The following forms need to be completed by your child’s health care provider:

Diabetes Medical Management Plan

Emergency Care Plan for Hypo- and Hyperglycemia
These forms will assist us in providing the best possible care for your diabetic child at school. Your child’s health care provider will be able to share pertinent information with the clinic staff to better manage your child’s symptoms. After the form is completed by your child’s health care provider, a parent/guardian should sign the bottom portion, and return to the school clinic. We will accept alternate forms from your child’s physician if they prefer to use their own. Please make sure that their forms include all of the same information as the forms Pleasanton ISD has provided. Please bring your child’s current medications with the completed forms to the clinic office. A new form must be completed each school year.

Your child may be permitted to self-carry/self-administer emergency diabetic medication only after these forms have been completed by the health care provider and written permission is given.

Please see the following links for diabetic information and resources.