Get Ks Hks Severe Allergies & Anaphylaxis – Health Intake Form

Filling out the KS HKS Severe Allergies & Anaphylaxis – Health Intake Form online is an essential step in ensuring the safety and well-being of students with severe allergies. This guide provides a comprehensive overview of the form, offering clear, step-by-step instructions for users to easily navigate through the process.

Follow the steps to complete the intake form effectively.

1. Click the ‘Get Form’ button to access and open the KS HKS Severe Allergies & Anaphylaxis – Health Intake Form online.
2. Enter the student's name, date of birth, grade, and today's date at the top of the form. This information is crucial for the school to identify the student accurately.
3. Provide details for parent/guardian 1 and 2. Include their names and contact information to ensure the school can reach them in case of an emergency or if further clarification is needed.
4. Indicate the name and phone number of the physician treating the student's allergies. This will assist the school nurse in communicating with the healthcare provider if needed.
5. Select the appropriate health insurance options available. Check the relevant boxes for Private, Medicaid/KanCare, or indicate if the student is currently without insurance.
6. Indicate whether the student wears medical alert jewelry. This is important information for school staff during an emergency.
7. Answer questions regarding the student’s Individualized Education Plan (IEP) and 504 Plan if applicable.
8. Describe the mode of transportation the student uses to get to and from school. This can help understand their daily routine.
9. Answer whether the student participates in before or after school activities, as these settings may require additional considerations for safety.
10. Indicate if the student has a diagnosis of severe allergy from a healthcare provider by selecting 'Yes' or 'No.'
11. Check all known allergens that the student has been diagnosed with, including options like peanuts, tree nuts, eggs, and more.
12. Provide detailed information about the student's first allergic reaction, including symptoms and severity. This can help school staff prepare for similar situations in the future.
13. Similarly, describe the most recent allergic reaction the student experienced, noting age, symptoms, and severity.
14. State whether an epinephrine injection has been administered in the past and how many times it has been given.
15. Discuss the student's early signs and symptoms of an allergic reaction and how they communicate these symptoms to others.
16. Check all symptoms the student has experienced in the past, categorizing them by skin, mouth, abdominal, throat, lungs, and heart.
17. Assess the student's self-care abilities, marking whether they know what foods to avoid, ask about ingredients, read food labels, and communicate about their allergies.
18. Indicate meal participation at school by answering questions about breakfast, lunch, and snacks.
19. Decide if the parent/guardian will provide all food for the student or if they can eat snacks provided by others, specifying the preference.
20. Confirm whether the student has a support system in place, and describe how the student copes with their severe allergies.
21. Finally, ensure that the parent or guardian signs and dates the form to validate the information provided.
22. Once all sections are complete, users can save changes and either download, print, or share the completed form as needed.

Complete the KS HKS Severe Allergies & Anaphylaxis – Health Intake Form online to ensure your student's safety at school.