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Diabetes has long been a problem for countless children. The Child Advocate is devoted to children and the parents and professionals that work with them and advocate for them.  Here is a example document originally developed by Dr. Mary Simon and shared through Bear Skin Meadow Camp.  This document goes a long way toward addressing school issues in the use of  diabetes testing in the classroom.  The information presented at this site is for general use only and is not intended to provide personal advice or substitute for the advice of a qualified professional.  If you have questions about the information presented here, please consult a physician skilled in diabetes management, the resources listed or other professional in your area.




STUDENT NAME______________________________________________    DOB____________________________________


ADDRESS____________________________________________________   CITY____________STATE____ZIP__________


(Based on official protocol adopted 5/31/94)


Diabetic Students: Under the physician and parent’s authorization, test kits for diabetes may be carried by students and tests administered on campus and in classrooms under the following conditions:


If the test is administered in the classroom:


1) The pupil’s teacher is given notice when the test is being administered.


2) Test administered in an area away from other students.


3) If the student is not acting responsibly, the testing will be confined to the health office.


4) All sharp objects and contaminated materials used for testing shall be stored in a hard closed container carried by the individual student. Materials are to be disposed of in a biohazard container located either in the health office or off campus.


5) Snacks or glucose tablets will be allowed in the classroom at regular intervals based on individual need and to alleviate a low‑blood sugar episode.


6) Universal precautions utilized at all times.


The medical justification for providing the procedure(s) during school hours is Insulin Dependent Diabetes Mellitus.


Parent/Guardian Signature_____________________________________________________________


Duration of Procedure(s) to be in effect: _________________Date Reviewed: _____________________




Medical Center

Anytown, CA 55555


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