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

DukeS@friscoisd.org

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