Ehrhardt Clinic
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Allergy & Anaphylaxis
Please contact the school nurse to discuss your child's allergy.

• The medication and the self-administration must be authorized by a licensed health care provider and documented on the KISD Permission to Carry Anaphylaxis Auto Injector form.
• The student must demonstrate to the licensed health care provider and to the school nurse the skill level necessary to self-administer the medication.
• The student must have a current Allergy Action plan on file with the School Nurse.

Forms related to Allergy and Anaphylaxis:
• Anaphylaxis Packet – to be completed by the Licensed HealthCare Provider and parent/guardian.

Paperwork to be signed by you and your physician:
   1. Allergy Questionnaire
   2. Allergy Action Plan
   3. Medication Authorization Form
   4. Parent consent to release info form
   5. Physician's diet modification form

Allergy Action Plan Forms

Parent Request Milk Substitute Form:
Milk Form

Parent Request Food Substitute Form:
Parent food sub form

Link to Klein Food Service for food Nutrient Analysis List:
Klein ISD Food Service Dept