School Administrator's Responsibility
- Ensure all eligible students are provided Home & Hospital services.
- Provide parent/guardian the following forms for completion:
- Health Professional's Statement of Needs (Dr.'s Note)
- Registration Form
- Disclosure Statement (Short-term Disclosure Statement if the student will be out 45 days or less, Long-term Disclosure Statement if the student will be out 46 days or more)
- Determine the length of Home & Hospital services (short-term/long-term) with consideration of the Health Professional's Statement of Needs.
- Short-term Home & Hospital instruction (Absent 10 to 45 days) will be serviced from the school the student is currently attending.
- Long-term Home & Hospital instruction (Absent 46 days or longer) may be provided by the school or referred to the District Home & Hospital administrator, at 801-567-8187.
- Students with an IEP; refer to Special Education.
- Make teaching assignments on the basis of teacher interest, availability and curriculum qualifications.
- Teachers shall be reimbursed for providing Home & Hospital instruction at their current hourly base rate.
- Teachers are accountable to provide Utah State Core curriculum educational services.
- May arrange for a Home & Hospital teacher from another school or may call the District Home & Hospital administrator for assistance at 801-567-8187 when a Home & Hospital teacher is not available.
- Meet with the assigned teacher to explain the Home & Hospital procedures to provide the necessary documentation and answer questions.
- Review forms with assigned teacher. Forms must be submitted to the school administrator monthly for signatures and submitted to Student Support Services for reimbursement.
- Registration Form for Home & Hospital Instruction, the Health Professional's Statement of Needs and the Short or Long-term Home and Hospital Instruction Disclosure Statement are to be submitted to the Student Support Department, at the District Office
- Monthly Teaching Record – The teacher records weekly visits to students including time with the student, prep time, mileage, and any comments. This record must include original signatures, including a parent's, preferably in blue ink. One half-hour of prep time is allowed for every 2 hours of actual instruction. Submit to Student Support Services by the 2nd business day of the month.
- Time Sheet - District time sheet is to be submitted monthly – be sure to correspond the name of the student served with time charged. Please include prep time and actual teaching time. Please fill out Home Base School and Distribution number: 10 E (XXX your school location number) 9410 1015 131. Submit to Payroll by 2nd business day of the month. Please use the online fillable form.
- Mileage Form – Home & Hospital teachers will receive mileage reimbursement at the current district rate. The District Mileage Report is to be submitted monthly for each student on the program. Be sure to list the student's name and address. Mileage should be verified by a school secretary and the form signed by the teacher and administrator. Please fill in the vendor key (skyward login) and mileage codes: 10 E (XXX school location code) 9410 1090 581. Mileage is based upon distance from school to student’s home or other designated public location (e.g. library, police station, fire station, etc.) to the teacher’s home and also between students' homes if applicable.
- Please use the online fillable form. The rate per mile changes every January, thus using the online forms every month ensures the use of the most current form. Submit to Student Support Services by the 2nd business day of the month.
Residents of another school district in the state may be provided services to hospitalized students between the ages of six and eighteen when:
- The district of residence agrees to pay the costs of Home & Hospital services.
- Written approval has been sent from the district of residence.
A principal shall forward referrals to the Home & Hospital Department at the District Office for students with unusual health problems, which will seriously interfere with their education. This could include frequent absences (part or whole-day), district-imposed absences, or a recommendation from the local school with an appropriate referral.
- Home & Hospital Administrator Checklist
- Health Professional's Statement of Needs
Physician, Psychologist, or Licensed Clinical Social Worker verification stating the reason(s) for Home & Hospital services and the length of time recommended.
- Home & Hospital Registration Form
Parent/guardian and current school administrator complete the Home & Hospital Registration Form.
- Short Term Home & Hospital Disclosure
Parent/guardian and current school administrator complete the form.
- Short Term Disclosure Statement Spanish
- Padre / tutor y administrador actual de la escuela complete.
- Long Term Home & Hospital Disclosure
- Parent/guardian and current school administrator complete the form.
- Long Term Disclosure Statement Spanish
Padre / tutor y administrador actual de la escuela complete.