Life Threatening Allergy Action Plan
If your child has a life-threatening allergy and requires medication, such as an anti-histamine or Epi-pen, to be available in the School Health Office, the "Request for Pupil Medication to be Taken at School" form, "Consent Form and Notice for Administration of Epinephrine via Epi-Pen", and the "Life Threatening (Anaphylaxis) Allergy Action Plan" form must be completed by your physician and signed by a parent/guardian. If both an anti-histamine, such as benadryl, and an Epi-Pen is indicated on the "Life Threatening (Anaphylaxis) Allergy Action Plan", a "Request for Pupil Medication to be Taken at School" for each medication must be returned. The forms can be returned to the Health Office or faxed by the doctor's office to (856) 589-6909.
Click to open R_5330_Life_Threatening_Allergy_Anaphylaxis_Action_Plan_092910.pdf Life Threatening Allergy (Anaphylaxis) Action Plan Epipen_Forms.pdf Epi Pen Forms