These are commonly used forms for the student with diabetes. Please call Nurse Kathy at 731-5017 to set up a meeting at the start of each school year or when your child is diagnosed with diabetes so that we can work together to set up an individualized plan for your child's care at school. Please provide the school with diabetes care orders from your child's physician for the school year.
Parent Delegation for Diabetes Care
To be signed by parent to permit nurse to train other school personnel as Diabetes Trained Persons
School Diabetes Care Plan by Parent
Used along with medical orders for diabetic student who uses injected insulin
School Diabetes Care Plan by Parent - Insulin Pump
Used along with medical orders for diabetic student who uses an insulin pump
Diabetic Care Plan Hyper and Hypoglycemia (High and low blood sugar)
Filled out by parent to identify student's signs of hyperglycemia
HIPAA Form
Permits your child's doctor to communicate with your school nurse to coordinate care
Parent Delegation for Diabetes Care
To be signed by parent to permit nurse to train other school personnel as Diabetes Trained Persons
School Diabetes Care Plan by Parent
Used along with medical orders for diabetic student who uses injected insulin
School Diabetes Care Plan by Parent - Insulin Pump
Used along with medical orders for diabetic student who uses an insulin pump
Diabetic Care Plan Hyper and Hypoglycemia (High and low blood sugar)
Filled out by parent to identify student's signs of hyperglycemia
HIPAA Form
Permits your child's doctor to communicate with your school nurse to coordinate care