Diabetes

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Home > Services > School Health Services > Diabetes Bucket

Choose the bolded statement that best describes your child's situation.
Click the link for each document under the statement you chose.  Print and complete the form.  Return the form to your child's school office or scan and email the completed forms to hservices@mesd.k12.or.us  If any form you access has yellow highlighted areas, then be sure to complete all those sections in particular.

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authorization_to_exchange_health_information_11-2005-highlighted.docMy child will need supervision/assistance with their diabetes
  (counting carbs, giving insulin, etc.)

• Child's Medical History: Diabetes (DOC)
• Authorization to Exchange Health Information (DOC)
• Parent Authorization for Specialized Health Care (PDF)
• Diabetes Treatment Orders - Provide a copy of medical orders to school office or email them to hservices@mesd.k12.or.us
• Authorization for Medication Administration by School Personnel (PDF)

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authorization_to_exchange_health_information_11-2005-highlighted.docMy child will be able to manage their diabetes independently
 (no staff supervision will be given except to administer glucagon as ordered)

• Child's Medical History: Diabetes (DOC)
• Authorization to Exchange Health Information (DOC)
• Parent Authorization for Specialized Health Care (PDF)
• Self-Manager Agreement for Students with Diabetes (PDF)
• Diabetes Treatment Orders - Provide a copy of medical orders to school office or email them to hservices@mesd.k12.or.us
• Authorization for Medication Administration by School Personnel (PDF)