504 Plan Provisions

SAFETY & HEALTH*
(1) Trained staff (nurses and teachers) to treat emergency low and high blood sugars
(2) Multiple staff members must be trained to administer a Glucagon, in the event of severe hypoglycemia, a life-threatening emergency
(3) Emergency Protocol, stating symptoms of severe hypoglycemia and instruction to call 911 immediately if glucagon is administered
(4) Carbohydrate Counting Support, nutritional information for cafeteria meals
(5) Unrestricted access to a Continuous Glucose Monitor (CGM) and any mobile device used to track data (cell phone), in the classroom or during exams (regardless of school policy banning cell phone use)
(6) Unlimited access to insulin administration and insulin pump support, including site failures and storage (if detachable) for contact sports
(7) Ketone testing if student has very high blood sugar (to prevent Diabetic Ketoacidosis (DKA), a life-threatening condition
(8) Unlimited bathroom breaks
(9) No penalty for absences, tardiness, or missed class time for medical needs

*504 Plans may be based on individualized Diabetes Medical Management Plan (DMMP) provided to school by endocrinologist
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EDUCATION
Since low and high blood sugars impair cognitive function, 504 Plans should include: blood sugar testing before, during, and after all school tests and exams to assure blood sugars are in target range. This should apply to all standardized tests, EOGs, and all tests that are calculated as part of final grades or GPAs.
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PRIVACY
Assure a private setting to administer insulin, test blood sugarRestrict personnel not involved in diabetic management from entering nurse room while student or nurse is managing T1D
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ALL SCHOOL SPONSORED ACTIVITIES COVERED: The 504 safety provisions apply to field trips, sports, all in-school and after-school extracurricular activities (without the need of parental presence).
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SAFETY
(1) If applicable, the provisions for Type 1 diabetics (1) through (6) (above) may be added to a 504 Plan for a Type 2 diabetic, depending on the individualized medical plan of the Type 2 diabetic
(2) The right to test and treat blood sugar anywhere, anytime.
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HEALTH
(1) If exercise is a part of medical management, then 504 Plan may include guaranteed time for physical activity, regardless of schedule changes
(2) Providing dietary substitutions or meal timing to manage insulin resistanceNo penalty for absences, tardiness, or missed class time for medical needs
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EDUCATIONAL
To the extent that the student with Type 2 diabetes has extreme fluctuating blood sugars (out of a target range), then the same educational accommodations available to T1Ds would apply.

PRIVACY
(1) Assure a private setting to administer insulin, test blood sugar
(2) Restrict personnel not involved in diabetic management from entering nurse room while student or nurse is managing T1D
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ALL SCHOOL SPONSORED ACTIVITIES COVERED: The 504 safety provisions apply to field trips, sports, all in-school and after-school extracurricular activities (without the need of parental presence).

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SAFETY
(1) Designated nut-free tables or classrooms
(2) Staff training (mandatory) on recognizing anaphylaxis and administering epinephrine
(3) Handwashing requirements, no-food-sharing rules, safety practices for field trips and class parties
(4) Written Emergency Care Plan to manage accidental exposure
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SAFETY
(1) Written Asthma Action Plan from a physician outlining treatment and emergency procedures (often an Individualized Health Care Plan)
(2) Trained Staff (teachers, coaches, bus drivers) to recognize symptoms and follow Asthma Action Plan
(3) Medication Access: Permission for student to self-carry and self-administer quick-relief medicine at school and on field trips
(4) Storage: a spare inhaler in the nurse’s office, with a nebulizer if needed
(5) Trigger Reduction: Steps to minimize exposure to known triggers such as scented sprays, cleaning products, latex, dust, mold
(6) Indoor Activity: allowing for indoor physical activity during high pollen, high ozone, or poor air quality days
(7) Modifications to PE or recess, or taking medication before activity
(8) Classroom Location: sitting away from allergens
(9) Permission for student to leave the classroom to use medication or rest, if necessary
(10) Home/School Notification: protocols to notify parents of asthma attacks, missed medication, or school-wide sickness
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HEALTH
Excusing absences for asthma-related illnesses, allowing extra time to make up assignments without penalty

BEHAVIORAL SUPPORTS
(1) Preferential Seating: to minimize distractions, student may require seating near the teacher, away from doors, windows, high-traffic areas
(2) Permission to use movement tools, such as wiggle chairs, exercise bands, standing desks
(3) Distraction-free, quiet, separate area for testing and assignments
(4) Daily check-in for planners, checklists for tasks, shortening long-term projects into segments
(5) Movement breaks: scheduled, non-disruptive breaksPositive reinforcement: implement reward systems for behavior, no punishment or consequences for behavior
(6) Communication: daily report card or communication notebook to keep parents updated on progress
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EDUCATIONAL ACCOMMODATIONS
(1) Testing: extra time, break tests into smaller segments, provide oral testing options
(2) Assignments: reduced homework volume, provide copies of class notes, all use of computer for writing
(3) Visual/verbal cues: use private, non-verbal signals to redirect attention to prevent public embarrassment

SAFETY
(1) requirement that the Automated External Defibrillator (AED) be operational and accessible on-site (and for field trips)
(2) Staff trained in CPR and AED use
(3) Teachers and staff should be trained on signs of cardiac distress, such as fainting or shortness of breath, and have a plan of action
(4) Hydration Access: ensure student is allowed to carry and use a water bottle to prevent hydration, which can worsen certain heart conditions
(5) Medical Passes: grant a “free pass” or “no-ask” system to leave class immediately to go to nurse or restroom if student feels unwell
(6) PE Modifications: permit PE to be at student’s pace level, with right to stop or rest if student feels short of breath, tired, or dizzy
(7) Activity Restrictions: prohibitions may include high-intensity activities, or competitive sports with strenuous training
(8) Allow extra time to travel between classrooms, access to an elevator, or use of a rolling backpack to minimize physical strain
(9) Allow student to stay indoors during extreme temperatures, as weather extremes can put additional stress on the cardiovascular system

EDUCATIONAL SUPPORT
(1) scheduled rest periods during the day or shorten school day if student experiences chronic fatigue
(2) Extended time for tests and assignments, especially if medications cause side effects such as drowsiness, dizziness
(3) Written plan for makeup work, homebound tutoring in the event student is absent for surgeries, procedures, medical appointments

PRIVACY
Determine how much information is shared with peers about the student’s medical condition

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SAFETY AND HEALTH
(1) Enzymes: assurance that student will take pancreatic enzymes before all meals/snacks
(2) Medication: dedicated access to school nurse for other medications or treatments (nebulizers)
(3) Allow student to carry enzymes, water, and snacks
(4) Teacher and Staff Education/Training: required training on CF, symptoms to look for, and emergency procedures
(5) Ensuring substitute teachers are aware of student’s needs
(6) Ensure that students with CF stay at least 6 feet apart from each other to prevent the spread of cross-infection
(7) Illness Prevention: access to sanitizing wipes and hand sanitizer, ensure distance from visibly sick peers
(8) Immediate, private, unlimited access to bathroom to manage digestive issues
(9) Unlimited water access
(10) Air conditioning during warm months
(11) Hygiene: required frequent handwashing
(12) PE: allow student to rest, modify activity, or not participate in PE activity if student is experiencing breathing difficulties or fatigue

EDUCATIONAL SUPPORT
(1) Fexible or waived attendance policies to accommodate medical care or morning coughing or fatigue
(2) Plan for making up or modifying assignments and tests when student is absent
(3) Extended time for assignments and tests due to fatigue or treatment times

EDUCATIONAL
(1) Extended Time: (typically 1.5 or 2 x extra) for tests, quizzes, and assignments involving reading/writing
(2) Reduced Writing Load: allowing word processing (typing) instead of handwriting, using speech-to-text software, or allowing verbal answers
(3) Exemptions from copying notes from the board, and using spell-check/word prediction software
(4) Quiet, separate setting for tests to minimize distractions and reduce processing strain

INSTRUCTIONAL ACCOMODATIONS
(1) Audiobooks/Digital Texts: access to audio versions of textbooks and literature
(2) Pre-teaching Vocabulary: allowing student to preview reading materials or new vocabulary before the lesson
(3) Note-Taking Support: provide copies of teacher notes, outlines, or allowing recording of lessons
(4) Visual Aids: using graphic organizers, highlighted texts, and color-coded materials
(5) Multi-sensory Instruction: explicit, structured multi sensory methods for reading and spelling

ENVIRONMENT & SUPPORT
(1) Preferred seating near the teacher to facilitate monitoring
(2) Use of planners, timers, checklists for tracking assignments
(3) Provide a second set of textbooks at home to reduce tracking

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SAFETY
(1) Seizure Action Plan & Medical Management, including an Individualized Health Plan (IHP) and Emergency Care Plan (ECP) outlining seizure types, triggers, and emergency contact information
(2) Instructions on when to call 911
(3) Procedures for administering rescue medication if needed, and methods to administer (nasal spray)
(4) Required training for staff, including teachers, bus drivers, and cafeteria staff, on seizure first aid
(5) Designation of a quiet, private area for rest following a seizure
Modified PE and safety supervision on playgrounds, near stairs, or during swimming activities
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ENVIRONMENTAL
(1) Avoidance of seizure triggers, such as flashing lights or strobe effects in classroom technology or at school events
(2) Preferential seating for better monitoring
(3) Peer education to reduce stigma and foster understanding

EDUCATIONAL
(1) Extra time for tests, quizzes, and assignments to account for potential cognitive fatigue or medication side effects
(2) Flexibility with attendance and homework deadlines due to seizures or medical appointments
(3) Support for missed instruction, such as recorded lessons, note-taking assistance, or tutoring
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SAFETY & HEALTH
(1) Permission to take medications during school hours
(2) Detailed emergency plan for medical situations
(3) Procedures for informing parents of health alters (eg. Flu outbreak)
(4) Unrestricted access to bathroom and water, essential for fluid management and medication side effects
(5) Reduced walking distances, extra time between classes, or elevator access
(6) Hygiene: a germ-safe environment to protect a potentially comprised immune systemPadding or specialized seating for comfort
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EDUCATIONAL
(1) Absences: excused absences for dialysis, medical appointments, or sickness without penalty
(2) Extra time for assignments/tests, and modified homework loads to manage fatigue
(3) Access to a tutor if needed and receiving audio/video recordings of missed classes
(4) Providing 2 sets of textbooks (one for home use)
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ENVIRONMENTAL
(1) Preferential Seating near the door for quick exists, or away from distractions
(2) Safe Space Access: pre-arranged quiet, calm area, such as nurse’s or counselor’s office, to regulate emotions
(3) Safe Person: designated staff member for check-ins when feeling overwhelmed
(4) Flexible Environment: reduced stimuli in the classroom

EDUCATIONAL
(1) Extended time for tests, quizzes, assignments to reduce pressure
(2) Modified assignments; breaking large projects into smaller unitsAlternative testing, either alone or in a quiet secluded location
(3) Modified Participation: allowing oral rather than written tests, or not forcing student to read or speak in front of the classNote-(4) (4) Taking: provide copies of notes or allowing recording of lectures
(5) Flexible attendance, excused lateness or absences due to acute anxiety symptoms or therapy appointments
(6) Transition Time: allowing student to leave class early to avoid crowded hallways between periodsFlexible Scheduling: breaking up school days if necessary
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BEHAVIORAL SUPPORT
(1) Emergency Passes: permanent, discreet pass to leave the classroom to visit a support person
(2) Alternative Activities: options for group work (alone, or with a partner) to manage social anxiety
(3) Reduced Sensory Load: allowing headphones to reduce noise anxiety
(4) Positive Reinforcement: proactive, positive feedback from staff to build confidenceRegular check-ins with a counselor to practice coping skills
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EDUCATIONAL
(1) Extended time for tests, quizzes, assignments to manage slow-processing speed caused by obsessions or perfectionism
(2) Reduce Workload: shortened assignments or reduced homework to prevent burnout and anxiety, focusing on mastery rather than repetition
(3) Alternative Assessment: allow student to demonstrate knowledge through alternative methods, such as oral reports instead of written work
(4) Deadline Flexibility: to accommodate times when OCD symptoms are high
(5) Testing Adjustments: provide quiet, separate, or private location to minimize distractions and anxiety
(6) Note-Taking Assistance: provide a copy of class notes to compensate for difficulty focusing during lectures

BEHAVIORAL
(1) Breaks/Movement: designated breaks to practice response prevention techniques, manage anxiety, or handle compulsions
(2) Preferential Seating: to minimize distraction or allow quick, discreet exit
(3) Safe Space Access: to manage anxiety, and a designate staff member to support (such as a counselor)
(4) Fidget Items: allow use of stress balls or sensory items to help focus and reduce anxiety
(5) Modified Assignments: allow modification on how work is completed, such as using a compute for writing if handwriting is causing distress

ENVIRONMENTAL
(1) Late Arrival/Absences: excuse absences or tardiness related to medical appointments or severe morning OCD symptoms
(2) Routine Management: posting consistent classroom schedule, provide advance notice of routine changes
(3) Technology Access: all the use of speech-to-text software of computers to assist with output