Health Care Plan

Severe Allergy to: _______________________________________________

Child’s Name:____________________________            Date of Birth:________________

EMERGENCY TREATMENT

For Mild Symptoms

·        Several hives

·        Itchy Skin                 OR if an ingestion (or sting) is suspected

·        Swelling at site of an insect sting

Treatment

  1. Give_______________ of _________________ by mouth.

  2. Contact the parent or emergency contact person.

  3. Stay with the child, keep child quiet, monitor symptoms until person arrives.

  4. Watch child for more serious symptoms listed below.

 

Special Instructions (for health care provider to complete):

 

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