PLAN OF CAREANAPHYLAXIS PLAN OF CARE - DSBN 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by filling out the 'STUDENT INFORMATION' section. Enter the school name, age, homeroom teacher, and student name. Optionally, you can add a student photo.
3. In the 'EMERGENCY CONTACTS' section, list contacts in priority order along with their relationship to the student and phone numbers.
4. Identify known life-threatening triggers by checking the appropriate boxes for insect stings, food allergies, or other triggers. Specify details as needed.
5. Complete the 'DAILY/ROUTINE ANAPHYLAXIS MANAGEMENT' section by listing food allergens to avoid and safety measures for both food and insect stings.
6. Follow with the 'EMERGENCY PROCEDURES' section detailing steps to take during an anaphylactic reaction. Ensure clarity on administering epinephrine and contacting emergency services.
7. Optionally fill out the 'HEALTHCARE PROVIDER INFORMATION' if applicable, including provider details and any special instructions regarding medications.
8. Finally, complete the 'AUTHORIZATION/PLAN REVIEW' section by obtaining necessary signatures from parents/guardians and school officials.

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