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Get the free Asthma Inhaler and Epi Pen Permission Form

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This form is required to grant permission for a child to possess and use an asthma inhaler or epinephrine auto-injector at Camp Calumet. It must be completed and submitted four weeks prior to attendance, with appropriate medical authorization.
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How to fill out asthma inhaler and epi

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How to fill out asthma inhaler and epi

01
Gather your asthma inhaler and epinephrine auto-injector (EpiPen).
02
For the asthma inhaler: Shake the inhaler well before use.
03
Remove the cap from the inhaler.
04
Breathe out fully, away from the inhaler.
05
Place the inhaler in your mouth, sealing your lips around it.
06
Press down on the inhaler while inhaling deeply to get the medication.
07
Hold your breath for about 10 seconds to allow the medicine to settle in your lungs.
08
For the EpiPen: Remove the safety cap from the EpiPen.
09
Hold the EpiPen in your fist with the orange tip pointing downward.
10
Press the orange tip firmly into the outer thigh, holding for 3 seconds.
11
Massage the injection site for 10 seconds after removal.

Who needs asthma inhaler and epi?

01
Anyone diagnosed with asthma who has an asthma management plan.
02
Individuals who experience severe allergic reactions or anaphylactic reactions.
03
People with a history of asthma attacks or allergic responses.
04
Patients advised by healthcare professionals to carry an inhaler and EpiPen.
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An asthma inhaler is a device that delivers medication directly to the lungs to help relieve asthma symptoms. Epi, short for epinephrine, is a medication used in emergency situations to treat severe allergic reactions (anaphylaxis).
Individuals who use asthma inhalers or carry epinephrine auto-injectors for allergies may be required to file information for safety reporting, especially in certain regulations or guidelines that govern medication use.
To fill out the necessary forms for asthma inhalers and epinephrine, follow the instructions provided with the forms, ensuring that all required fields regarding personal information, medication details, and usage instructions are completed accurately.
The purpose of an asthma inhaler is to provide quick relief from asthma symptoms such as wheezing and shortness of breath, while the purpose of an epi is to quickly counteract severe allergic reactions and prevent shock.
The information that must be reported typically includes the patient's name, medication type, dosage, frequency of use, and any adverse effects or incidents related to the inhaler or epi.
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