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Diabetes Association 504 Plan Form
_________________
______________________________
Student’s Name
____________________________________
Homeroom Teacher
________________
Birth Date
_____
Grade
_____________
Disability
_________________________________
Bus Number
BACKGROUND
The student has type ____ diabetes. Diabetes is a serious, chronic disease that impairs the body’s ability
to use food. Insulin, a hormone produced by the pancreas, helps the body convert food into energy. In
people with diabetes, either the pancreas...
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