Introduction

There are many state and federal regulations, statutes, and administrative codes that govern schools in the USA. Many of these regulations affect only schools who receive federal funding. However, some regulations and rules affect all public, charter, private, and even home schools.

Licensure and Competencies for School Health Professionals

In New Mexico, public and charter schools are regulated by the New Mexico Public Education Department (NMPED). Licensure issued by the NMPED is required for all individuals working in public schools and public charter schools. This state statute was established in the 1960s to protect and standardize requirements for school staff. Licensure is determined by educational background and by the position applied for. All PED licensure now requires a background check, which is the responsibility of the applicant.

For more information, see NMSA § 22-10A-5.

New Mexico Administrative Codes are rules written, or promulgated, after a statute has passed both the State Senate and the House of Representatives and has been signed by the governor. The rule outlines how the statute will be carried out. Usually, the division of government responsible for overseeing the statute writes and updates the rules, also known as New Mexico Administrative Code (NMAC). The process of rule-making is difficult and highly regulated. Listed below are rules that affect school personnel and school services.

New Mexico Nurse Licensure

The current NMAC for school nursing establishes the requirement for three types of school nurse licenses. An associate school nurse license is issued to a nurse who has an associate's degree in nursing from a regionally accredited college, university, or diploma program accredited by the National League of Nursing. A professional nurse Level Two licensure is issued to a nurse with a bachelor’s degree in nursing or related health field from a regionally accredited college, university, or institution accredited by the National League of Nursing. A supervisory school nurse NM Level Three licensure is issued to a nurse with a master’s degree in nursing or a health-related field from a regionally accredited college, university, or institution accredited by the National League of Nursing.

For more information, see NMSA § 61-3.

Other Licensure Resources

• NMAC § 16.12.2 — Nursing Licensure
• NMAC § 6.68 — School Personnel: Denial, Suspension, and Revocation of License
• NMPED School Nurse Licensure Requirements
• NMPED Licensed Practical Nurse Licensure Requirements
• NMPED Health Assistant Licensure Requirements

School Nurse Evaluation Tools

School Nurse Evaluation Tools are required to be used to evaluate school nurses. These tools are in Chapter 1 of this Manual.

School Health Program

New Mexico School Health Program

School health programs provide opportunities for all students to develop healthy behaviors. Districts and charter schools shall provide or make provisions for school health programs that address the health needs of students and staff. Districts and charter schools shall provide the following programs: health education, physical education, health services and school counseling. Additional programs may include: nutrition, staff wellness, family-school-community partnerships, healthy environment and psychological services.

These programs shall:

1. be in accordance with Section 22-10A-34 and Section 24-5-1 through 24-5-6 NMSA 1978;
2. provide education and skill development program offerings;
3. provide community partnerships which help to achieve the goal of healthy students and staff;
4. be assessed as part of the EPSS process; and
5. support the local curriculum and EPSS.

NMAC § 6.29.1.11

School Health Support Services

Districts and charter schools shall provide support service programs which strengthen the instructional program. Required support service programs are: library media, school counseling and health services.

Support services shall:

1. have a written, delivered and assessed program, K-12;
2. provide licensed staff to develop and supervise the program;
3. be assessed as part of the EPSS process; and
4. support the local curriculum and EPSS.

NMAC § 6.29.1.11

Special Education

For more information, see NMAC § 6.31.2.

Health Screening

New Mexico Statute and Rules require some school health screenings. These include immunizations, vision screenings, and requests from Special Education or Student Assistant Teams. Most school nurses choose to do a general screening for vision and hearing. The School Nurse schedule and the size of the school district may determine how many grades are screened and what they are screened for. However, for vision screenings, kindergarten, first grade, and third grade are required; immunization requirements are for all grades.

For more information, see Chapter 3: Vision Screening and Chapter 9: Immunizations, Law, Authority, NMAC, and NMSIIS.

Specific School Health Issues Covered by NMAC

• NMAC § 6.12 — Public School Administration: Health and Safety

Provides excused absences for pregnant and parenting students as follows:

1. Provides at least ten days of excused absences for a student who provides documentation of the birth of the student’s child and allows the student a time period to make up the work that the student missed that equals the number of days the student was absent for the birth of a child;
2. Provides excused absences for any additional days missed by a pregnant or parenting student for which a longer period of absence is deemed medically necessary by the student’s physician and allows the student a time period to make up the work that the student missed that equals the number of days the student was absent;
3. Provides four days per semester of excused absences, in addition to the number of allowed absences for all students, for a student who provides appropriate documentation of pregnancy or that the student is the parent of a child under the age of thirteen needing care and allows the student a time period to make up the work that the student missed that equals the number of days the student was absent;
4. Clearly states that the pregnant or parenting student is responsible for communicating the student’s pregnancy and parenting status to the appropriate school personnel if the student chooses to disclose the information; and
5. Provides that the school district or charter school shall provide a copy of the pregnant and parenting student absence policies to all students in middle, junior high and high schools.

NMAC § 6.10.8

Child Abuse and Neglect

Historical NM Statutes, Annotated 1978

According to the New Mexico statutes, everyone has the duty to report child abuse and child neglect.

A. Every person, including but not limited to a licensed physician, a resident or an intern examining, attending or treating a child, a law enforcement officer, a judge presiding during any proceeding, a registered nurse, a visiting nurse, a schoolteacher, or a school official or social worker acting in an official capacity who knows or has a reasonable suspicion that a child is an abused or a neglected child shall report the matter immediately to:

1. a local law enforcement agency;
2. the department office in the county where the child resides; or
3. tribal law enforcement or social services agencies for any Indian child residing in Indian country.

The penalty for not reporting

G. Any person who violates the provisions of Subsection A of this section is guilty of a misdemeanor and shall be sentenced pursuant to the provisions of Section 31-19-1 NMSA 1978.

NMSA § 32A-4-3

Tier 3 Referral and the Multidisciplinary Evaluation Process

When an individual student is referred to the Student’s Assessment Team (SAT) because a concern is raised, the team members are responsible for collecting information about the student and forming a hypothesis about the possible factors contributing to the student’s difficulties academically and/or behaviorally. IEP and Section 504 may or may not include nursing services. If the IEP includes nursing services, these are usually services which may be billed for under Medicaid in the Schools. A student cannot have both a Section 504 and an IEP. If the SAT process decides the student is Tier 3, then that student gets all the supports and services needed, which must be provided.

Relevant Laws

There are three main Federal Laws that affect students with disabilities and/or health conditions in schools:

1. Americans with Disabilities Act (ADA);
2. Section 504 of the Rehabilitation Act; and
3. Individuals with Disabilities Education Act (IDEA).

Americans with Disabilities Act National Network. (2018). Disability Rights Laws in Public Primary and Secondary Education: How Do They Relate? Retrieved July 6, 2022, from https://adata.org/factsheet/disability-rights-laws-public-primary-and-secondary-education-how-do-they-relate

Difference Between ADA, 504, and an IEP

These laws each address different parts of the educational picture for students with disabilities.

The ADA is a broad law that provides civil rights protections to all individuals with disabilities in the US in many different aspects of life. Title II of the ADA prohibits discrimination by state and local governments, which includes public schools.

Section 504 is more limited. It provides civil rights protections to all individuals with disabilities in programs that receive federal funding, which includes most public schools. Both the ADA and Section 504 are nondiscrimination laws that do not provide any funding to the covered entity.

IDEA is not an antidiscrimination law; it is a statute that mandates free appropriate public education (FAPE) in the least restrictive environment (LRE) for students with disabilities eligible under IDEA. IDEA provides federal funding to schools to support IDEA-eligible students.

Americans with Disabilities Act National Network. (2018). Disability Rights Laws in Public Primary and Secondary Education: How Do They Relate? Retrieved July 6, 2022, from https://adata.org/factsheet/disability-rights-laws-public-primary-and-secondary-education-how-do-they-relate

Section 504 – NM PED

Section 504 is federal civil rights law under the Rehabilitation Act of 1973. The U.S. Department of Education’s Office for Civil Rights (OCR) administers Section 504—not the State. Section 504 is the other service option available to students with disabilities, but who are not eligible and/or are receiving special education services under the eligibility requirements of the IDEA. It is designed to provide equal access and fairness in general education to students with disabilities, thereby leveling the playing field for them. Under New Mexico’s three-tier model of student intervention, a Section 504 Plan is a Tier 2 service and/or support.

• Fact Sheet: Section 504
• Tip Sheet: Section 504 Evaluation
• Tip Sheet: Section 504 and Related Services
• Tip Sheet: Section 504 and Graduate NM

New Mexico Public Education Department. (2022). Section 504 Resources.

Example of a 504 Plan

Example: A student has been diagnosed as having asthma. The disability limits the major life activity of breathing.

Possible Accommodations

• Develop health care and emergency plan.
• Modify activity level for recess, physical education, etc.
• Use air purifier or inhalants.
• Provide inhalant therapy assistance.
• Administer medication as prescribed.
• Provide homebound instruction.
• Remove allergens, such as hairspray, lotions, perfumes, pine trees, or carpet.
• Make field trips non-mandatory and supplement with videos, audios, movies, etc.
• Accommodate medical absence; arrange transportation to home or clinic.
• Provide education to peers, teachers, and others, such as bus drivers or cooks.
• Provide access to water, gum, etc.
• Provide curriculum considerations for science class, physical education, etc.
• Provide alternatives if the individual misses an excessive amount of school.
• Have peers available to carry materials to and from classes, such as lunch tray or books.
• Provide rest periods.
• Make school health care needs known to appropriate staff.
• Modify field trip experiences.
• Provide indoor space for before and after school.
• Arrange for access to wheelchair for transition purposes.
• Have a locker location that is centralized and free of atmosphere changes.
• Reimburse parent for transportation costs or provide alternate transportation to and from school.
• Modify attendance policies.
• Modify certain learning activities.

Health Records Retention

All student health records should be retained, regardless of media, for the period required by the agency’s records retention program for any legal, user, historical, or other purpose. Electronic files are subject to the same retention rules as hard-copy files. A new record retention and disposition schedule was promulgated October 2015 which covers all public records. Your school or district may require longer retention of health records than what is listed at the link below.

Note: The original manual included a local computer file link for 1.21.2 NMAC. That link should be replaced with a public web link before launch.

For more information, see NMAC § 1.21.2.187.

Confidentiality, Written Consent, HIPAA, FERPA, and Services for Minors

Confidentiality is an abstract concept that is inextricably intertwined with the individual’s “right to privacy” and with communication and record-keeping practices in health care settings and schools. With respect to minors in school settings, these challenges can be confounding.

Schwab, N.C., & Gelfman, M. H. B. (2005). Legal issues in school health services. Authors Choice Press, p. 261.

The issues for school nurses surrounding confidentiality include what constitutes student health information, who has a need to know, and why they need to know unless potential disclosure is discussed with the patient and/or parent/guardian.

In the health care setting, there are situations when confidentiality might not be maintained. At any time if information a student has shared indicates the student is at imminent risk of endangering him/herself or others, that information must be shared with those who need to intervene to protect the student or others. Therefore, a statement from the School Nurse in the nurse/student discussion should disclose to the student that any information will be kept confidential unless the nurse chooses to share it to protect the student or others from what she/he perceives to be harm.

In the school setting, the issue of “need to know” arises when other school personnel need to know confidential information to provide appropriate educational services beneficial to the student. However, care must be given as to how the information is shared and to what extent to maintain the student’s privacy.

Information provided to teachers of students who may require accommodations or have the potential for life-threatening emergencies should be disclosed as signs and symptoms, not necessarily as a medical diagnosis. It is recommended that school nurses utilize nursing diagnoses when teaching staff about any student’s health problem. For example, two students might be labeled with asthma. While one of them rarely uses an inhaler, the other might be at high risk for respiratory distress and require frequent, on-demand inhaler use. It is more important to meet specific needs rather than to treat the diagnosed condition generically. School staff members need to know how to recognize a health problem and what to do if that problem occurs.

School administrators should be given sufficient information about the health and safety needs of students to plan appropriate programs, ensure a safe environment, and provide adequate staff training. The school administrator should also be able to access emergency care plans for students within his/her buildings of responsibility.

Written Informed Consent

A parent/guardian of a minor may give written informed consent for personal health information to be shared with identified school personnel. The consent should specify what information will be shared and with whom. The expected outcomes and potential ramifications associated with written informed consent should also be discussed with the individual(s) giving consent. School districts may choose to define members of the health team and obtain a blanket written informed consent from the parent/guardian to allow disclosure of information on a “need to know” basis for these members. Many times, this blanket consent is on the Emergency Health Authorization Form.

FERPA and HIPAA

The Federal Educational Rights and Privacy Act (FERPA) of 1974 established confidentiality standards and access rights to student records.

FERPA gives parents certain rights with respect to their children's education records. These rights transfer to the student when he or she reaches the age of 18 or attends a school beyond the high school level. Students to whom the rights have transferred are “eligible students.”

• Parents or eligible students have the right to inspect and review the student’s education records.
• Parents or eligible students have the right to request that a school correct records which they believe to be inaccurate or misleading.
• Generally, schools must have written permission from the parent or eligible student in order to release any information from a student’s education record. However, FERPA allows schools to disclose those records, without consent, to the following parties or under the following conditions:

• School officials with legitimate educational interest;
• Other schools to which a student is transferring;
• Specified officials for audit or evaluation purposes;
• Appropriate parties in connection with financial aid to a student;
• Organizations conducting certain studies for or on behalf of the school;
• Accrediting organizations;
• To comply with a judicial order or lawfully issued subpoena;
• Appropriate officials in cases of health and safety emergencies; and
• State and local authorities, within a juvenile justice system, pursuant to specific State law.

Schools may disclose, without consent, “directory” information such as a student’s name, address, telephone number, date and place of birth, honors and awards, and dates of attendance. However, schools must tell parents and eligible students about directory information and allow parents and eligible students a reasonable amount of time to request that the school not disclose directory information about them. Schools must notify parents and eligible students annually of their rights under FERPA.

U.S. Department of Education. (2021). Family Educational Rights and Privacy Act (FERPA). Retrieved July 6, 2022, from https://www2.ed.gov/policy/gen/guid/fpco/ferpa/index.html

Congress enacted the Health Insurance Portability and Accountability Act (HIPAA) in 1996 to address the problem of health insurance confidentiality in the era of electronic information. Under HIPAA, any identifiable personal health information is protected, and specific authorization is required for transfer of that information. However, in New Mexico school nurses have been granted Public Health Authority in the exchange of immunization information and, therefore, can obtain this information without parental authorization.

It is advisable that the school nurse obtain appropriate consent from parents before sharing protected health information outside of the school if there is any question regarding the need for consent. School nurses are encouraged to be knowledgeable of both HIPAA and FERPA regulations and be proactive in assisting school districts with establishing policy for sharing student medical information that is compliant with both.

For more information, see the U.S. Department of Health and Human Services' Health Information Privacy website.

Confidential Services for Minors

Sexually Transmitted Disease

Any person regardless of age has the capacity to consent to an examination and treatment by a licensed physician for any sexually transmitted disease.

Test results for sexually transmitted diseases may be released to:

1. the subject of the test or the subject's legally authorized representative, guardian or legal custodian;
2. any person designated in a legally effective release of the test results executed prior to or after the test by the subject of the test or the subject's legally authorized representative;
3. an authorized agent, a credentialed or privileged physician or an employee of a health facility or health care provider if the health care facility or health care provider itself is authorized to obtain the test results, the agent or employee provides patient care or handles or processes specimens of body fluids or tissues and the agent or employee has a need to know such information;
4. the department of health and the centers for disease control and prevention of the United States public health service in accordance with reporting requirements for a diagnosed case of a sexually transmitted infection;
5. a health facility or health care provider that procures, processes, distributes or uses a human body part, semen, blood or blood products, or human body parts for transplant with respect to medical information regarding the donor or recipient;
6. health facility staff committees or accreditation or oversight review organizations that are conducting program monitoring, program evaluation, or service reviews, as long as any identity remains confidential;
7. authorized medical or epidemiological researchers who may not further disclose any identifying characteristics or information; and
8. for purposes of application or reapplication for insurance coverage, an insurer or reinsurer upon whose request the test was performed.

Whenever disclosure is made, it shall be accompanied by a statement in writing that includes the following or substantially similar language: “This information has been disclosed to you from records whose confidentiality is protected by state law. State law prohibits you from making any further disclosure of this information without the specific written consent of the person to whom this information pertains or as otherwise permitted by law.”

NMSA § 24-1-9

Pregnancy

A health care provider shall have the authority, within the limits of his license, to provide prenatal, delivery and postnatal care to a female minor. A female minor shall have the capacity to consent to prenatal, delivery and postnatal care by a licensed health care provider.

NMSA § 24-1-13.1

Family Planning

A. The legislature finds that:

1. family planning has been recognized as an essential component of standard health care and has been recognized nationally and internationally as a universal human right;
2. continuing population growth causes or aggravates many social, economic and environmental problems, both in this state and in the nation;
3. family planning services are not available as a practical matter to many persons in this state;
4. it is desirable that family planning services be readily accessible to all who want and need them; and
5. dissemination of information about family planning by the state and its local governmental units is consistent with public policy.

B. It is the purpose of the Family Planning Act to assure that comprehensive family planning services are accessible on a voluntary basis to all who want and need them.

NMSA § 24-8

Emergency Conditions

In cases of emergency in which a minor needs immediate hospitalization, medical attention or surgery and the parents of the minor cannot be located for the purpose of consenting thereto, after reasonable efforts have been made under the circumstances, consent for the emergency attention may be given by any person standing in locus parentis to the minor.

NMSA § 24-10-2 see also NMSA § 24-7A-6.2

Homeless Youth

Consent for certain minors fourteen years or older, homeless youth or parent of a child.

A. An unemancipated minor fourteen years of age or older who has capacity to consent may give consent for medically necessary health care, provided that the minor is:

1. living apart from the minor's parents or legal guardian; or
2. the parent of a child.

B. For purposes of this section, "medically necessary health care" means clinical and rehabilitative, physical, mental or behavioral health services that are essential to prevent, diagnose, or treat medical conditions or that are essential to enable an unemancipated minor to attain, maintain, or regain functional capacity.

C. The consent of the unemancipated minor to examination or treatment pursuant to this section shall not be disaffirmed because of minority.

D. The parent or legal guardian of an unemancipated minor who receives medically necessary health care is not liable for payment for those services unless the parent or legal guardian has consented to such medically necessary health care.

E. A health-care provider or a health-care institution shall not be liable for reasonably relying on statements made by an unemancipated minor that the minor is eligible to give consent pursuant to Subsection A of this section.

F. Nothing in this section shall otherwise limit the rights of an unemancipated minor to consent to treatment, nor shall this section be read to conflict with the rights of parents and children pursuant to the Children's Mental Health and Developmental Disabilities Act.

NMSA § 24-7A-6.2

Mental Health

Consent for services; children under fourteen years of age

A. Except as provided in Subsection B of this section, the informed consent of a child's legal custodian shall be required before treatment or habilitation, including psychotherapy or psychotropic medications, is administered to a child under fourteen years of age.

B. A child under fourteen years of age may initiate and consent to an initial assessment with a clinician and for medically necessary early intervention service limited to verbal therapy as set forth in this section. The purpose of the initial assessment is to allow a clinician to interview the child and determine what, if any, action needs to be taken to ensure appropriate mental health or habilitation services are provided to the child.

NMSA § 32A-6A-14

Consent for services; children fourteen years of age or older

A. A child fourteen years of age or older is presumed to have capacity to consent to treatment without consent of the child's legal custodian, including consent for individual psychotherapy, group psychotherapy, guidance counseling, case management, behavioral therapy, family therapy, counseling, substance abuse treatment or other forms of verbal treatment that do not include aversive interventions.

B. Psychotropic medications may be administered to a child fourteen years of age or older with the informed consent of the child. When psychotropic medications are administered to a child fourteen years of age or older, the child's legal custodian shall be notified by the clinician.

C. A clinician or other mental health and developmental disabilities professional shall promote the healthy involvement of a child's legal custodians and family members in developing and implementing the child's treatment plan. However, nothing in this section shall limit the rights of a child fourteen years of age or older to consent to services and to consent to disclosure of mental health records.

NMSA § 32A-6A-15

Documentation

Documentation is critical to the development and maintenance of school health service programs. It is essential to the practice of nursing and a fundamental component of the nursing process. Among other things, documentation:

• validates the nursing process was used;
• provides a basis for evaluation;
• demonstrates the standard of care was followed;
• facilitates communication with other nurses, providers, and school staff; and
• provides data which generates funding initiatives.

Schwab, N. C., & Gelfman, M. H. B. (2005). Legal issues in school health services. Authors Choice Press, p. 157.

Student Health Record

In general, each student health record should contain the following pieces of documentation and information.

• Health history.
• Health screening results, including hearing, vision, and immunizations.
• Chronic conditions, diagnoses, and problem list.
• Emergency information, contact, and health care provider list.
• Progress notes.
• Appropriate Individual Health Plan/Individual Emergency Management Plan (IHP/EMP).

Health Room Visit Documentation

A description of each health room visit should be reflected in the student health record. The following inclusions in the documentation will help guide the School Nurse toward completion of an adequate report of the visit.

• Document frequency and length of visits.
• Document reassessment each time it occurs.
• With recurrent visits, document symptoms to demonstrate a pattern.
• Document gut-level feelings.
• Use the concept of “FACT” when documenting:

• Factual
• Accurate
• Complete and Comprehensive
• Timely

• Complete documentation on the day of occurrence.
• Do not provide care or discontinue assessment if, in one’s professional opinion, medical information needed to arrive at a diagnosis is lacking.
• Show that a health history was taken before care was provided.
• Assure that the plan of care reflects appropriate health history and health screen(s).
• Document the method used to notify parent/guardian of the student’s health office visit, for example by phone or in writing.
• Document what information is sent home with the student for exchange with the parent/guardian.
• Failure to document delivery of nursing services violates the nurse practice act.

Consistency in Documentation

The health record is an information management document for the student throughout his/her school career. Consistency is the key to organization, continuity, and accuracy. Likewise, all forms and documentation should have a signature and/or initials of the care giver and the name of the student. Any medication log sheets should contain a space for physician order, date, prescription changes, as well as a comment section. The same health record forms should be used in the same manner for the same purpose in all schools within a school district.

Sign-in/Documentation Logs

Unless maintained without known patient identifiers, sign-in logs and patient activity logs may infringe upon patient confidentiality rights. Computerized logs may be acceptable if access is limited to identified individuals with a “need to know.”

Adverse Event Reporting Documentation

In New Mexico, the Department of Health (NMDOH) Regional Health Officers (RHO) are charged by state statute with oversight responsibilities of all school nurses. During the legislative session of 2017, the Public Health Act was amended to include medical oversight responsibilities. See NMSA § 24-1-4.

Protocol for Reporting an Adverse Event

Should a School Nurse have knowledge of any of the below listed adverse events occurring in the school or school district in which he/she provides services, that nurse or the school nurse leader/supervisor of the school district is required to report the event(s) to the local RHO through School Health Advocate (SHA) by the Smartsheet database link. An Adverse Event Report should be completed as soon as possible following that notification phone call to alert the SHA of the outstanding report. If there is a question regarding whether a situation should be reported, the nurse should contact the Regional SHA. Any school personnel may submit this report form to their regional SHA. If the school has an RN, the nurse should be notified of all Adverse Event Form submissions.

For more information, see the NMDOH Adverse Event Form for Schools.

Adverse Events Reporting Form

In these instances, an Adverse Event Form should be submitted via the Smartsheet database, which will automatically notify the SHA. Please note: no PHI should be included on the form. Do not break HIPAA.

1. Any death of a student or staff member that occurs during school hours or on school grounds.
2. Any known suicide attempt, including completed or suspected, of a student, including those occurring after hours or during school vacation.
3. EMS activation.
4. Any untoward event with the potential of impacting physical or mental health of the school community.
5. Administration of emergency medications, including Narcan, Albuterol, Epinephrine, or Oxygen.

The Adverse Events Form is now a fillable Smartsheet database. It should be filled out electronically. This information is collected and provides data for follow-up action such as training.

The Adverse Event Report form is available here: NMDOH Adverse Event Form for Schools.

Notification Timeframe

Reporting of adverse events should occur within 24–72 hours.

Public Health Medical Oversight

New Mexico school nurses are licensed by the NMPED; however, it is the Department of Health (DOH) that provides medical oversight of all school nurses. New Mexico State Statute 24-1-4(B) of the Public Health Act states: “a regional health officer shall provide medical oversight to school nurses in the regional health officer’s region. A school nurse shall make reports relating to public health as the regional health officer in the school nurse’s region requires” (NMSA § 24-1-4). Regional School Health Advocates assist the regional health officers and the school districts in their regions in compliance with this statute.

Primary Editor: Crista Pierce, BA, RN, CLNC, ADA, School Health Advocate, SW Region, New Mexico Department of Health

Secondary Editor: Susan Acosta, BS, RN, NCSN, State School Health Consultant, New Mexico Department of Health