Get Fairfax County Epinephrine Authorization Form
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How to fill out the Fairfax County epinephrine authorization form online
Filling out the Fairfax County Epinephrine Authorization Form online is a straightforward process that ensures proper authorization for administering epinephrine in school settings. This guide provides clear instructions for completing each section of the form to meet the necessary requirements.
Follow the steps to complete the form successfully.
- Click ‘Get Form’ button to access the Fairfax County Epinephrine Authorization Form and open it for editing.
- Begin with Part I, where the parent or guardian must complete the authorization. Fill in the student’s name, date of birth, school name, school year, and grade.
- Review the authorization statement where you agree to release and hold harmless Fairfax County Public Schools, the Fairfax County Health Department, and School Age Child Care personnel for administering epinephrine by a trained non-health professional.
- Sign and date the form in the designated areas to confirm the authorization and provide a daytime telephone number for contact.
- Proceed to Part II, where the physician will complete the necessary information. They must indicate the specific allergens, route of exposure, and administer instructions, including the dosage of epinephrine.
- Ensure the physician reviews and documents whether the student is trained to carry their epinephrine autoinjector and provide the required signature.
- Move to Part III, where the principal or their designee will check the appropriateness of the completed forms and provide their signature and date.
- Finally, after completing all sections, save the changes to the form. You can then download, print, or share the form as needed.
Complete and submit your Fairfax County Epinephrine Authorization Form online today to ensure your child’s safety.
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The first step in administering the epinephrine auto injector is to remove the safety cap. Next, hold the injector firmly and place it against the outer thigh, pressing down until you hear the click signaling that the injection has begun. Finally, hold the injector in place for several seconds to ensure the full dose is delivered. Utilizing the Fairfax County Epinephrine Authorization Form helps provide vital details that can confirm the need and procedure for this life-saving action.
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