Diabetes Clinic Care Management Forms
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Blood sugar logbook (Microsoft Excel)
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Blood sugar logbook (PDF)
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School Plan (PDF)
- School Plan Dosing Worksheet (PDF)
- School Plan Dosing Guidelines Sheet (PDF)
- Clinic follow-up form with pump therapy (PDF)
- Sick Day Management Flow Chart (PDF)
- Pump Logbook page (PDF)
- Pump Logbook page 3 day(Microsoft Excel)
- Pump Logbook page 7 day (Microsoft Excel)
- Pump Logbook comment sheet (Microsoft Excel)
- Site rotation chart (PDF)
2011-2012 School plans
Patients are required to have an annual diabetes care plan on file at their school. A copy also needs to be on file in the Diabetes Clinic.
School Plan Instruction Sheet (PDF)
School Plan (PDF)
School Plan dosing guideline sheet (PDF)
If you have questions or problems completing your school plan, call the clinic where you receive care:
Diabetes Clinic: (414) 266-3380
Children's Hospital of Wisconsin (Milwaukee)
Diabetes Clinic: (920) 969-5390
Children's Hospital of Wisconsin Fox Valley Clinic