Medication Authorization Form
(for prescription and over-the-counter medications)

Asthma Treatment Plan Form

Allergy Information

Spanish Allergy Information

HEALTHCARE PROVIDER'S ORDERS FOR ALLERGY EMERGENCY TREATMENT

1) PERMISSION TO ADMINISTER EPINEPHRINE VIA PRE-FILLED AUTO-INJECTOR;
2) PERMISSION OR REFUSAL TO APPOINT DESIGNEE

1) PERMISO PARA ADMINISTRAR EPINEFRINA VIA AUTOINYECTOR PRELLENADO;
2) PERMISO O RECHAZO PARA DESIGNAR ENCARGADO