DIABETES

if you student manages type 1 or 2 diabetes please complete the following:

• Authorization of Diabetes Management Form: Completed by parent and student. MUST complete new form every year.

• Diabetes Medical Management Plan (DMMP): Completed and signed by Primary Care Physician/Endocrinologist and parent. A NEW form MUST be completed and reviewed with school nurse every school year.

• Individualized School Health Plan - Type 1 Diabetes: Completed by parent and nurse using the DMMP. Contact school nurse. A NEW form MUST be completed and reviewed with school nurse every school year.

• H-14-3 Diabetes Emergency Action Plan: Will bee completed every school year by school nurse (here for an example).

• H-3-13 Diabetes Management During Disaster/Lock-down/Extended Study Trip: Completed by parent and reviewed/signed by nurse. A NEW form MUST be completed every school year.

• H-3-2 Mediation During School Day: If medication is required during school hours, to include study trips (sports, Far East events, etc.). To be completed and signed by physician and parent. A NEW form MUST be completed every school year.

• H-3-9 Student Retention of Medication: If STUDENT wants to carry medication (Inhaler, Zyrtec, etc.) during school hours or on study trips (sports, Far East events, etc.). To be completed and signed by physician and parent. A NEW form MUST be completed every school year.