Diabetes
If your child has insulin-dependent diabetes, please review/submit the following forms to me. Before school begins, I would like to meet with you and your child regarding his/her insulin regimen and level of self-management.
Stephanie Duke, RN, BSN
Hosp School Nurse
FORMS:
PARENTS REQUEST FOR ADMINISTRATION OF MEDICATION BY SCHOOL PERSONNEL (click link to download form)
- required for all medications
- each form can hold up to two medications
- must be signed by parent/guardian
- child's physician can also sign form which would serve as physician's orders
DIABETES MEDICAL MANAGEMENT PLAN -- click link to download form
- required (can be physician's own form)
- completed and signed by both parent and child's physician
- updated each school year or as needed
AUTHORIZATION FOR UNLICENSED DIABETES CARE ASSISTANT (UDCA) - click link to download form
RECOMMENDED DIABETES SUPPLIES FOR SCHOOL - click to download form