Uniformity in Allergy Response Plan forms

By:  Dr. Sonja Burmeister OTD, MSPA-C, OTR/L, EICP-OT

When a child with food allergies attends school there are multiple considerations for their safety:

-Should they sit at a table designated for students with food allergies?  What if this is not with their friends?

-What if students bring in food or snacks and eat them in the classroom, are they safe?

-Does their school allow them to carry their own Epi-pen and self-administer it?

-How does nursing want medications to be shared from the physician and parent?

Being a student, especially during times when COVID-19 complicates everything, presents a challenge to those students attending school in person.  Upon researching current documentation required in several area school districts I found there is no consistent medication administration form to present to the school nurse along with your child’s medicine.  The multitude of forms required by each district becomes burdensome to physicians and nurses in allergists’ offices who are trying to prescribe concise allergy response plans.

There are, however, consistencies between forms and the cumulative summary of requested information is as follows:

-Child/Student’s name


-Date of birth



-Directions/Epi-pen instructions/Time schedule for administration

-Can students self-administer

-Side effects of medications

-Physician’s initials/Nurse’s initials/Parent’s initials

-Phone numbers:  Physician/Pharmacy

Ancillary information requested that did not directly relate to food allergies is:

-Can the student be excused to take medications

-Field trips: Students are responsible for their own medication

-School delays/Early dismissals: Alteration in administration schedule

-Asthma action plan

MyHeatlhcareKit™ was designed to alleviate the stress of responding to a food allergy exposure: at home, in school or within any environment.  We have designed a form that has been accepted by local allergists and school districts to prepare nurses with the correct information and plan to respond to a food allergy exposure.  This form correlates directly with our kit’s organized approach for how medication can be easily and accurately administered in the event of an emergency.  Visit: www.myhealthcarekit.com for details.

It is within your power, backed by the National Association of School Nurses, to collectively agree on what information is needed in order to be most effective in responding to a school-based food allergy emergency. Myhealthcare kit would love to help you with that, through the power of awareness, connections and research!  Please reach out to us: contact@myhealthcarekit.com.

Dr. Sonja Burmeister, Professor/Clinician

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