Get the free Self Administration of Epinephrine Auto Injector Authorization Form

Buckeye Valley Local School District Self Administration of Epinephrine Auto Injector Authorization Form A completed Allergy Action Plan must accompany this form. Student Name: Date of Birth Student

How to fill out self administration of epinephrine

How to fill out self administration of epinephrine:

1. Check the expiration date: Before using an epinephrine auto-injector, ensure that it is not expired. Expired medication may not be effective.
2. Remove the safety cap: Grip the auto-injector firmly with one hand and use the other hand to remove the safety cap. The needle will be exposed once the cap is off.
3. Administer the injection: Hold the auto-injector against the outer thigh, making sure to align the black tip with the outer thigh. Press firmly and hold in place for a few seconds until the medication is fully delivered.
4. Seek emergency medical help: After administering epinephrine, call emergency services immediately or have someone nearby do so. It is crucial to receive professional medical attention, even if symptoms improve.
5. Dispose of the used auto-injector properly: Safely dispose of the used auto-injector as per local regulations. Some pharmacies or healthcare providers may have collection programs for sharps or used auto-injectors.

Who needs self administration of epinephrine?

1. Individuals with severe allergies: People who are at risk of severe allergic reactions, such as those with food allergies, insect sting allergies, or medication allergies, may need to carry and self-administer epinephrine.
2. People with a history of anaphylaxis: Individuals who have previously experienced anaphylaxis, a life-threatening allergic reaction, are commonly advised to have epinephrine available and be trained in its self-administration.
3. Individuals at risk in certain environments: People who spend time in environments where they may be exposed to allergens, such as schools, workplaces, or outdoor areas, may need self-administration of epinephrine to be prepared for potential allergic reactions.

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