West Independent School District

• Information Letter for Parents - (English) | Information Letter for Parents - (Española)
• TEA English Special Health Needs of Students with Diabetes (English) | TEA Spanish Special Health Needs of Students with Diabetes (Española)

Parents of students with diabetes need to communicate fully with the school nurse about the student’s needs. If possible, plan to meet with the nurse before the beginning of the school year or before the first day of attendance for students who start later in the school year.

The West ISD requires the following forms be signed by the parent/guardian for all students seeking diabetes care while at school: (all forms are linked below)

1. Required: Diabetes Medical Management Plan (DMMP) signed by the student’s physician (may be the WISD form or similar form from the primary physician or Diabetes Clinic) Diabetes Medical Management Plan (English)
2. Required: Medication Authorization Forms for the use of insulin, glucagon, glucose tablets/gels, etc.
   Medication Authorization Form (English) | Medication Authorization Form (Spanish)
3. Required: Authorization for Administration of Diabetes Management and Care Services by Unlicensed Diabetes Care Assistant form. Authorization Form (English) | Authorization Form (Española)
   • If the student’s parent/guardian chooses not to sign the Unlicensed Diabetes Care Assistant form, the parent/guardian will be responsible for the administration of the diabetes care in the event the school nurse is unavailable. (This authorization is part of the WISD DMMP and may be included on some physician forms so may not be needed in some instances)
4. For the refusal to allow the UDCA to participate in the student's care, a form must be signed by the parent, notarized, and turned in to the nurse's office. Refusal to Allow UDCA (English) | Refusal to Allow UDCA (Española)
5. Dexcom Parent Consent Form (English link) | Dexcom Parent Consent Form (Española) (If Applicable) If your child wears a Dexcom of any brand and you want the nurse or staff of West ISD, you will need to have this form filled out. This allows staff access to the student's Dexcom blood sugar levels. Parents need to sign and return the form to the campus nurse.
6. Continuous Glucose Monitor Agreement Form – FORM If a student wears a CGM (Continuous Glucose Monitor)
7. Insulin Pump Physician Orders (English) | Insulin Pump Physician Orders (Española) (If Applicable) Insulin Pump Physician Orders for students using an insulin pump (may be the WISD form or similar form from the physician or Diabetes Clinic)
8. (Optional) Parent Consent for School Health Staff to Contact Student’s Medical Provider to clarify plan of care. Parent Consent to Contact Medical Provider (English) | Parent Consent to Contact Medical Provider (Española)

A student’s parent/guardian is required to provide all necessary supplies/food for the student with diabetes.

House Bill No. 984 (Care of the Student with Diabetes) enacted in 2005, specifies that each school train one (1) unlicensed diabetes care assistant (UDCA) if a full-time nurse is assigned to the school. To protect the safety and health of students, West ISD has chosen to have a minimum of one (1) UDCAs trained at each campus, in addition to the nurse. Training of the UDCAs is provided under the supervision of a healthcare professional with expertise in the care of persons with diabetes. The UDCAs will provide diabetes management and care services if the nurse is unavailable. Such services include, but are not limited to, the administration of insulin, or in an emergency, the administration of glucagon.

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