District Nurse

Dear Parents/Guardians,

The primary goal of Marion ISD Health Services is to maximize each child’s potential for growth and development as well to ensure the safety and physical well-being of your child while on campus. Please be observant of the MISD Health Services Handbook in order to provide the safest environment possible for your child. The school appreciates your understanding and assistance in these matters.

****If you have questions about COVID-19, or need to report a positive result with your child attending Marion ISD, please contact your campus nurse.****

Kreuger Primary – 830-914-1062
Karrer – 830-914-1067
Middle School – 830-914-1072
High School – 830-914-1098

Thank You,
Gayla Wilson
District Nurse

Gayle Wilson

Gayla Wilson

District Nurse

Medications should be given at home when possible. The district will not purchase medication to give to a student.

Authorized employees of the district may administer medications under these circumstances:

  • Prescription medication, in the original, properly labeled container, provided by the parent/guardian, properly filled out medication authorization form provided by the school nurse
  • Non-prescription medication, in the original, properly labeled, unopened container, provided by the parent/guardian, with properly filled out medication authorization form provided by the school nurse
  • FDA-approved herbal substances or dietary supplements provided by the parent/guardian only if required by the student’s individualized education program (IEP), Individual Healthcare Plan (IHP), or Section 504 plan for a student with disabilities, properly filled out medication authorization form from the school nurse

Parent/guardian must fill out the medication authorization form available from the school nurse in order for any medication to be administered at school. Over the counter medication taken longer than 5 consecutive days requires a physician order/signature (including cough drops). Herbal supplements, vitamins, essential oils, sunscreen, and bug spray will not be administered to students by the nurse or any staff member. If bug spray or sunscreen is needed, please apply at home before school. A physician signature is required for any exception to district rules.

Student cannot transport medication back and forth to school due to an increased potential for its misuse while in the student’s possession. A responsible adult must bring all medications to the clinic. If this presents difficulties for you, please contact the school nurse with a plan for alternate arrangements in transportation of your child’s medication. If a student brings medication to school, the medication will not be administered and the parent will be contacted to arrange for pickup of the medication. Over the counter medication will not be given longer than five consecutive days without a physician order/signature. When prescription medications are empty, the empty labeled container will be sent home with the student. At the end of the school year a letter will be sent informing parent/guardian to pick up medications by the last day of school. Any medications (prescription or over the counter) that are not picked up at the end of the school year will be discarded by the school nurse. Medications cannot be left over the summer to be given next year.

Students who suffer from asthma, diabetes, or severe allergic reactions who have written permission from parent/guardian and the physician or licensed health care provider may be permitted to possess and administer prescribed medications at school or school-related events.

Medication Authorization Form

If your child is sent home from school with a fever (temperature of 100
degrees or higher) or diarrhea, the child MUST remain home from school until
they are fever free or diarrhea free for at least 24 hours without medications to
reduce the fever or diarrhea.
If your child is sent home from school with vomiting, or other viral/flu like
symptoms, it is requested that the child remain home from school until at least
24 hours after symptoms have resolved (without the use of medication). This
may help prevent your child’s illness from making other children ill.
A student with pink eye may return to school after any prescribed therapy is
implemented, except when accompanied with another systemic illness.
Students with bacterial or viral conjunctivitis should remain home if their
behavior is such that they cannot avoid close contact with other students.
Students with allergic conjunctivitis are not contagious and may remain in

Please make sure each year you submit the current year health form that is provided at the beginning of the year. This keeps the school nurse updated on your students important health needs, allergies, and emergency contacts. If your student is diagnosed with asthma, seizures, allergy/anaphylaxis, bleeding disorders or diabetes, it is requested that you have an action plan updated at the beginning of each school year, these should be filled out by your student’s physician or health care provider, and forms are available with the school nurse.  All medications (prescription/over the counter) require a medication authorization form to be filled out by the parent/guardian at the time medication is dropped off. Medications will not be accepted or administered without this form filled out-form available with the school nurse. If your student has food allergies or needs food accommodations due to allergy a food allergy form should be filled out and signed by the physician, this will be sent to the schools nutrition coordinator.

Student Emergency Procedure Forms: These forms are required of every student.  Please provide information at the beginning of each school year with updated health needs, allergies, medications taken (even if taken at home), and emergency contacts.  This keeps the school nurse updated on your student’s health needs.  These forms are included in each school’s registration packets.

Emergency Action Plans: If your student is diagnosed with asthma (if they have a rescue inhaler, it is important to keep one at school), seizures, severe allergy/anaphylaxis, bleeding disorders or diabetes, it is requested that you have an action plan updated at the beginning of each school year.

Medication Forms: All medications (prescription AND over the counter) require a medication authorization form to be filled out by the parent/guardian at the time medication is dropped off. Medications will not be accepted or administered without this form completed.  The form is available below and with the school nurse.  Over the counter medications can only be administered for 10 school days without a health care provider’s signature.  It is recommended that if your student has recurring needs for over the counter medications (for example, after orthodontic work) that the form be signed by a health care provider.

Food Allergies or Sensitivities: If your student has food allergies or needs food accommodations due to an allergy, a food allergy form should be filled out and signed by the physician. This will be sent to the school’s nutrition coordinator.


The thought of lice makes everyone’s head itch! No one chooses to have lice in their child’s hair or in their home. Lice, however, are not responsible for the spread of any diseases, they are simply a nuisance. Many schools in the past have had “no nit policies”. Evidence-based research has shown that these policies are NOT effective in controlling the spread of lice in schools. In fact, they do more harm than good by keeping students out of school for prolonged periods of time. If careful observation indicates that a student has head lice, the Campus Nurse will contact the student’s parent to determine whether the child will need to be picked up from school and to discuss a plan for treatment. Students may return to school after their first lice treatment has been done at home.

Facts about LICE:
– Having Head Lice is NOT a sign of uncleanliness or poor hygiene.
– Nits are lice eggs and can be found close to the scalp as they require the heat
from the scalp to hatch; Look like tiny oval white to yellow dots
– Nymphs are baby lice
– Adult Lice are no bigger than a sesame seed and a brownish tan
– Lice cannot hop, jump, or fly
– Lice move from person to person through close bodily contact
– Live Lice need warmth and blood supply to live
– Lice cannot survive more than 48 hours without warmth and a blood supply
– Live Lice and Nits do NOT carry diseases
– In most cases, a person has had lice for 3-4 weeks before it is identified

Treatment for LICE:
– There are a variety of treatments available for lice
– Over the counter: Nix & Rid or Prescription medication
– Read and follow all instructions on medications
– Thorough treatment includes combing through the hair with a special lice comb every day for several days to remove the nits
– Retreatment with a medicated lice shampoo is often needed 7-10 days after the initial treatment to kill any newly hatched lice
– Don’t use a hair dryer on your child’s hair after applying any of the currently
available scalp treatments (some contain flammable ingredients)
– Don’t use a cream rinse or shampoo/conditioner combination before applying the lice medication
– Don’t wash your child’s hair for 1-2 days after using a medicated treatment
– Don’t use more than one head lice medication at a time

– Don’t use the same medication more than three times on one person. If it
doesn’t seem to be working, contact your child’s doctor
– Wash and Dry clothing, bed linens and other items the infected person wore or used during the 2 days before treatment. Use hot water and the high heat drying cycle
– Items that cannot be washed (to include stuffed animals) can be sealed in a
plastic bag and stored for 2 weeks
– There is no need to fumigate or spray the house as they do not live in cracks and crevices in the house

State Law and MISD policy requires up-to-date immunizations and official documentation to be on file for all students to remain in attendance, and enrolled, at school. Official Immunization records must be as complete as medically feasible.

Texas mandated immunizations for school year 2022-2023 include:

1)DTAP: Diphtheria, Tetanus and Acellular Pertussis (Whooping Cough); Records may indicate DTaP, TdaP, DTP, DT, or Td

Pre-K only: 4 doses of DTaP vaccine.

     K-6th grade: 4 or 5 doses of DTaP vaccine with 1 dose received ON or AFTER the 4th birthday.  For students over the age of 7, 3 doses meet the requirements if 1 dose was received on or after the 4th birthday.

     7th grade: 1 additional dose of Tdap is required IF at least 5 years have passed since the last dose of Tetanus-containing Vaccine.

     8th-12 grade: 1 additional dose of Tdap/Td is required IF 10 years have passed since the last dose of Tetanus-containing Vaccine.

2)Polio: Inactivated Polio Vaccine (IPV); Oral Polio Vaccine (OPV)

Pre-K only: 3 doses of Polio

     K-12th grade: 3 or 4 doses of Polio with 1 dose received ON or AFTER the 4th birthday.


3)Hep B: Hepatitis B Vaccine

Pre-K only: 3 doses of Hep B

     K-12th grade: 3 doses.  For ages 11-15 years, 2 doses meet the requirement IF the adult Hepatitis B vaccine (Recombivax®) was received.  Dosage and type of vaccine (Recombivax®) must be clearly documented.

4)Hep A: Hepatitis A Vaccine

     Pre-K only: 2 doses of Hep A.

     K-11th grade: 2 doses. The first dose must be received ON or AFTER the 1st birthday.


5)MMR: Measles, Mumps and Rubella Vaccine (combined)

Pre-K only: 1 dose of MMR ON or AFTER the 1st birthday.

     K-12th grade: 2 doses. The first dose must be received ON or AFTER the 1st birthday. Students vaccinated prior to 2009 with 2 doses of Measles and 1 dose of each Mumps and Rubella satisfy this requirement.


6)Varicella: Chickenpox Vaccine

Pre-K only: 1 dose of Varicella ON or AFTER the 1st birthday.

     K-12th grade: 2 doses. The first dose must be received ON or AFTER the 1st birthday.

7) Hib: Haemophilus influenzae type b

Pre-K only: 3 doses of Hib.

K-12 grade: NO requirement for Hib.


8) PCV: Pneumococcal conjugate vaccine

Pre-K only: 4 doses of PCV.

K-12 grade: NO requirement for PCV

9) Meningococcal: Meningitis Vaccine (MCV4)

     7-12th grade: 1 dose of Quadrivalent Meningococcal conjugate vaccine is required ON or AFTER the 11th birthday.  If the student received the vaccine at 10 years of age, this will satisfy this requirement.

NOTE: Documented evidence of previous illness (Varicella, Measles, Mumps, Rubella, Hepatitis A, or Hepatitis B) is acceptable in place of these vaccines.  Please contact the Campus Nurse for requirements.


Texas Law allows:

a physician to write a statement stating that the vaccine(s) required would be medically harmful or injurious to the health and well-being of the child.  NOTE: These statements MUST be renewed ANNUALLY at the beginning of each new school year unless the physician documents the exemption is due to a lifelong condition.

parents/guardians who choose an exemption from immunization requirements for reasons of conscience, including religious belief.  The law does NOT allow parents/guardians to elect an exemption simply because of inconvenience (for example, a record that is lost or incomplete and it is too much trouble to go to a physician or clinic to correct the problem). NOTE: The affidavit MUST be renewed EVERY 2 years.

For children needing medical exemptions, a written statement should be completed by the child’s physician OR parents/guardians should complete the medical immunization exemption affidavit they obtained from the State of Texas.  Completed documentation should be submitted to the Campus Nurse.

Instructions for the affidavit can be found at:  https://www.dshs.texas.gov/immunize/school/exemptions.aspx

Students with exemptions can be excluded from attending school if an outbreak occurs.

NOTE: It is the parent’s/guardian’s responsibility to ensure that exemptions remain current.  Failure to maintain the current status of exemptions, results in non-compliance and the student is placed in a provisional enrollment status.  The school shall exclude the student from school attendance until the required dose is administered or the exemption is notarized and filed with the school and after 30 days the student may be disenrolled.


ALL immunizations must be completed and verification documents received by the first day of attendance.  The law requires that students be fully vaccinated against specified diseases.  A student may be enrolled provisionally, if the student has a valid immunization record that indicates the student has received at least one dose of each of the required age-specific immunizations.  To remain enrolled, the student must complete the required subsequent doses in each vaccine series ON SCHEDULE and provide acceptable proof of vaccination to the school as quickly as feasible.  The District Nurse will review the immunizations and provide a catch-up plan for all delinquent immunizations in provisional status.  The immunization status of a provisionally enrolled student will be reviewed every 30 days by a campus nurse or administrator.  If, at the end of the 30-day period, a student has not received a subsequent dose of vaccine, the student is not in compliance and the school shall exclude the student from school attendance until the required dose is administered.  The student may also be disenrolled.


Since many types of personal immunization records are in use, a variety of documentation will be acceptable provided a physician or public health personnel have validated it (includes a signature, initials or stamp).  Official documentation from the Texas Immunization Registry is also acceptable.  An immunization record generated from an electronic health record must include the clinic information as well as the student’s name.

Immunizations Table K-12 (English/Spanish): https://www.dshs.texas.gov/immunize/school/pdf/6-14-2022-2023-MinReq_K-12.pdf


Immunizations Table Pre-K (English/Spanish): https://www.dshs.texas.gov/immunize/school/pdf/6-15-2022-2023-MinReq-Child-Care-PreK-1.pdf


State Exemptions (English): https://www.dshs.texas.gov/immunize/school/exemption-faq.aspx


State Exemptions (Spanish): https://www.dshs.texas.gov/immunize/school/pdf/E11-13159-Spanish.pdf


Flu Vaccination Availability: Methodist School-Based Health Clinic, Guadalupe Regional Medical Center; HEB, Walgreens, CVC, and most Pediatric Health providers

 Home COVID tests are valid tests for students and staff at MARION ISD.
     Free Home COVID tests can be requested by mail at https://special.usps.com/testkits
While COVID Vaccinations are not a requirement, there are many questions about the process for children 12-17.
       Vaccines are being administered through the following locations (please consult with them and your insurance company to determine eligibility at these locations):
              – Baptist Health System –  (866) 309-2873
              – Military affiliated students – Call CAMO at (210) 916-9900


         The information provided below is meant as a resource for parents and students. As always, it is best to speak with your child’s healthcare provider for specific questions or concerns.

In the 86th Legislature, HB 3884 required DSHS to create procedures for school districts to provide information relating to bacterial meningitis to students and parents.

En Español: Meningitis Bacteriana


Meningitis is an inflammation of the covering of the brain and spinal cord.  It can be caused by viruses, parasites, fungi, and bacteria. Viral meningitis is most common and the least serious. Meningitis caused by bacteria is the most likely form of the disease to cause serious, long-term complications. It is an uncommon disease but requires urgent treatment with antibiotics to prevent permanent damage or death.

Bacterial meningitis can be caused by multiple organisms. Two common types are Streptococcus pneumoniae, with over 80 serogroups that can cause illness, and Neisseria meningitidis, with 5 serogroups that most commonly cause meningitis.


Someone with bacterial meningitis will become very ill. The illness may develop over one or two days, but it can also rapidly progress in a matter of hours. Not everyone with meningitis will have the same symptoms.

Children (over 1-year-old) and adults with meningitis may have a severe headache, high temperature, vomiting, sensitivity to bright lights, neck stiffness, and drowsiness or confusion. In both children and adults, there may be a rash of tiny, red-purple spots. These can occur anywhere on the body.

The diagnosis of bacterial meningitis is based on a combination of symptoms and laboratory results.


If it is diagnosed early and treated promptly, most people make a complete recovery. If left untreated or treatment is delayed, bacterial meningitis can be fatal, or a person may be left with permanent disability.


Fortunately, none of the bacteria that cause meningitis are as contagious as diseases like the common cold or the flu, and they are not spread by simply breathing the air where a person with meningitis has been. The germs live naturally in the back of our noses and throats, but they do not live for long outside the body. They are spread when people exchange saliva (such as by kissing; sharing drinking containers, utensils, or cigarettes) or when people cough or sneeze without covering their mouth and nose.

The bacteria do not cause meningitis in most people. Instead, most people become carriers of the bacteria for days, weeks or even months. The bacteria rarely overcome the body’s immune system and cause meningitis or another serious illness.



Bacterial meningitis caused by Streptococcus pneumoniae and Neisseria meningitidis may be prevented through vaccination. The vaccine which protects against Streptococcus pneumoniae is called pneumococcal conjugate vaccine or PCV. This vaccine is recommended by the Advisory Council on Immunization Practices (ACIP) for children in the first year of life. Neisseria meningitidis is prevented through two types of vaccines. The first is a meningococcal conjugate vaccine which protects against 4 serogroups A, C, W, and Y and is referred to as MCV4. The second is a vaccine against Neisseria meningitidis serogroup B and is referred to as MenB.

The ACIP recommends MCV4 for children at age 11-12 years, with a booster dose at 16-18 years. In Texas, one dose of MCV4 given at or after age 11 years is required for children in 7th-12th grades. One dose of MCV4 received in the previous five years is required in Texas for those under the age of 22 years and enrolling in college. Teens and young adults (16-23 years of age) may be vaccinated with MenB. This vaccine is not required for school or college enrollment in Texas. 

Vaccines to protect against bacterial meningitis are safe and effective. Common side effects include redness and pain at the injection site lasting up to two days. Immunity develops about 1-2 weeks after the vaccines are given and lasts for 5 years to life depending on vaccine. 

Healthy habits

Do not share food, drinks, utensils, toothbrushes, or cigarettes. Wash your hands. Limit the number of persons you kiss. Cover your mouth and nose when you sneeze or cough. Maintaining healthy habits, like getting plenty of rest and not having close contact with people who are sick, also helps.


Certain groups are at increased risk for bacterial meningitis caused by Neisseria meningitidis. These risk factors include HIV infection, travel to places where meningococcal disease is common (such as certain countries in Africa and in Saudi Arabia), and college students living in a dormitory. Other risk factors include having a previous viral infection, living in a crowded household, or having an underlying chronic illness.

Children ages 11-15 years have the second highest rate of death from bacterial meningitis caused by Neisseria meningitidis. And children ages 16-23 years also have the second highest rates of disease caused by Neisseria meningiditis.


Seek prompt medical attention.


Your school nurse, family doctor, and the staff at your local or regional health department office are excellent sources for information on all infectious diseases. You may call your family doctor or local health department office to ask about meningococcal vaccine.  Additional information may also be found at the web sites for the Centers for Disease Control and Prevention (CDC): https://www.cdc.gov/meningitis/index.html and the Texas Department of State Health Services (DSHS): https://www.dshs.texas.gov/immunize/PreteenVaccines.aspx or https://dshs.texas.gov/IDCU/disease/meningitis/Meningitis.aspx



Last updated by DSHS on October 8, 2019