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TOWN OF SMITHSON SCHOOL AGE CHILD CARE
2017/2018 MEDICAL FORM INSTRUCTIONS FOR EPIPENAccording to New York State Office of Children and Family Services, these are the only
forms that will be accepted
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How to fill out medical cover sheet-epi-pen
How to fill out medical cover sheet-epi-pen
01
Gather all necessary information such as personal details, medical history, and emergency contact information.
02
Ensure you have the medical cover sheet form for the epi-pen specifically.
03
Start by writing your name, date of birth, and contact information on the form.
04
Fill in information about any known allergies or medical conditions.
05
Include details about your current medications.
06
Provide emergency contact information, including the phone number of someone who can be reached in case of an emergency.
07
If applicable, indicate any special instructions or additional information that may be important for medical personnel to know.
08
Review the completed form for accuracy and legibility.
09
Sign and date the form to validate it.
10
Keep a copy of the filled medical cover sheet-epi-pen for your records, and provide a copy to your healthcare provider or school as needed.
Who needs medical cover sheet-epi-pen?
01
Individuals who have been prescribed an epi-pen by their healthcare provider.
02
People who have severe allergies or are at risk of anaphylaxis.
03
Individuals with a history of severe allergic reactions to certain substances or foods.
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What is medical cover sheet-epi-pen?
The medical cover sheet-epi-pen is a form that provides information about an individual's need for an EpiPen in case of an allergic reaction.
Who is required to file medical cover sheet-epi-pen?
Individuals who have been prescribed an EpiPen by a healthcare provider are required to file the medical cover sheet-epi-pen.
How to fill out medical cover sheet-epi-pen?
To fill out the medical cover sheet-epi-pen, you will need to provide personal information, details about your allergy, information about your healthcare provider, and any other relevant medical information.
What is the purpose of medical cover sheet-epi-pen?
The purpose of the medical cover sheet-epi-pen is to ensure that individuals who require an EpiPen have access to it in case of emergency.
What information must be reported on medical cover sheet-epi-pen?
The medical cover sheet-epi-pen must include personal information, details about the allergy, information about the prescribing healthcare provider, and any other medically relevant information.
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