Medical Alert Form School District No. 43, Coquitlam School Board Page 4
Download a blank fillable Medical Alert Form School District No. 43, Coquitlam School Board in PDF format just by clicking the "DOWNLOAD PDF" button.
Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.
Complete Medical Alert Form School District No. 43, Coquitlam School Board with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.
Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.
ADVERTISEMENT
1
2
3
4
5Anaphylaxis Emergency Action Plan for:
My child’s anaphylaxis triggers are:
Peanuts nuts milk all diary eggs shellfish fish
Food additives (list)
Insect stings (list)
Medication (list)
Others (list)
My Child’s anaphylaxis symptoms
are usually:
swelling (eyes, lips, face, tongue)
nausea or vomiting
Others (list below)
difficulty breathing or swallowing
coughing or choking
hives
stomach cramps, diarrhea
fainting or loss of consciousness
dizziness, confusion
My child’s emergency treatment is:
1. Give EpiPen Location of EpiPen:
2. Call 911 and tell the dispatcher that a child is having a life‐threatening anaphylactic reaction.
3. Call the parent, guardian or emergency contact person.
DO NOT LEAVE THE STUDENT ALONE
Page 4 of 5
ADVERTISEMENT
0 votes
Related Articles
Related forms
Form M-144 - Vision Screening Referral Form - School Health Services The School District Of Philadelphia
Medical
Form Boe-531-ae(s1f) - Schedule Ae - Computation Schedule For District Tax - State Of California - Board Of Equalization
Financial
Related Categories
Parent category: Medical