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    NIAGARA CATHOLIC DISTRICT SCHOOL BOARD

    STUDENT DIABETES MANAGEMENT PLAN OF CARE ANNUAL REVIEW : APPENDIX D
     


     
    When there are no significant changes to Sections 3-8 of the Student Diabetes Plan of Care (Appendix B), school staff, parent(s), and student (where age-appropriate) can use this Annual Review Record to confirm that the plan has been reviewed, and any changes to Sections 1 and 2 (Student Profile and Information and Emergency Contacts) has been updated and included with the Plan of Care. When the Plan of Care requires significant changes, complete a new Student Diabetes Management Plan of Care  (Appendix B).  
    ☐ This plan remains in effect for the YYYY to YYYY school year without change.
    Parent/Guardian:
    		 
    Date:
    		 
    Principal:
    		 
    Date:
    		 
    ☐ This plan remains in effect for the YYYY to YYYY school year without change.
    Parent/Guardian:
    		 
    Date:
    		 
    Principal:
    		 
    Date:
    		 
    ☐ This plan remains in effect for the YYYY to YYYY school year without change.
    Parent/Guardian:
    		 
    Date:
    		 
    Principal:
    		 
    Date:
    		 
    ☐ This plan remains in effect for the YYYY to YYYY school year without change.
    Parent/Guardian:
    		 
    Date:
    		 
    Principal:
    		 
    Date:
    		 
    ☐ This plan remains in effect for the YYYY to YYYY school year without change.
    Parent/Guardian:
    		 
    Date:
    		 
    Principal:
    		 
    Date:
    		 
     

     

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    *This information is being collected pursuant to the provisions of the Municipal Freedom of Information and Protection of Privacy Act and under the Authority of the Education Act, and will be used by Student Support. Questions about this collection should be directed to the Superintendent of Education – Student Support, Niagara Catholic District School Board, 427 Rice Road, Welland, Ontario L3C 7C1, 905-735-0240.