Express Check-In 2019 - Camp Sweeney

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Express Check In - Online Medical Survey	Criteria for Express Check-In * Attended a 3-week session in 2018 * Completed and turned in all enrollment paperwork * Completed this online survey * Available for follow-up medical phone call When your paperwork and this survey is complete, the Camp Sweeney medical staff will follow up with a personal phone call. Please make sure you will be available at the phone number you provide in this survey. CALL TIMES: Med Staff will be calling from now through 1PM on Saturday before opening day.
Camper Name	Clayton Halpin
Camper Birthdate MM/DD/YYYY	03/05/2003
Session Camper is Attending	Third Session
Primary Guardian	This is the person we will be contacting for follow-up.
Primary Guardian Name	Erica Halpin
Primary Guardian Phone	(214) 394-6211
Phone Type	Cell
Special instructions for calls to primary guardian, if any	no
Primary Guardian Email	Email hidden; Javascript is required.
Primary Guardian Relationship to Camper	Mother
Alternate Guardian	In case we cannot reach the primary guardian.
Alternate Guardian Name	Joel Halpin
Alternate Guardian Phone	(214) 912-9715
Phone Type	Cell
Alternate Guardian Email	Email hidden; Javascript is required.
Alternate Guardian Relationship to Camper	Father
Medication and General Health
Has your camper been ill or prescribed any antibiotics within last 60 days?	No recent illnesses
Does your camper have any medical conditions other than diabetes?	No other medical conditions
Is your camper currently taking any over-the-counter or prescription medication (not including insulin)?	No medications
Does your camper have any DRUG ALLERGIES?	No drug allergies
Meals
Meal Plan link	Please make sure you choose the correct meal plan for your child. We will not be able to change it during EXPRESS registration. Click the button below to see more information about specific meal plans. Meal Plans
Select a Meal Plan	2500 kCal (80g/meal)
Are you open to the Medical Staff adjusting your camper's meal plan as needed over the summer?	Yes
Does your child want Milk at meal times? Check all that apply.	No milk at any meal
Vegetable Portion Size?	Small Vegetable
Does your camper have any FOOD ALLERGIES or INTOLERANCES?	No food allergies or intolerances
Diabetes
Does this camper have diabetes?	Yes
What year was your camper diagnosed?	2014
When was the date of your camper's most recent HbA1c? MM/DD/YYYY	04/29/2019
What was your camper's most recent HbA1c?	7.1
Insulin
What type(s) of insulin will your camper use this summer at Camp?	H-Humalog
What is your camper's insulin to carb ratio for BREAKFAST?	1:6
What is your camper's insulin to carb ratio for LUNCH?	1:5
What is your camper's insulin to carb ratio for DINNER?	1:5
What is your camper's insulin to carb ratio for BEDTIME?	1:5
Would you like your camper to receive insulin for a 15g afternoon snack?	No
Correction Scales
How much insulin do you give when correcting for highs during BREAKFAST/MORNING?	1 unit for every 25 over 120
How much insulin do you give when correcting for highs during LUNCH/AFTERNOON?	1 unit for every 25 over 120
How much insulin do you give when correcting for highs during DINNER/EVENING?	1 unit for every 25 over 120
How much insulin do you give when correcting for highs during BEDTIME/OVERNIGHT?	1 unit for every 25 over 150
Insulin Delivery
Will your camper use a pump at Camp?	Yes
What is the color of your pump/skin?	grey
What is your pump serial number?	(21)130424187
How often does your camper change the pump site?	2 days
When will be the last time the pump site is changed before arriving at Camp?	07/19/2019
Enter your camper's Basal Rates:	12a-4a 2units 4a-11a 2.3 units 11a-2p 2.4 units 2p-6p 1.6 units 6p-10p 2.6 units 10p-12 a 2.6
CGM
Will your camper use a CGM at Camp?	No
Call	Not Called
Completed	No
Entry ID	37531
Entry Date	July 18, 2019