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Medical Orders & 504 Accommodations in 1 Document?

Discussion in 'Parents of Children with Type 1' started by momandwifeoftype1s, Oct 12, 2011.

  1. momandwifeoftype1s

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    First, I'm sorry I stormed off of CWD in a huff after getting upset about responses to another thread :eek:. I hope you'll welcome me back. I need some advice about an issue with school, and I didn't think it was appropriate for FB. Thank you!

    We have recently moved to NC from TN. We had all of our ducks in a row with 504 eligibility for diabetes and ADHD, doctors' orders (DMMP), and a 504 accommodations for both diabetes and ADHD. Everything was finally just the way I wanted it to be - formalized and signed by everyone on the team.

    Then we moved to NC last March. I sent all of Connor's paperwork to the principal and school nurse before he even started school, and they assured me that they received the information. We got new doctors' orders in the form of a Diabetes Care Plan (same as a DMMP). The difference is that this form originated from the school instead of from the hospital/doctor. The first page of the Diabetes Care Plan has a paragraph that says:

    "504 Accommodations are in place Yes/No (I circled yes) - carried from TN
    Date Received: I wrote in 3/29/11 (date Connor started school in NC, since his 504 carried over from TN)
    Reasonable accommodations for this student include but are not limited to:
    Bathroom privileges: Allow free and unlimited use of bathroom facility. If this is being abused, please contact school nurse.
    Access to water: Student should be allowed to carry water bottle if desired.
    Testing concerns: Academic performance may be adversely affected due to fluctuations in blood sugar levels. Therefore, additional accommodations may be necessary."

    Since this form does not have room to write in all of Connor's 504 Accommodations (established in TN), I hand wrote "*See 504 Plan for full list of accommodations" and added to the section about water access "and unlimited access to water fountain". I also wrote an added section under the last sentence "See 504 Plan".

    We used this wording from March until the end of school last year and never had a 504 Review meeting, since it was just a short time that Connor would be in school for the remainder of the year. That was fine with me because I knew the school had a copy of his 504 Plan from TN (sent to Principal and School Nurse).

    Sooo....At the beginning of this year, the school psychologist set up a 504 Review meeting. She called me before the meeting to tell me that Connor's diabetes accommodations did not need to be in a 504 Plan because all his needs are covered in the school's Diabetes Care Plan (DMMP) :rolleyes:. I told her that this was unacceptable to me, and I needed his accommodations to continue to be in a formal 504 plan for accountability. Since he has diabetes and ADHD, they could see if they'd prefer an IEP to cover both. Either way, it was going to continue to be a formal accommodations plan.

    DH took time off work to attend the 504 review meeting with the school administration, including the Principal, School Psychologist and his teachers (team). The nurse was not in attendance. When we first walked in the room, I knew something was wrong. There was only one piece of paper in front of everyone, and it was the 504 Accommodations page for ADHD. There was no 6-page document of Connor's diabetes accommodations from TN. I immediately pointed out the ommission, and the school staff acted like they didn't know what I was talking about. I took it out of my binder and reminded the Principal that I had sent it to him before Connor started school. He said that he did, but he didn't know what it was. The School Psychologist made a copy of the 504 Plan that I brought. I said we would have to meet again to discuss his diabetes accommodations since nobody had a copy before today. So - total waste of DH and my time.

    We went over Connor's ADHD accommodations, which went fine and new NC forms were filled out - transferred the information from TN to NC forms. We were running out of time for the meeting, so the Principal and School Psychologist and my DH and I stayed behind to go over a rough draft of changing minor cosmetic changes to Connor's existing 504 Plan from TN (just to tweak to his new school). We agreed to keep the bones of the plan, and just change it to be specific to his new school. Everything seemed fine and dandy at this point. The School Psychologist said that the nurse would be following up with me to address the things in the 504 Plan that might need her input. Then we'd meet again to formalize the 504 Plan.

    I got an e-mail from the School Nurse the next week to set up a meeting with her to go over the 504 Plan. I thought we'd just be going making minor cosmetic changes to Connor's 504 Plan from TN to be specific to his new school. Instead, I was ambushed with her insistence that all his accommodations are already covered in his Diabetes Care Plan (DMMP), and than I don't need a separate document. Again, I explained why this was not acceptable to me. She would not budge. I called my ADA Legal Advocate from the school, and he advised that perhaps we could find a way to compromise by adding a line to Connor's Section 504 Accommodations Plan (mostly for ADHD), but listing out both Type-1 Diabetes and ADHD as reasons for elibility. The first line would read, "Follow (name of school) Diabetes Care Plan and attached accommodations. I did not like having the Diabetes Care Plan being attached in one packet to his accommodations, but I tentatively went with it for that day (I didn't sign anything).

    The School Nurse told me that she give the teachers and TDP's copies of the entire packet, including the Diabetes Care Plan (medical orders), daily schedule, a copy of his log book page as a sample, and his accommodations. It is all one big packet. When I got home, I started to think about this. I don't think it's appropriate for staff who don't take care of Connor's medical care at school to have access to his Diabetes Care Plan (medical orders). Do you? I think it's against FERPA and violates Connor's rights to privacy. I don't think his teachers need to know what medications Connor is taking and the dosages, etc. I think they only need access to his 504 accommodations that are educationally relevant. What do you think? Am I wrong? I'd like the DMMP (or Diabetes Care Plan) to be for the school nurse and TDP's only. The other information should be in a separate document to distribute to his teachers and other school staff as needed. I don't like the idea of a substitute or other random staff having access to Connor's medical information, other than what to do to treat a low/high and protocol for diabetes emergencies.

    I sent an e-mail last Tuesday to the Principal, School Psychologist, and School Nurse to request that we meet again as a complete team to go over Connor's 504 Plan for diabetes. I did not get a reply, so I followed up again with another e-mail this morning. I'm waiting for a reply to that e-mail.

    Please advise on how best to handle this situation. I seem to be getting nowhere about getting Connor's diabetes accommodations finalized in NC. Since we have not come to an agreement as a team, are his TN accommodations still in place? What do I do if the school continues to avoid getting back to me to set up this meeting? How do I get the Diabetes Care Plan and 504 Accommodations Plan to be two different documents? Or should I not press this issue, and allow them to be stapled to the Diabetes Care Plan (DMMP)?

    I know this is really long. I'm sorry. I really appreciate your help!

    Amy
     
  2. momandwifeoftype1s

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    If I am understanding you correctly (if not, let me know), you write up the DMMP and have your doctor sign off? You don't use a form provided by the endo or the school? You make your own? Does the school accept that? I get a blank DMMP or Diabetes Care Plan (whatever is used in the area), and I fill it in the way I want and have it signed by Connor's endo. Sounds similar to what you do (I think).

    The nurse here has a 1 page sheet for all Connor's teachers, but it's stapled together with his medical orders and 504 Accommodations. I think that's too much information for his teachers unless they are providing medical care for him, which they are not. I did not sign a waiver releasing his medical information to them, and it makes me uncomfortable that his private information is distributed to whoever the nurse decides to give it to. I don't even know who has the packet.

    So, you think it's okay to attach his 504 Accommodations to his Diabetes Care Plan (DMMP)? Will that provide enough legal accountability? I am fine with making our accommodations less wordy. I'd love for you to send me what you have. Thanks, Tammy! Can you please call me if you have time to talk? Thank you!
     
  3. momandwifeoftype1s

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    That is a really good idea. Thanks for you fresh set of eyes! I think that's exactly what we will do. I will PM you with my e-mail address. Thanks again for your help!

    Yes, I'm glad that things are going so well for our family here in NC. :D
     
  4. selketine

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    I think our 504 is what you are looking for - and what it was before in TN for you. Our 504 accommodations are on their own paper. There is a 504 form as a cover sheet and there are more accommodations than can fit on the school form so it is attached on a separate piece of paper.

    The state of Maryland has a couple of mostly excellent forms that I fill out each year and the doctor signs that are his DMMP. This has all the technical insulin/pump stuff in it. There IS a line in the 504 that says that the DMMP is part of the 504.

    The nurse "rewrites" just the DMMP into a care plan and some of that goes to teachers - but mostly just as emergency info like in a lock down situation. There is info in there on how much insulin to give for what (highs, eating, etc). I doubt the teachers looks at it much. The rest of the 504 plan with accommodations goes to them in full.

    I think it can work either way - the way we do it (which sounds like what you used to do) or have all the diabetes stuff in the DMMP and have the nurse distill it down to what the teachers need. I think there is a bit more room for error there if she doesn't get everything in.

    It sounds like the issue is just how it is organized and given out. As long as it isn't confusing I don't think it matters!
     
  5. momandwifeoftype1s

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    Yes, that is exactly how we had our forms put together in TN. I cannot for the life of me figure out why the school nurse here is insisting on making everything into one big document. Why fix it if it's not broken? I'd like separate documents - DMMP, IHP, 504 Plan Accommodations, etc. Everything lumped together makes me feel like none of it is legally binding because the front page of the document is titled "Diabetes Health Plan", which is a standardized form for NC schools. Although it's great if you don't already have a 504 Plan because it is quite comprehensive, it's not great when you already have one in place from another state. The nurse keeps saying that the Diabetes Health Plan has to be followed per the law, so it is legally binding per state law. I feel like I'm talking in circles with her. Is this all just a matter of semantics, or am I right to keep pushing the documents to have their own titles and keep them separate? I feel like it's all just becoming a big mush pile, and we worked for years to get things just so :(. Who wants to come be me at our next 504 Review meeting? I'm TIRED.
     
  6. momandwifeoftype1s

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    "The Stupid Diabetes Manual". I like it! I can't even tell you how hard I laughed reading this! :D Thanks for letting me know what the OCR guy said.
     
  7. Lee

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    I've tried reading all of this - but you lost me. It just sounds like they want you to bring some supplies, follow doctors orders, and add a little cya in there as well...

    It sounds like the school has one way of doing it and you have another. As long as the form covers your child's needs, it doesn't have to match your style...

    We have had 504's and Health Plans and Care plans - and they all say the same thing and they are all legally covered.

    Do these forms cover the care of your child? If not, add what is missing - in clear and concise terminology. Honestly, and I say this is a nice way, it seems like you are making mountains out a molehill. This is the school your son is going to attending for years, instead of trying to make them conform to what you are used to in a different state, try and conform to their method. IF things are missing, add them in.

    The best thing about 504's is that they can be adjusted when needed. If you feel like an accommodation is not being followed or was overlooked, you can add it in and have the nurse and the school administrator sign it. Most of us do not have major school issues surrounding the 504 and I would assume that you will not as well. Then you follow up when you need to.

    Some families do have an incredibly difficult time with 504's and need to get OCR involved, but I wouldn't say you are there yet.
     
  8. momandwifeoftype1s

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    No, I'm not anywhere near getting OCR involved or filing any sort of formal complaint. I guess I'm just feeling lost. I've been doing things a certain way for years in TN, and then everything is getting completely changed here in NC. It makes me nervous that I'm losing what I fought so hard for from kindergarten through the end of 3rd grade. I understand that Tammy that it's a matter of semantics, and it seems that everything will be covered by 504 eligibility (which we all agree on). I may very well be making a mountain out of a molehill. That's why I'm asking for opinions. I don't know if I just need to let this go or not. Change is hard. I want to make sure that Connor has legal accountability for his accommodations. Everything is going great at school, so I don't want to make this into a situation that will cause unnecessary tension. We have a great relationship - great teachers - diabetes care. It's just this paperwork that is causing me anguish. Maybe I need to just let it go? I don't know.

    It just is hard to walk into the umpteen millionth meeting with school to discuss 504 stuff and feel like everything I know has been turned topsy turvy. It's disconcerting. It makes me unfortable and makes me doubt my abililty to advocate for my son. It's just so hard. Sigh.

    I don't want confrontation. I just want to make sure we're fully covered and not getting screwed over. That's the bottom line.
     
  9. Lee

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    Based on this
    What exactly do you think is missing?

    It sounds like things are different here then what you are used to. And instead of you making the change to what was a very personal battle to you at the old system, you expect them to change to accommodate you.

    This doesn't have to be a battle...here is my suggestion:
    Take a copy of your old 504
    Mae a copy of the new 504

    Cross off each item that is covered on both forms.
    Write down, in 1 column, what was not covered on the new 504, based on what was covered on the old 504.
    Write down, in column 2, what this new 504 covers that is not covered in the old 504.

    Put the two 504's away and look at your list. Add and remove things from this simple list as needed.

    This exercise will take the wording, the terminology, and yes, the emotion out of the 504 process and boil it down to simple facts. When we react emotionally to something and feel like we cannot make a decision, it is based on emotion. You admit this emotion is based in your reluctance to change. So, you are taking the emotion out.

    Bottom line - facts don't lie and you need to get to the facts.
     
  10. momandwifeoftype1s

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    Yes, I'm doing a red-line to find the differences between the documents. I want to make sure everything is covered. It is very hard to assume the best in a school system when you've gone through h-e-l-l. I want to trust, but I'm also very cautious to make sure that all my i's are dotted and t's are crossed before finalizing documentation. Especially since I continue advocacy for more than just my son. I want to make sure I fully understand NC paperwork and that it is just as legally binding as it was in TN. Even if it's very different. Good point that I can revise the 504 if it's not exactly right. Sometimes I get caught up in being too precise about little details, when I should just let it go. Thanks for the reminder!
     
  11. Mom2Will

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    I'm in NC, Will has been in NC schools since kindergarten. ALL of his needs have and are being met in a form called 504 that has "see attached diabetes care plan" which plan includes anything I wanted it too. Not complicated at all. No big fuss with a 504 meeting. Actually, I emailed the people involved before the meeting with what I wanted in the 504 and the form I wanted it in and when I got to the meeting all that needed done was me to sign it, the others already had.

    Does NC want you to be a responsible parent--YES--does the state want you to furnish supplies--YES--does the state want you or someone else to be available if something happens--YES--does all that have to be in writing---YES--why? Because people like to sue......and others want the school to supply things like insulin, syringes, pump supplies and the school system wants to make perfectly clear to parents what is expected of them and what is expected of the school.
     
  12. Christopher

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    Since you asked for opinions I am going to say this. I think you are wayy over thinking this. You stated that things are going great at school. Teachers are great, diabetes care is great, relationships are great, everything is going Great! It is just the "paperwork" that you are concerned about. I say just do what they want you to do with the paperwork and let it go. It seems you are concerned that something in the paperwork is going to change how they deal with your son. IF in the future something comes up, then deal with it IF it happens.
    Your son is being cared for in a Great way right now. Be thankful for that and let things continue to go the way they are going...which is....Great! :cwds:

    Just my 2 cents. Good luck.
     
    Last edited: Oct 13, 2011
  13. momandwifeoftype1s

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    I appreciate all of your input, and I agree that I need to just focus on the actual care (which is great!) and not try to get the paperwork conformed to be exactly what I want. I'd rather have great communication and nursing coverage with some wording on papers that I'm not 100% in agreement with than perfect paperwork and lousy care.

    The standard diabetes paperwork here in NC is very comprehensive, but it's not very specific to the needs of the individual child. I think it's hard to have a one-size-fits-all form for all children with diabetes because all children have different needs. I wish there was more room on the form to address the specific needs of CWD instead of having to make additional attachments/addendums. Ah, well. I guess I can't solve everything today.

    As long as they're not debating his 504 eligibility and keeping the accommodations that are most important for Connor, I think we can make this work. I just need to breathe and let some minor things go.
     

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