Pond Springs Elementary
Diabetes

For students with type 1 diabetes, please use these forms along with your student’s diabetic school orders from their diabetes care provider to give to the campus nurse.

Authorization for Administration of Diabetes Management and Care Services By An Unlicensed Diabetes Care Assistant (UDCA)

Under HB 984, each school must train other employees to serve as Unlicensed Diabetes Care Assistants who can provide diabetes management and care services if a nurse is not available when a student needs such services. Such services include the administration of insulin or, in an emergency, glucagon. Round Rock ISD has trained staff at each school to provide such services. HB 984 further specifies that an Unlicensed Diabetes Care Assistant exercises his or her judgment and discretion in providing diabetes care services and that nothing in the statute limits the immunity from liability afforded to employees under section 22.0511 of the Texas Education Code.

• Parent Consent Authorization for Unlicensed Diabetes Care Assistant
  
  

Round Rock ISD Blood Glucose Monitoring Information and Parental Consent Form
Parents of students in Round Rock ISD have obtained a blood glucose monitoring device, including, but not limited to a “Dexcom” (“device”) and have requested that Round Rock ISD allow the pairing unit (e.g. cell phone, tablet) and the device to access RRISD wifi, and be viewed and monitored by Round Rock ISD employees, including but not limited to nurses (Herein referred to as “Monitoring”). Monitoring will be allowed ONLY as outlined in this Information and Consent Form.

• Parent Consent Blood Glucose Monitoring Device “Dexcom” (English)

• Parent Consent Blood Glucose Monitoring Device “Dexcom” (Spanish)