Administration of Epinephrine

  • Please read the following important points prior to downloading the attached forms.
     
    If your child has a life threatening allergy and may require the administration of Epinephrine and/or Benadryl while at school, the following forms are required.
     
    1.Administration of Epinephrine for Life Threatening Allergic Reactions. (3pages - Completed by the parent)
     
    2.Food Allergy Action plan completed by the physician and the parent.  Includes orders for administration of Benadryl and Epinephrine.
     
    3.If you would like your child to carry his/her Epi-pen, please complete the Authorization for Self-Administration of Asthma Medication Form. The parent signs one form and the student’s physician signs the second form. (Please be sure to complete the bottom left portion that lists the medical condition and medication to be self-administered.)
     
    Medication will not be accepted in the nurse’s office without the proper completion of the above forms. All medication must be in the original container.  Epi pens should not be expired and have a prescription label which matches the doctor's order.
     

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