Get the free Food Allergy Action Plan - Lacey Township School District

Students name___Food Allergy Action Plan Students name___D. O.B.___Teacher___ Allergy to:___ Documented episode of anaphylaxis: Yes___ No___ Asthmatic? Yes*___ No___ *Higher risk for SEVERE reaction

How to fill out food allergy action plan

How to fill out food allergy action plan

1. Obtain the food allergy action plan form from your healthcare provider or school nurse.
2. Fill out the student's personal information including name, date of birth, and emergency contact information.
3. List the specific food allergies that the student has and indicate the severity of the allergies.
4. Detail the symptoms that may occur in case of an allergic reaction and the appropriate steps to take.
5. Include information about any medications that the student needs to take in case of an allergic reaction.
6. Sign and date the form and make a copy for the school nurse, teacher, and any other relevant parties.

Who needs food allergy action plan?

1. Individuals who have been diagnosed with food allergies
2. Students who attend school or participate in extracurricular activities where exposure to allergens may occur
3. Parents or caregivers of children with food allergies

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What is food allergy action plan?

A food allergy action plan is a detailed document that outlines the specific steps to be taken in the event of an allergic reaction to food. It typically includes information on identifying symptoms, emergency contact information, and treatment procedures.

Who is required to file food allergy action plan?

Individuals who have diagnosed food allergies, parents of children with food allergies, and schools or childcare providers that attend to children with known food allergies are usually required to file a food allergy action plan.

How to fill out food allergy action plan?

To fill out a food allergy action plan, one must provide personal information, list known allergens, detail symptoms and emergency response actions, include contact information for healthcare providers, and emergency contacts, and ensure the plan is signed by a medical professional.

What is the purpose of food allergy action plan?

The purpose of a food allergy action plan is to ensure that individuals with food allergies are protected and have a clear guideline on how to respond in case of an allergic reaction, thereby minimizing risk and ensuring prompt treatment.

What information must be reported on food allergy action plan?

The information that must be reported includes the individual's name, a list of allergens, recognition of symptoms, emergency contacts, healthcare provider details, and specific treatment protocols, including the use of epinephrine if necessary.