Request for Self-Administration of Diabetic Insulin and Glucose Testing 7.270 F3

Public Act 92-402 states that students who have been diagnosed with diabetes and prescribed insulin medication be permitted to administer the medication and glucose test independently. Documentation from the parent and physician certifying that the student has been instructed in the use and self-administration of the medication and glucose meter must be on file at the school.

This form must be completed, signed by the parent and physician, and submitted to the school office on an annual basis, at the beginning of each school year.

Request for Self-Administration of Diabetic Insulin and Glucose Testing 7.270 F3