"Health Care Consultant Agreement Template" - Massachusetts

This Massachusetts-specific "Health Care Consultant Agreement Template" is a document released by the Massachusetts Department of Early Education and Care.

Download the fillable PDF by clicking the link below and use it according to the applicable legal guidelines.

Download "Health Care Consultant Agreement Template" - Massachusetts

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"Health Care Consultant Agreement Template" - Massachusetts

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"Health Care Consultant Agreement Template" - Massachusetts, Page 2

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THE COMMONWEALTH OF MASSACHUSETTS

Department of Early Education and Care

Health Care Consultant Agreement

Name of Program: ______________________________________________________

Address of Program: _____________________________________________________

The Department of Early Education and Care Standards for the Licensure or Approval

of Large Group and School Age Child Care Programs, 606 CMR 7.11(19)(b) require

that each licensee designate a Massachusetts licensed physician, registered nurse,

nurse practitioner or physician’s assistant with pediatric or family health training and/or

experience. In accordance with the regulations, the Health Care Consultant shall

approve the program’s health care policy initially and at least upon renewal of the

regular license, shall approve changes in the health care policy, shall approve first aid

training and training in medication administration for staff and shall be available for

consultation as needed.

Regulation 7.11(19)(a) require that the Health Care Policy include:

1. The name, address and telephone number of the health care consultant and local

health care authority; the telephone number of the fire department, police,

ambulance, nearest health care facility, and the Poison Control Center; the name

and telephone number of the emergency back-up person, if applicable; and the

telephone and address of the program, including where applicable, the location of

the program in the facility;

2. The procedures to be followed in case of illness, injury or emergency, method of

transportation, notification of parents, and procedures where parent(s) cannot be

reached including procedures to be followed when on field trips;

3. A list defining mild symptoms which ill children may remain in care, and more

severe symptoms that require notification of the parents or back-up contact to pick

up the child;

4. A plan for caring for mildly ill children who remain in care;

5. A plan for administering medication, including:

a. Annual evaluation of the ability of any staff authorized to administer medication

to follow the medication administration procedures specified at 606 CMR

7.11(2), and above;

b. A requirement that parents provide written authorization by a licensed health

care practitioner for administration of any non-topical, non-prescription

medication to their child. Such authorization shall be valid for one year unless

earlier revoked;

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LG/SAHealthCareConsultant20100122

THE COMMONWEALTH OF MASSACHUSETTS

Department of Early Education and Care

Health Care Consultant Agreement

Name of Program: ______________________________________________________

Address of Program: _____________________________________________________

The Department of Early Education and Care Standards for the Licensure or Approval

of Large Group and School Age Child Care Programs, 606 CMR 7.11(19)(b) require

that each licensee designate a Massachusetts licensed physician, registered nurse,

nurse practitioner or physician’s assistant with pediatric or family health training and/or

experience. In accordance with the regulations, the Health Care Consultant shall

approve the program’s health care policy initially and at least upon renewal of the

regular license, shall approve changes in the health care policy, shall approve first aid

training and training in medication administration for staff and shall be available for

consultation as needed.

Regulation 7.11(19)(a) require that the Health Care Policy include:

1. The name, address and telephone number of the health care consultant and local

health care authority; the telephone number of the fire department, police,

ambulance, nearest health care facility, and the Poison Control Center; the name

and telephone number of the emergency back-up person, if applicable; and the

telephone and address of the program, including where applicable, the location of

the program in the facility;

2. The procedures to be followed in case of illness, injury or emergency, method of

transportation, notification of parents, and procedures where parent(s) cannot be

reached including procedures to be followed when on field trips;

3. A list defining mild symptoms which ill children may remain in care, and more

severe symptoms that require notification of the parents or back-up contact to pick

up the child;

4. A plan for caring for mildly ill children who remain in care;

5. A plan for administering medication, including:

a. Annual evaluation of the ability of any staff authorized to administer medication

to follow the medication administration procedures specified at 606 CMR

7.11(2), and above;

b. A requirement that parents provide written authorization by a licensed health

care practitioner for administration of any non-topical, non-prescription

medication to their child. Such authorization shall be valid for one year unless

earlier revoked;

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LG/SAHealthCareConsultant20100122

6. A plan for meeting individual children’s specific health care needs, including the

procedure for identifying children with allergies and protecting children from that to

which they are allergic;

7. A plan to allow parents, with the written permission of the child’s health care

practitioner, to train staff in implementation of their child’s individual health care

plan;

8. A plan to ensure that all appropriate specific measures will be taken to ensure that

the health requirements of children with disabilities are met, when children with

disabilities are enrolled;

9. A plan to ensure that all children twelve months of age or younger are placed on

their backs for sleeping, unless the child’s health care professional orders

otherwise in writing;

10. Notification to parents that educators are mandated reporters and must, by law,

report suspected child abuse or neglect to the Department of Children and

Families.

I certify by my signature below that I meet the requirements of the health care

consultant as described above. I have reviewed and understand the regulations

referenced above and have agreed to assist this program regarding the same.

Health Care Consultant___________________________________________________

Title____________________________ Telephone____________________________

MA Certification/Registration Number________________________________________

Expiration Date of MA Certification__________________________________________

Signature_____________________________________________________________

Date of Agreement______________________________________________________

Please refer to A Guide to Developing Sample Health Care Policies for Assistance

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LG/SAHealthCareConsultant20100122

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