Food Allergy Action Plan
This form documents the foods which cause an allergic reaction for the student. Typical symptoms and first aid action are outlined. Specific instructions for use of emergency medications for allergic reactions and anaphylaxis to food and are documented by the child's physician. After this form is completed, the physician and parent sign the form. This information is used for permission to administer medications as well as consideration when developing the student's individual health plan. Each school year a new plan is required.
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This form documents the foods which cause an allergic reaction for the student. Typical symptoms and first aid action are outlined. Specific instructions for use of emergency medications for allergic reactions and anaphylaxis to food and are documented by the child's physician. After this form is completed, the physician and parent sign the form. This information is used for permission to administer medications as well as consideration when developing the student's individual health plan. Each school year a new plan is required.
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Allergy to Insects or nonfood items
This form documents the allergens. Specific care for inadvertent exposure to the allergen is completed by the physician. Emergency administration of medication in the case of exposure and anaphylactic symptoms is ordered. Both the physician and child's parent sign the form. Each school year a new form is required. This information is used to develop the child's individual health plan.
PRINT FORM
This form documents the allergens. Specific care for inadvertent exposure to the allergen is completed by the physician. Emergency administration of medication in the case of exposure and anaphylactic symptoms is ordered. Both the physician and child's parent sign the form. Each school year a new form is required. This information is used to develop the child's individual health plan.
PRINT FORM