Allergy Action Plan (Aap)

ALLERGY ACTION PLAN (AAP) (FOOD & BEE STING ALLERGIES ONLY)

______is allergic to______Student’s Name PHOTO

VIA: INGESTION, CONTACT OR INHALANT-PLEASE CIRCLE ALL THAT APPLY

Symptoms or signs your child might exhibit.

Symptoms can change quickly!

The following action must be taken immediately!

Call 911 – Request a paramedic with EPIEPHRINE. State the child had a severe allergic reaction, and additional epinephrine may be needed.

3. Parent/Guardian names and emergency contact numbers

1. Name______Phone______

2. Name______Phone______

3. Name______Phone______

4. Name______Phone______

IF PARENTS CANNOT BE REACHED WE AUTHORIZE A TRAINED STAFF MEMBER TO ADMINISTER MEDICATION INITIAL BOX IF YES

Physician’s Signature Date Grove Preschool Teacher Signature Dats

Grove Preschool Director Signature Date Parent/Guardian Signature Date