Follow the steps to fill out the form correctly.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by filling in the student’s information section. Enter the last name, first name, date of birth (DOB), student ID number, school, grade, and the parent or guardian's name and cell number. Ensure that all fields are filled out correctly to avoid processing delays.
3. Look for the section designated for a licensed healthcare provider. Here, the provider will need to specify the allergies, confirm whether the student has had anaphylaxis or asthma, and whether the student can carry or self-administer epinephrine. These details are crucial for emergency responses.
4. Proceed to fill in the specifics regarding severe allergies and anaphylaxis. The healthcare provider should detail the symptoms to look out for and the corresponding actions to take. This section is essential for accurate and timely care.
5. Complete the mild allergic reaction section by noting the mild symptoms and actions to be taken in case these symptoms occur. Ensuring this information is clear can help the school staff respond appropriately.
6. In the medicines/doses section, accurately denote the type of epinephrine auto-injector prescribed and any antihistamines that may be needed. This information is important for the health office to have on record.
7. The healthcare provider must print and sign their name on the form, along with the date and National Provider Identifier (NPI). This validates the order and ensures it meets legal requirements.
8. Finally, fill out the parent/guardian's name and signature. Ensure they understand and agree to the terms regarding medication administration and responsibilities outlined in the document.
9. Once the form is complete, review all entries for accuracy before proceeding to save changes. After finalizing, you may download, print, or share the completed form as needed.

Complete your documents online to ensure a safe school environment for all students with allergies.