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Allergy and Anaphylaxis Action Plan and Medication Orders Students Name: D.O.B. Grade: School: Teacher: ALLERGY TO: Place children photo here History: Asthma: YES (Higher risk for severe reaction)

How to fill out allergy and anaphylaxis plan

How to fill out an allergy and anaphylaxis plan:

Start by gathering relevant information:

1. Get a copy of the allergy and anaphylaxis plan template, which can usually be obtained from your child's school, daycare, or healthcare provider.
2. Collect information about your child's specific allergies and triggers. This may include food allergies, insect allergies, medication allergies, or other potential allergens.
3. Consult with your child's healthcare provider to ensure accuracy and clarity in documenting their allergies.

Personalize the plan for your child:

1. Fill in your child's name, birth date, and any other pertinent identification details on the form.
2. Include emergency contact information, such as your phone number and an alternate emergency contact, in case immediate medical attention is required.

Document the specific allergies and triggers:

1. Clearly list each allergy or trigger your child has, providing detailed information about the specific allergen and the symptoms it may cause.
2. Specify if your child has a history of anaphylaxis, which is a severe, life-threatening allergic reaction that requires immediate medical attention.

Describe the symptoms and signs of an allergic reaction:

1. Outline the signs and symptoms that may indicate an allergic reaction in your child. These may include hives, facial swelling, difficulty breathing, rapid heartbeat, or gastrointestinal distress.
2. Include any other specific symptoms that your child experiences during an allergic reaction.

Detail emergency procedures and treatments:

1. Write down step-by-step instructions for how to respond in case of an allergic reaction, including administering emergency medication such as epinephrine auto-injectors (EpiPen) or antihistamines.
2. Include dosage instructions for medications and any additional treatments or precautions that should be taken.

Make copies and distribute the plan:

1. Create multiple copies of the completed allergy and anaphylaxis plan.
2. Provide copies to your child's school, daycare, sports coaches, and any other relevant individuals who may be responsible for your child's safety.
3. Keep a copy on hand at home, in your car, or in your bag for easy access in case of an emergency.

Who needs an allergy and anaphylaxis plan:

Individuals with known allergies and triggers:

1. People of all ages who have documented allergies to foods, medications, insects, or other substances should have an allergy and anaphylaxis plan.
2. This includes children, adolescents, and adults who may be at risk of experiencing an allergic reaction.

Children attending schools, daycares, or camps:

1. Schools, daycares, and camps typically require students to have an allergy and anaphylaxis plan on file.
2. This helps ensure that appropriate precautions are taken, and teachers or staff members are aware of the child's allergies and what to do in case of an emergency.

Adults participating in sports or organized activities:

1. Individuals who regularly engage in sports or organized activities may have an increased risk of exposure to allergens.
2. Having an allergy and anaphylaxis plan in place can help protect them in case of an allergic reaction during these activities.

Remember, it is essential to consult with your healthcare provider for personalized guidance and to ensure accuracy in completing the allergy and anaphylaxis plan.

For pdfFiller’s FAQs

What is allergy and anaphylaxis plan?

An allergy and anaphylaxis plan is a document outlining specific steps to be taken in case of an allergic reaction or anaphylactic shock.

Who is required to file allergy and anaphylaxis plan?

Anyone who has known allergies or anaphylactic reactions should have an allergy and anaphylaxis plan on file.

How to fill out allergy and anaphylaxis plan?

An allergy and anaphylaxis plan can typically be filled out with the assistance of a healthcare provider or school nurse.

What is the purpose of allergy and anaphylaxis plan?

The purpose of an allergy and anaphylaxis plan is to ensure that proper procedures are in place in case of an allergic reaction or anaphylactic shock.

What information must be reported on allergy and anaphylaxis plan?

An allergy and anaphylaxis plan should include information on specific allergies, triggers, symptoms, emergency contacts, and medications.

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