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Home Hospital

Parents

Below you will find the application including medical forms that will help determine the need for exemption from school and for the provision of Home/Hospital instruction for your child. The entire application (items 1-4 below) must be returned to our office to determine eligibility before instruction can begin. Please ask your doctor to complete them quickly and then we need for you to mail or hand deliver the original copy to Harlan County Public Schools, ATTN: Scott Pace, Home/Hospital Director, 251 Ball Park Road, Harlan, KY 40831. Requests for school exemptions based on medical reasons must be completed by your child’s licensed physician. Requests for school exemptions based on mental health reasons must be completed by the licensed psychologist or psychiatrist who is treating your child. Please complete the following:

  1. Section I: Parent/Student Information - This MUST be completed by the legal parent(s) / guardian(s) prior to full completion by the licensed medical or mental health professional.
  2. Section II: Medical Professional Statement - This section is to be filled out by the authorized medical or mental health professional. Please note that to be in compliance with 704 KAR 7:120, Secton 2, Subsection 4 'an application for mental health reasons may be considered if completed by a licensed phychologist or psychiatrist'. Please call if you have questions or need assistance. The application can be faxed (606-573-5767) or preferably hand delivered by the parent to Harlan County Public Schools, ATTN: Scott Pace, Home/Hospital Director, 251 Ball Park Road, Harlan, KY 40831
  3. Section III: School District Home/Hospital Review Committee - This section is to be completed by the Home/Hospital Review Committee.
  4. Parent Agreement Letter for Home/Hospital Instruction - Along with Section I, the document MUST be completed by the legal parent(s) / guardian(s) before your child can be approved for Home/Hospital.

Home/Hospital Teachers

We would like to start by thanking you for your willingness to be a part of the Home/Hospital program within the Harlan County Public School District! Being the bridge between our classroom instructors and the students we serve takes a lot of commitment and attention to detail. Over the years your hard work has ensured the success of this program and allowed our students to continue to obtain a quality education during times of hardship!

Notes:

  • The HCPSD pays $25 per visit
  • Beginning with the date of enrollment in the H/H program, the H/H Teacher meets with the student for individualized instruction a minimum of two (2) visits a week with a minimum of one (1) hour of instruction per visit as equivalent to the attendance of one (1) child five (5) days in school.
  • Timesheets and the Visitation and Planning Schedule must be turned in by the 1st and 15th of each month in order to process payment. The Program Form is due only at the conclusion of HH Services.
  • Please make sure that the Timesheets and Visitation and Planning Schedules are turned in together and match exactly
  • Your ID Number must appear at the bottom of the Timesheet in order for it to be processed for payment
  • Please have the parent/guardian sign the Visitation and Planning Schedule each time you make a visit
  • Copies of your documents can be turned it for payment, but the originals must be turned in as well for filing

If you are interested in becoming a Home/Hospital teacher please contact Scott Pace, H/H Director at 606-574-4330 x2047 / scott.pace@harlan.kyschools.us!

Forms/Documents