Diabetes School Orders Form

What is a Diabetes School Orders Form?
The care of diabetes is as unique as each individual. A Diabetes School Orders Form (or doctor's orders) from their child's diabetes care provider is given to the child's school to implement and carry out doctor's orders and is typically used as the foundation for a 504 Plan (see below). This form must be updated whenever medical changes occur and is necessary for both the school your child attends and for your child's diabetes care team at our clinic. Parent/guardians are responsible for filling out and updating a diabetes medical school orders form.

Where is this form created?
OHSU’s Harold Schnitzer Diabetes Health Center School Orders Form. The link to the online form is here.

Examples of what is included in a Diabetes School Orders Form related to diabetes care?

• Your child needs to adjust insulin dosing for school breakfast or school lunch on PE days
• Needs to adjust insulin dosing at other times of the day
• Is changing from using injections to an insulin pump

504 Plan

What is a 504 Plan?
A 504 Plan is a tailored document to protect students with disabilities in receiving access to the same education as students without disabilities. It is also a tool to ensure that a student with diabetes is medically safe. Parent/guardians are responsible for contacting the school their child attends to create this plan.

Where is this form created?
Your child's school–contact your school administrators. Learn more: 504 Plan guidance from the American Diabetes Association

Examples of what is included in a 504 Plan related to diabetes care?

• Extra blood sugar checks prior to PE
• Snacks prior to PE or a long bus ride home
• Ability to eat snacks in the classroom
• Use of phone in class to read sensor data/blood glucose levels
• Access to water and  bathrooms
• Celebration foods such as cupcakes
• Participation in all sports, extracurricular activities, and field trips