Get Sample 504 - Hackensack University Medical Center

The Sample 504 form is essential for ensuring that students with diabetes receive the appropriate support in schools. This guide will walk you through the process of completing the form online, ensuring that all necessary information is included for the child's health and safety.

Follow the steps to complete the Sample 504 form online.

1. Use the ‘Get Form’ button to access the Sample 504 form and open it in your editor.
2. Begin by filling in the date, school name, and grade of the student in the designated fields.
3. Complete the student's name and birthdate, ensuring accuracy for proper identification.
4. Provide the home address of the student, which is crucial for emergency contacts.
5. Fill in the parent's or guardian's full name and contact information, including home and work phone numbers.
6. Enter the name, number, and relationship of an emergency contact to ensure swift communication in case of health issues.
7. List any known allergies the student has to prevent adverse reactions while at school.
8. Provide detailed information regarding the child's diabetes diagnosis and any pertinent medical history, including contacts for primary care and specialists.
9. In the section for school personnel, explain general information about diabetes, and add specific instructions regarding the child's care, such as handling low or high blood sugar.
10. Review the form for completeness, ensuring all sections are filled accurately.
11. Once you have filled in all necessary information, save the completed form, and choose to download, print, or share the document as needed.

Complete your documents online with confidence and ensure a smooth process for your child's health needs.