To assist your child in maintaining optimum health, it is necessary for the school to have current information regarding his/her diagnosis of diabetes or hypoglycemia. Written permission is required from the parent and physician for the nurse to test your child’s blood glucose level at school during a crisis or emergency situation.

Please be aware that:

A nurse may not always be available when a situation arises which may indicate the need for blood glucose testing. When the nurse is not in the building, the parents or emergency medical assistance (911) will be notified depending on the state of the crisis.

If equipment is needed for blood glucose testing, this must be provided by the family. The procedure for blood glucose testing will be followed according to instructions provided by the manufacturer of the specific meter.

The parent should notify the school nurse if routine blood glucose monitoring is necessary during school hours.

Please complete the attached forms and return to the school nurse as soon as possible. Physician and Parent/Guardian signatures are both required. Also, continue to keep the school nurse updated on your child’s changing health needs.

School Nurse: ______________________________

Phone: ____________________________________