Severe Allergic Reaction (SAR)

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Home > Services > School Health Services > SAR Bucket

Choose the bolded statement that best describes your child's situation.
Click the link for each document under the statement you chose.  Print and complete the form.  Return the form to your child's school office or scan and email the completed forms to hservices@mesd.k12.or.us 

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My child’s emergency EpiPen/epinephrine will be kept in the health room

• Child's Medical History: Severe Allergic Reaction (SAR) (DOC)
• Parent Authorization for Specialized Health Care (administration of epinephrine) for Severe Allergic Reaction (SAR) (PDF)
• Authorization for Medication Administration by School Personnel (PDF) - (only complete if your child also has an antihistamine at school in addition to epinephrine)

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My child is able to carry and use an EpiPen/epinephrine without help

• Child's Medical History: Severe Allergic Reaction (SAR) (DOC)
  
• Parent Authorization for Specialized Health Care (administration of epinephrine) for Severe Allergic Reaction (SAR) (PDF)