Colorado School Diabetes Provider Orders #201/#202

Colorado school diabetes care uses two Word templates from the Colorado Kids with Diabetes collaborative: Provider Orders #201 for students on injections or oral medication and #202 for students on an insulin pump. The orders set glucose targets, hypoglycemia and hyperglycemia care, correction and carbohydrate dosing, and self-care level, and they feed the school nurse's Individualized Health Plan. Each order lasts a maximum of one year.

Who completes it

The student's diabetes provider (physician, NP or PA) completes the whole order and signs it; the parent and the school nurse also sign, authorizing the orders and the exchange of health information for the Individualized Health Plan.

Submitting and payment

How to submit it
Give the signed orders to the parent, who returns them to the school nurse or child care provider; the nurse uses them with the IHP-Diabetes plan and its addenda.

Good to know

  • Both forms default to the Standards of Care for Diabetes Management in the School Setting unless the provider writes exceptions, and offer age-based glucose targets from 80-200 to 70-130 mg/dl.
  • Severe hypoglycemia orders cover glucagon injection or BAQSIMI nasal spray with a 911 call; the pump version also tells staff to disconnect the pump.
  • Optional checkboxes let parents adjust the sliding scale by up to 2 units or the carb ratio by 1 unit per 5 grams; the pump form adds malfunction orders.
  • For a one-off change, the school nurse can use form #203, One Time Order for BG Correction, to request or document an order from the provider.

Get the official form

Download the current version from the source each time; forms change without notice.

Provider Orders Injections 2020 #201 / Provider Orders Pump 2020 #202

Get the note ready with Vero

This form is a Word template, not a PDF. Vero Scribe writes the visit note it draws on, so the details are ready when you complete it.

How this list is checked

A form is listed only after its name and number were confirmed on the issuing agency’s or insurer’s own website, or in the form itself. Each entry links to that source. The list was last checked in October 2026. Forms and their requirements change without notice, so check the official page for the current version before you complete one.

Vero is not affiliated with, or endorsed by, the agencies and insurers listed here. Read our editorial policy.

Frequently asked questions

How long are Colorado school diabetes provider orders valid?

The signature section on both #201 and #202 states that the order is for a maximum of one year. It also notes that procedures may be performed by unlicensed designated school personnel under the training and supervision of the school nurse, in line with state laws and regulations.

Can school staff change insulin pump settings under form #202?

No. The pump orders say settings are established by the student's health care provider and should not be changed by school staff; changes are made at home or by a student providing self-care as indicated on the IHP. The pump's internal safety features stay active at school, with alarms set conservatively.

Does the Barbara Davis Center use these Colorado forms?

The Barbara Davis Center issues its own computer-generated orders, which Colorado Kids with Diabetes says align with the orders on its site. Other providers can use the #201 or #202 Word templates, which CDE reaches through its link to the Colorado Kids with Diabetes nurse files.