Allergy & Anaphylaxis Action Plan
Complete this plan so staff know exactly how to keep your child safe.
Re-enter your child's details, allergy, prescribed auto-injector, and the allergist appointment from the other systems. This form does not share data with the clinic or pharmacy.
Child information
Allergens
Symptoms to watch for
Emergency medication
Allergist & appointment
Guardian authorization
Complete child info, at least one allergen, storage location, and signature.