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Get IL Charleston CUSD 1 Emergency Plan For: Bee Stings/Severe Allergy Or Anaphylaxis

Irth date: Physician: School: Teacher: Physician Ph#: Name: has an allergy to: (check allergy(s) that apply) Bee/Wasp stings Other *Student will be carrying an Epi-Pen on their person, authorized to self-administer Yes No Symptoms of allergic reaction/ anaphylaxis are: IF YOU SEE THIS: Hives/rash/itching Wheezing/difficulty breathing (itching of the throat or feels like the throat is closing up) Tachycard.

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