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.

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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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