Get Epinephrine Auto- Injector Permission Form - Columbia County ...

Filling out the Epinephrine Auto-Injector Permission Form is essential for ensuring that students with severe allergies receive the necessary treatment promptly. This guide provides clear, step-by-step instructions for completing the form accurately online.

Follow the steps to complete your form effortlessly.

1. Click the ‘Get Form’ button to access the Epinephrine Auto-Injector Permission Form.
2. Enter the school year at the top of the form, ensuring you specify the correct year.
3. Fill in the student’s name and date of birth (DOB) in the designated areas.
4. Provide a brief description of the physical condition for which the treatment is required.
5. Initial any applicable blank(s) to indicate the type of severe systemic reaction the student experiences.
6. Circle the appropriate epinephrine device option, selecting between , Jr., 0.3 mg., or 0.15 mg.
7. Specify the circumstances under which treatment should be administered based on the provided options regarding local and systemic reactions.
8. Include any special instructions that may be necessary for the administration of the epinephrine kit.
9. Have the physician sign the form in the designated space — note that a stamp is not accepted.
10. Ensure the parent or guardian also signs the form and includes their printed name and contact details.
11. Finalize your form by saving changes, downloading a copy, printing it for records, or sharing it as needed.

Complete your Epinephrine Auto-Injector Permission Form online today to ensure timely medical care for your student.