Get the free Form 504.1.4 Anaphylaxis Emergency Plan - Lethbridge School ... - lethsd ab
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LETHBRIDGE SCHOOL DISTRICT NO. 51 Revised January 2015 Form 504.1.4 Anaphylaxis Emergency Plan Name: This person has a potentially life-threatening allergy (anaphylaxis) to: Peanut Other: Tree Nuts
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How to fill out form 50414 anaphylaxis emergency
How to fill out Form 50414 Anaphylaxis Emergency:
01
Fill in the header section: Provide your name, date of birth, and contact information in the designated fields.
02
Provide medical information: Indicate any known allergies or triggers that may cause an anaphylactic reaction. Specify the severity of your allergies as well.
03
Emergency contact details: Share the contact information of a trusted individual who should be notified in the event of an anaphylactic emergency.
04
List emergency action plan: Detail the specific steps that should be taken if you experience an anaphylactic reaction. This may include administering an epinephrine auto-injector or calling 911.
05
Medication information: Include any medications you rely on to manage your allergies. Specify the name, dosage, and frequency of use for each medication.
06
Sign and date the form: In the designated section, provide your signature and the date to confirm that the information provided is accurate and up to date.
Who needs Form 50414 Anaphylaxis Emergency?
01
Individuals with known allergies: This form is relevant for individuals who have been diagnosed with allergies that have the potential to trigger an anaphylactic reaction.
02
People who require emergency assistance: Form 50414 is necessary for those who may need immediate medical help in the case of an anaphylaxis emergency.
03
Allergy sufferers with a prescribed emergency action plan: Individuals who have an established emergency action plan to manage their allergic reactions should fill out this form to ensure that relevant information is readily available in case of an emergency.
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What is form 50414 anaphylaxis emergency?
Form 50414 anaphylaxis emergency is a document used to report instances of anaphylaxis emergencies.
Who is required to file form 50414 anaphylaxis emergency?
Schools, daycare centers, and other institutions where anaphylaxis emergencies may occur are required to file form 50414.
How to fill out form 50414 anaphylaxis emergency?
Form 50414 should be filled out with relevant information regarding the anaphylaxis emergency, including the date, time, and details of the emergency.
What is the purpose of form 50414 anaphylaxis emergency?
The purpose of form 50414 is to provide a way to document and report anaphylaxis emergencies for proper record-keeping and analysis.
What information must be reported on form 50414 anaphylaxis emergency?
Information such as the name of the individual experiencing the anaphylaxis, the trigger of the reaction, and the steps taken in response to the emergency must be reported on form 50414.
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