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Maryland Department of Health (MPH) Center for Healthy Homes and Community Services (CHOCS) 6 St. Paul Street, Suite 1301 Baltimore, Maryland 212021608 (410) 7678417 FAX (410) 3338926 Toll Free 18774633464
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How to fill out emergency epinephrine certificate holder

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How to fill out emergency epinephrine certificate holder

01
Fill in the personal information section such as name, address, date of birth, and emergency contact information.
02
Provide information about the prescribed epinephrine medication including dosage, expiration date, and how it should be administered.
03
Include details about any known allergies or medical conditions that the individual may have.
04
Have a healthcare provider sign and date the certificate to certify that the information provided is accurate.

Who needs emergency epinephrine certificate holder?

01
Individuals who have been prescribed epinephrine by a healthcare provider for severe allergies or anaphylactic reactions.
02
Schools, workplaces, or public venues where there is a risk of allergic reactions occurring and access to emergency epinephrine is necessary.
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An emergency epinephrine certificate holder is a person or entity authorized to possess and administer epinephrine in emergency situations, particularly for severe allergic reactions.
Individuals, schools, camps, and organizations that wish to possess epinephrine auto-injectors and administer them during emergencies are required to file as emergency epinephrine certificate holders.
To fill out the emergency epinephrine certificate holder application, provide the required information including your name, address, purpose for possession, and any relevant training or certification details.
The purpose of an emergency epinephrine certificate holder is to ensure that trained individuals or organizations can effectively respond to anaphylactic emergencies by having access to epinephrine.
Information that must be reported includes the holder's name, contact information, number of epinephrine auto-injectors, location where they will be stored, and training details.
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