This Diabetes Medical Management Plan has been approved by:
I give permission to the school nurse or another qualified health care professional to perform and carry out the diabetes care tasks outlines in my son's Diabetes Medical Management Plan. I also consent to the release of the outlined in information contained in this Diabetes Medical Management Plan to all school staff members and other adults who have responsibility for my child and who may need to know this information to maintain my child's health and safety. I also give permission to the school nurse or another qualified health care professional to contact my child's physician/health care provider. This form is to be used together with the Endocrine Clinic permission to treat/orders.