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FOR OFFICE USE: Notified/Copy Given To: Classroom Teacher PE Teacher Initials PE Teacher Initials Other BP SSE 42b 04/16 Student Anaphylaxis Action Plan and Authorization for and Antihistamine (Effective
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How to fill out student anaphylaxis action plan

01
Gather the necessary information about the student's allergies, triggers, and medical history.
02
Obtain a copy of the student anaphylaxis action plan form from the school or medical professional.
03
Fill out the student's personal information, including their name, date of birth, and emergency contact details.
04
List the specific allergens that the student is allergic to, along with any triggers or symptoms that may occur.
05
Provide details of the student's prescribed medication, such as the name, dosage, and instructions for administration.
06
Include any additional emergency procedures or special instructions that may be required.
07
Ensure all sections of the action plan form are completed accurately and legibly.
08
Review the filled-out plan with the student's parents or guardians to ensure they understand and agree with its contents.
09
Submit the completed student anaphylaxis action plan to the school nurse or appropriate authority for record-keeping and dissemination.
10
Regularly update the action plan as necessary, especially if there are any changes in the student's allergies or medication.

Who needs student anaphylaxis action plan?

01
Any student with a known history of severe allergies or anaphylaxis needs a student anaphylaxis action plan.
02
This includes students who have been diagnosed with allergies to foods, insect stings, medications, or other triggers.
03
Students who require the use of an epinephrine auto-injector (EpiPen) or other emergency medication should also have an action plan.
04
Schools, camps, and other educational institutions often require students with severe allergies to have an action plan in place for their safety.
05
It is important to consult with a medical professional to determine if a student needs an anaphylaxis action plan.
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A student anaphylaxis action plan is a document outlining the necessary steps to be taken in case a student experiences a severe allergic reaction.
Schools, parents, and healthcare providers are required to collaborate and file a student anaphylaxis action plan for students with severe allergies.
The student anaphylaxis action plan can be filled out by providing medical history, emergency contact information, list of allergies, symptoms, and treatment plan.
The purpose of a student anaphylaxis action plan is to ensure a quick and appropriate response in case of a severe allergic reaction, to potentially save the student's life.
Important information to include on a student anaphylaxis action plan is the student's medical history, known allergies, emergency contact information, symptoms of an allergic reaction, and treatment plan.
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