ࡱ> AC@ bjbj 4*__zz         4T NpppppKKK$ KKKKK  pp!!!K. p p!K!!!}yR!0N!Z Z !Z !KK!KKKKKlKKKNKKKKZ KKKKKKKKKzX :  HS P-6 Your diabetic child rides a school bus. To maintain the safest environment for your child, please complete this letter in duplicate. Please personally give one copy to the driver of your childs bus so that they are aware of who your child is, the medical concern, and your instructions in the event of an emergency. Please return the other to the nurse at school. Please include a picture with this form. If you are unable to do this please contact the nurse. Drivers are generally the only adult on any given bus and may want to have your child sit where they can readily see them. In the event that your child has any evident diabetes reaction, feels low, confusion, behavior change, etc. (see sheet attached), driver will notify the district dispatch office to call you immediately so you can meet the bus. In the event that your child exhibits any loss of consciousness, seizure, or is unable to swallow juice or fast sugar, driver will call 911, and assist child until EMS arrives. Drivers would follow this procedure for any child with diabetes. Students on the buses are strongly discouraged from eating on the bus. But, your child needs to have juice, tabs, or fast sugars available in their backpack for use on the bus. A longer acting snack should also be available for follow up. Please make sure that any snacks your child carries are peanut/nut-free, as there may be risk to children with peanut/nut allergies who ride the bus. You may have medications for severe low blood sugar at school but these may not be with the child when on the bus. If your student carries diabetic supplies including Glucagon, Baqsimi or G-Voke with them, please make the driver and the nurse aware. If you and your physician need to make specific arrangements with transportation, we invite you to contact them directly at 602-467-5180. Nurse: ____________________ School: _____________________ Phone: ___________ Parents/Guardian, please complete in duplicate: My child is _________________________________________ (include full name and grade) and rides Bus Number AM: _______PM:__________  My child has insulin dependent diabetes. In the event of a possible low blood sugar reaction, proceed as follows: Student complains of feels low, has behavior changes, poor coordination, blurry vision, weakness, slurred speech, confusion, or complains of headache, or _________________________________. Driver is to: Remind the child to eat one of fast sugars in back pack, juice, glucose tabs, or ________________. Notify the district dispatch office to call you immediately so you can meet the bus. _______________________________________________________________________________________ Student is unable to swallow any fast sugar, has a seizure, or looses consciousness. Driver to call 911, and assist child until EMS arrives. Driver notifies dispatcher so parents can be notified immediately. ______________________________________________________________________________________ _______________________________________________________________________________________ Contact phone numbers in order of preference: 1st___________________________________ (home / cell) Circle 2nd _______________________________ (home / cell) 3rd _______________________________ (Other________) Circle Parent Name________________________________________Address_____________________________________ Print name Street Address Signature _________________________________________________________ Date: _______________________ Parent: Please give this copy to the bus driver. 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