District Nurse Resources
Please contact Dawn Kane for any modifications or updates needed for any of the documents below.
Asthma/Allergies
Allergy_Anaphylaxis Action Plan and Medication Orders
Asthma Care Plan Letter to Parents
Delegation Nebulizer Treatments
Parent Form for Students with Asthma_Breathing Problems
Diabetes
Diabetes Supply List Master (click Here for Spanish version)
Diabetes Master Summer Letter (click Here for Spanish version)
Glucose Monitoring_Carb Counting_Insulin Log
2011-12 Carb Count (Elementary)
Diabetes Individualized Health Plan (Form 100) (Spanish)
Diabetes Individualized Health Plan with Pump (Form 101) (Spanish)
Health Care Provider Order for Student with Diabetes (Form 200) (Spanish)
Health Care Provider Order for Student with Diabetes on Pump (Form 201) (Spanish)
Diabetes Classroom Health Care Plan (Form 300) (Spanish)
Diabetes Independent Management Plan (Form 400) (Spanish)
Agreement/Contract for Students Independent Management of Diabetes (Form 401) (Spanish)
Seizures
Delegation Diastat Administration (Seizures)
Parent Questionnaire of Student with Seizures
Miscellaneous Forms/Delegation Forms
Urinary Catheter Delegation Form Female