The health coordinator asks the parent/guardian all the questions on the form and documents the parent responses. The health coordinator then gives the parent the “Illinois Food Allergy Emergency Action Plan and Treatment Authorization” for the primary care physician or allergist physician to complete. Health Services Manual Authorization for Administration of Medication Physician Authorization for Administration of Treatment Physician’s Order for EPI Pens and Inhalers Management of Asthma Exacerbations Illinois Food Allergy Emergency Action Plan & Treatment Authorization Parent Letters Regarding Medication Supplies Student Medication Labels – Sample Student Services / Health Forms Life-Threatening Allergy Assessment. Asthma. Asthma Action Plan and Medication Permission for Students with Asthma Asthma History Form Medication Permission for Students with Asthma No Supervision. Dental. Formulario Comprobante del Examen Dental Escolar Proof of School Dental Examination. Diabetes . Diabetes Management Plan List of Diabetes
The Illinois Food Allergy Emergency Action Plan and Treatment Authorization form can also be obtained in the nurse's office or downloaded to the right. Food allergies affect 4 to 6 percent of children and 4 percent of adults. Learn about the types of food allergies, symptoms, diagnosis and treatment ALLERGY/ANAPHYLAXIS ACTION PLAN Student Name
Food Allergy Management Education Food Allergy 31 Dec 2012 Epinephrine is the first-line treatment for meat allergy anaphylaxis,.. appropriate, a Emergency Care Plan (ECP)/Food Allergy Action Plan Refer to Authorization for Students to Self-Carry in the Forms.. Adapted from The School Nurse Task Force of the Illinois Emergency Medical Services for Children. Managing Life Threatening Food Allergies In Schools Appendix G: Sample Food Allergy Action Plan Form. Adapted from the.. warning signs of reactions and emergency treatment. The plan Action Plan. Form adapted from the Food Allergy Network). (3) The school nurse shall ensure that there is a written authorization by the parent or Arlington Heights, IL 60005.
School Medication Authorization Form for Medical Cannabis 19-20 (English) School Medication Authorization Form for Medical Cannabis 19-20 (Spanish) This webpage contains links to other Internet sites and information provided by persons not affiliated with Wauconda Community Unit School District 118. 2018 -2019 Student Medical and Health Checklist State Health complete an Illinois Food Allergy Emergency Action Plan and Treatment Authorization Form. This plan must be provided to school administration prior to your child’s first day of school. If an epinephrine auto injector is prescribed, the Illinois Food Allergy Emergency Action and Treatment Form will indicate it.
Dispensing Medicine Authorization Form I have provided Trinity Oaks with the Illinois Food Allergy Emergency Action Plan and Treatment Authorization form that has been fully completed and signed by my student’s physician, along with all prescribed rescue medications.
(b-5) A school district or nonpublic school may authorize the provision of an epinephrine auto-injector to a student or any personnel authorized under a student’s Individual Health Care Action Plan, Illinois Food Allergy Emergency Action Plan and Treatment Authorization Form, or plan pursuant to Section 504 of the federal Rehabilitation Act ILLINOIS FOOD ALLERGY EMERGENCY PLAN Food Allergy Initiative (FAI) KWWS ZZZ IDLXVD RUJ Food Allergy and Anaphylaxis Network (FAAN) KWWS ZZZ IRRGDOOHUJ\ RUJ This document is based on input from medical professionals including Physicians, APNs, RNs and certified school nurses. It is meant to be useful for anyone with any level of training in dealing with a food allergy reaction. Food Allergy & Anaphylaxis Emergency Care Plan | Food Allergy FARE's Food Allergy & Anaphylaxis Emergency Care Plan, formerly the Food Allergy Action Plan, outlines recommended treatment in case of an allergic reaction, is signed by a physician and includes emergency contact information.
Click here for State of Illinois Certificate of Child Health Examination Form. Click here for State of Illinois Eye Examination Report. Click here for Authorization To Provide Diabetes Care Form. Click here for Asthma Inhalers or EpiPen Form. Click here for Asthma Action Plan Form. Click here for Illinois Food Allergy Emergency Action Plan and
KMBT C224-20160412090324 ILLINOIS FOOD ALLERGY EMERGENCY ACTION PLAN AND TREATMENT AUTHORIZATION NAME: TEACHER: ALLERGY TO. Asthma: Yes (higher risk for a severe reaction) No ANY SEVERE SYMPTOMS AFTER SUSPECTED INGESTION: LUNG: Short of breath, wheeze, repetitive cough HEART: Pale, blue, faint, weak pulse, dizzy, confused THROAT: Tight, hoarse, trouble breathing/swallowing ILLINOIS FOOD ALLERGY EMERGENCY ACTION PLAN Student’s AND Allergy to: ILLINOIS FOOD ALLERGY EMERGENCY ACTION PLAN AND TREATMENT AUTHORIZATION or emergency treatment of my child and for the im- NM FOOD/INSECT & EMERGENCY ALLERGY ACTION PLAN and MEDICATION