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How to use or fill out AUTHORIZATION FOR ANAPHYLAXIS ACTION PLAN
- Click ‘Get Form’ to open it in the editor.
- 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.
- In this section, read and acknowledge the authorization statement regarding epinephrine administration by signing at the bottom.
- Proceed to Part II for the health care provider's section. Ensure that they complete all required fields including specific allergens and symptoms.
- The health care provider must also indicate the dosage and administration instructions for epinephrine. Make sure these details are clear and accurate.
- 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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