Diabetes record sheet
This child has diabetes
Name: ………………………………………
Date of birth: ……………………………….
Current year/class: …………………………..
If s/he has a hypo, you will need to take the action described on the next
page.
In case of medical emergency, use the contact numbers below.
If the parent(s) are not available, or you need to speak to a healthcare
professional, the telephone numbers of the child’s GP and hospital clinic are also given below.
Contact information
Family contact 1
Name: ………………………………………………………………
Telephone: …………………………………………………………
Relationship: ………………………………………………………
Family contact 2
Telephone: …………………………………………………………
GP
Name: ………………………………………………………………
Hospital clinic contact
Name: ………………………………………………………………
Telephone: …………………………………………………………
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