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Westfield Public Schools Epinephrine Administration Order TOP OF FORM TO BE COMPLETED BY HEALTH CARE PROVIDER Students Name Date of Birth Allergies Grade Teacher Asthmatic? Previous Anaphylaxis Diagnosis:
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What is epinephrine administration order?
An epinephrine administration order is a prescription or standing order that allows specific individuals to administer epinephrine in case of an allergic emergency.
Who is required to file epinephrine administration order?
Schools, daycares, camps, and other facilities that may need to administer epinephrine to individuals with known allergies are required to have an epinephrine administration order on file.
How to fill out epinephrine administration order?
The epinephrine administration order must be filled out by a licensed healthcare provider, such as a physician or nurse practitioner, and signed by the prescribing healthcare provider.
What is the purpose of epinephrine administration order?
The purpose of an epinephrine administration order is to ensure that trained individuals are authorized to administer epinephrine in emergency situations to treat severe allergic reactions.
What information must be reported on epinephrine administration order?
The epinephrine administration order must include the name of the individual receiving the epinephrine, the specific allergies or medical conditions requiring epinephrine, the dosage and method of administration, and the expiration date of the order.
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