Version 2.77


The "Type II Diabetes Action Plan" is a communication tool medical providers use to inform school staff of a patient's diabetic condition and treatment protocol. School staff uses this Information to guide and authorize their treatment of the child's diabetes while at school. The following information is included in the plan: 1. Patient Information: name, dob, , grade, date diabetes diagnosis, 2. Contact Information: parent/guardian, address, phone numbers, 3. Students Health Care Provider: provider and clinic names, phone numbers, 4. Emergency Contact: name, relationship, phone numbers, 5. Blood Glucose Monitoring: target range, times to check blood glucose, if student can do checks self, type of blood glucose monitor, 6. Insulin: if insulin at school or not, type of insulin, insulin doses: school, lunchtime, meal bolus: units/grams carbo, correction: units per md/dl over mg/dl (correction scale), if parents provide written, 7. Student's role in management of their diabetes (check skills present): basic skills, syringe/pen skills, insulin pumps, oral medications, 8. S/S abnormal blood sugars checklist, 9. Actions for Low Blood Sugar dependent on measurement and/or consciousness, 10. Actions for High Blood Sugar, 11. Daily School Routines/Classroom Information/Accommodations: checklist re lunchtime & snack carbs, access drinking water, bathroom privileges, recess time, physical education,12. Extra Snacks/Parties: checklist re treats in classroom, 13. Students who ride the bus: if low, 14. Students who drive: if low, 15. Field trips: check list, 16. Equipment and Supplies: list, and 17. Acknowledgment: provider signature and date, parent/guardian signature and date. Source: Southeast Minnesota Beacon Community

Basic Part Properties

Part Display Name
Diabetes Type II action plan
Part Type
Component (Describes the core component or analyte measured)
Created On
Construct for LOINC Short Name
Diabetes type II action plan

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Language Variants Get Info

Tag Language Translation
ru-RU Russian (Russian Federation) Диабет II типа план действий
zh-CN Chinese (China) 糖尿病II型行动计划
Synonyms: 糖尿病II型(糖尿病Ⅱ型、糖尿病2型、II型糖尿病、Ⅱ型糖尿病、2型糖尿病)行动计划(行动方案);糖尿病II型行动方案;糖尿病2型行动计划;糖尿病Ⅱ型行动计划
it-IT Italian (Italy) Diabete tipo 2, piano d'azione
Synonyms: Piano d''azione per diabete tipo 2