form: English/Spanish
 
2. Diastat - Diastat Guidelines  (3/2019)
     Authorization Form (3/2023): English/Spanish
 
3. Vagus Nerve Stimulation (VNS) - VNS Guidelines (3/2019)
    Authorization Form (3/2023): English/Spanish
       
Related Forms and Information
      b. Seizure Action PlanEnglish/Spanish
      c. Seizure Record
      d. Parent Questionnaire for Students with Seizures: English/Spanish | English/Korean
Protocols 
   1. Oral Nasal Suctioning (3/2019)
       Authorization Form for Oral/Nasal Suctioning (3/2023): English/Spanish
 
      Authorization Form: (3/2023): English/Spanish
 
   3. Tracheostomy Suctioning(3/2019)
      Authorization Form: (3/2023): English/Spanish
 
      Authorization Form (3/2023): English/Spanish
 
Training Videos Link and Related Forms:
  1. ORAL NASAL SUCTIONING
  2. TRACHEOSTOMY SUCTIONING
  3. TRACHEOSTOMY TUBE REPLACEMENT
  4. DAILY SUCTIONING CHECKLIST
  5. CAREPLAN: STUDENT WITH TRACHEOSTOMY
 
 
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    Contact Info

    121 N. Beaudry Ave.,
    Los Angeles, CA 90012 
    P: (213) 202-7580
    F: (213) 580-6557
    E: DistrictNursing@lausd.net

    Director:
    Sosse Bedrossian, MSN, MA, RN, FNP-C

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