Missouri Department of Health and Senior Services



Use this documentation training sheet if TDP will be working in building without direct, on-site nurse supervisionDiabetes Care TasksKnowledge TrainingRN Initials & DateSkills TrainingRN Initials & DateCompetence VerifiedRN Initials & DateDiabetes BasicsBlood Glucose MonitoringHypoglycemiaGlucagon administrationHyperglycemiaKetone Monitoring Insulin BasicsInsulin Administration – PenInsulin Administration –SyringeInsulin Administration – PumpCarbohydrate countingContinuous Glucose monitoring CGMHaving provided education and technical training, I agree that the above individual has been adequately trained and has achieved competence in the performance of the above named procedures, as documented on the form.RN signature _____________________________________________ Date:______________________ ................
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