Utilize this form if your child has a history diabetes. Please note, if your health care provider has a different Diabetes Management form, they may be filed with the school nurse in place of this district approved form.
This form requires the signature of your child's health care provider.
Please have this form completed and handed into the school nurse prior to the start of school. If you would like to sit down and review this plan, please call 715-854-2721 x347 or e-mail directly to ckubicek@crivitz.k12.wi.us.
