Get the free EpipenFormRevisedMay2013WebpageUpdate2014.doc - summit k12 nj

Summit Public Schools MEMO To: Parents of Children prescribed Epinephrine for Anaphylaxis From: Summit School Nurses RE: New Jersey P.L. 2007, c.57. And Epinephrine AutoInjector Packet In 2007, the

How to fill out epipenformrevisedmay2013webpageupdate2014doc - summit k12

How to Fill out Epipenformrevisedmay2013webpageupdate2014doc - Summit K12:

1. Obtain the form: Start by acquiring a copy of the Epipenformrevisedmay2013webpageupdate2014doc from the Summit K12 website or any authorized source.
2. Read the instructions: Carefully go through the form and read the instructions provided. Familiarize yourself with each section and understand the information required.
3. Personal information: Begin by filling out the personal information section, which typically includes your full name, address, contact number, and email. Ensure the information is accurate and up to date.
4. Allergy details: In this section, specify your allergies and the severity of each. Provide details on which specific allergens trigger your allergies and any specific instructions or precautions that need to be taken.
5. Emergency contact information: Include the contact details of at least one emergency contact person. This can be a family member, friend, or healthcare professional who can be reached in case of an allergic reaction or emergency.
6. Physician information: Enter the name, contact number, and address of your primary healthcare provider or allergist. This information is essential in case medical assistance is required during an allergic reaction.
7. Epinephrine auto-injector details: Specify the brand and model of your epinephrine auto-injector (such as Epipen, Auvi-Q, or generic). Include the expiration date of the device and any other relevant details requested.
8. Medication instructions: If you are on any additional medications or have specific instructions for the administration of the epinephrine auto-injector, provide them in this section.
9. Signature and date: Once you have completed filling out the form, sign and date it to verify the accuracy of the information provided. By signing, you acknowledge that you understand the purpose of the form and its implications.

Who Needs Epipenformrevisedmay2013webpageupdate2014doc - Summit K12:

1. Students with allergies: The Epipenformrevisedmay2013webpageupdate2014doc is primarily designed for students who have known allergies that may require the administration of epinephrine in case of an allergic reaction.
2. Parents or guardians: Parents or legal guardians of students with allergies may need to fill out this form on behalf of their child. It helps ensure that the school or educational institution has the necessary information to respond effectively to an allergic emergency.
3. School administration or healthcare staff: Professionals working in schools or educational settings, such as nurses or healthcare coordinators, may also need access to the Epipenformrevisedmay2013webpageupdate2014doc. They can use this document to gather important information about students with allergies and ensure their well-being while on school premises.

Please note that the specific individuals who need to fill out this form may vary depending on the policies and requirements of the educational institution. It is essential to consult the school administration or healthcare professionals for accurate information regarding the use and completion of this document.

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