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MAD RIVER LOCAL SCHOOLS PARENT REQUEST & AUTHORIZATION TO ADMINISTER MEDICATION (Prescribed or OvertheCounter) Student Name: Address: School: Grade: Teacher: Name of Medication Dosage Time(s) PART
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How to fill out when an epi-pen is
How to fill out when an epi-pen is
01
Remove the blue safety cap from the autoinjector.
02
Hold the autoinjector in your fist with the orange tip pointing downwards.
03
Form a fist around the autoinjector, leaving your thumb free to press the orange tip.
04
Firmly press the orange tip against the outer thigh until you hear a click.
05
Hold the autoinjector in place for 3 seconds before removing.
06
Massage the injection site for 10 seconds to help the epinephrine absorb.
07
Dispose of the used autoinjector properly.
Who needs when an epi-pen is?
01
People who have severe allergies or are at risk of anaphylaxis may need to use an epi-pen.
02
This includes those with a history of anaphylactic reactions to insect stings, certain foods, medications, or other triggers.
03
People with known allergies or a history of anaphylaxis should consult their doctor to determine if an epi-pen is necessary for their specific situation.
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What is when an epi-pen is?
An epi-pen is an emergency medical device used to administer a dose of epinephrine in cases of severe allergic reactions.
Who is required to file when an epi-pen is?
Individuals who are prescribed an epi-pen and their healthcare provider are required to file information about its usage.
How to fill out when an epi-pen is?
To fill out information about an epi-pen, individuals need to provide details on when it was used, the reason for its usage, and any adverse reactions experienced.
What is the purpose of when an epi-pen is?
The purpose of filing information about an epi-pen is to track its usage, effectiveness, and potential side effects for better medical management.
What information must be reported on when an epi-pen is?
Information such as the date and time of epi-pen usage, the person who used it, the reason for its usage, and any adverse reactions must be reported.
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