AUTHORIZATION FOR ANAPHYLAXIS ACTION PLAN 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin with Part I, where the parent or guardian must provide their information. Fill in the student’s name, date of birth, school name, school year, and grade.
3. In this section, read and acknowledge the authorization statement regarding epinephrine administration by signing at the bottom.
4. Proceed to Part II for the health care provider's section. Ensure that they complete all required fields including specific allergens and symptoms.
5. The health care provider must also indicate the dosage and administration instructions for epinephrine. Make sure these details are clear and accurate.
6. Finally, in Part III, have the principal or their designee review and sign off on the completed form to ensure all parts are filled correctly.

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