By signing below, I declare that I will be monitoring my own blood glucose (sugar) levels and do not require any assistance.

My responsibilities in monitoring my own blood glucose levels:

• Monitoring the expiry date for test strips, lancets and needles and reordering more when required.

• Recording my blood glucose levels at the times agreed upon by my doctor or diabetes health professional, or at the times stipulated in my Diabetes Care Plan.

• Carrying out treatment according to my Diabetes Care Plan should my blood glucose level be recorded as lower or higher than the recommended levels.

• Ensuring that I get bloods or other specimens taken if advised by my doctor or diabetes health professional.

• Informing my doctor or Skymac staff of any difficulties that I may encounter while monitoring my Blood Glucose Levels.

• Ensuring that my own blood glucose level equipment is always maintained in accordance with the manufacturer’s instructions and stored securely in my room.

• Not to share any equipment or supplies with other people.

Note from Skymac Pty Ltd:

We acknowledge and encourage residents to maintain their independence for as long as possible in a safe and effective manner. As an approved Level 3 supported accommodation facility and registered NDIS Service Provider, we also have a duty of care to ensure that your blood glucose level is managed safely and effectively, and we seek your cooperation to make this possible.

• Skymac maintains the right to inform the treating doctor that you have elected to manage your own blood glucose levels.

• Should your room be unattended and left unlocked/open and staff notice that your monitoring equipment is not secure, the room may be locked immediately.

• Should management become aware that you are misusing your blood glucose equipment or not recording and monitoring in accordance with your treating doctor’s orders, management may notify your treating doctor.

• Skymac and its staff do not take responsibility for any residents who manage their own blood glucose levels.

• Should I miss taking a reading at the times specified in my Diabetes Care Plan, I do so at my own risk and Skymac may notify my doctor or diabetes health professional.