LDSS-0792A. Individual Allergy and Anaphylaxis Emergency Action Card

Form LDSS-0792A - Individual Allergy and Anaphylaxis Emergency Action Card is a form issued by the New York State Office of Children and Family Services. This form is intended to be used to provide information on an individual’s allergies and anaphylaxis emergency action plan. It is important for the form to be completed accurately, as it is used to help ensure the safety of the individual in the event of an allergic reaction.

The form consists of several sections, which include basic information about the individual, such as name, date of birth, and address; information about the individual’s allergies, including the type of allergy, the reaction that could occur, and the treatment necessary; and a section for the individual’s emergency contact information. In addition to the sections outlined on the form, there are also instructions included on how to complete the form properly. It is important to read and follow these instructions in order to ensure that the form is completed accurately.

The form is intended to be filled out by a parent or guardian of the individual who has allergies. Important fields in this form include the individual’s name, date of birth, address, allergies, and emergency contact information. It is important to provide accurate information in these fields, as it could be used to help save the individual’s life in the event of a severe allergic reaction. It is also important to provide the individual’s doctor’s name and contact information, as this information may be used in the event of an emergency.

The form would be used in a variety of scenarios, such as when an individual is staying in a residential setting, attending school, or participating in a recreational activity. Specific instructions for completing the form are included on the form, and it is important to follow these instructions in order to ensure that the information provided is accurate and complete. The benefits of using this form are that it can help to ensure the safety of the individual in the event of an allergic reaction, and can provide important information to medical personnel in the event of an emergency.

Related forms that may be used for similar purposes include the Allergy and Anaphylaxis Emergency Care Plan (AECP) and Anaphylaxis Emergency Care Plan (AECP-S). While both forms provide information regarding