Pupil’s name: Date of birth: CHI: Address: School: Insert photograph of pupil This plan should be completed by the pupil’s parent/carer and, where it involves the administration of medication, it must be approved by the hospital consultant/specialist nurse. Name of approving clinician: Signature: Date: Signature of parent/carer: Date: Once completed, the parent/carer is responsible for taking a copy of this Individual Healthcare Plan to all relevant hospital appointments for updating.
Pupil’s name: Date of birth: CHI: Address: School: Insert photograph of pupil This plan should be completed by the pupil’s parent/carer and, where it involves the administration of medication, it must be approved by the hospital consultant/specialist nurse. Name of approving clinician: Signature: Date: Signature of parent/carer: Date: Once completed, the parent/carer is responsible for taking a copy of this Individual Healthcare Plan to all relevant hospital appointments for updating.
App_17_Form_11b_Diabetes_Insulin_Injections.docx