Pleasanton ISD CARE Plan for Students At-Risk of Anaphylaxis
Flow chart illustrating the PISD Care Plan for Students At-Risk for Anaphylaxis. This is to give you a better understanding of our objectives to ensure your child’s safety with regards to allergies. 

Allergy Action Plan
This form should be filled out by your child’s physician for any severe allergies. Your child’s physician should review this form and make recommendations specific for your child’s allergy. If your child is on medication that will need to be given at school, you will need to fill out a consent for medication administration with the school nurse or nurse’s assistant at your child’s campus. 

Special Dietary Needs Evaluation
This form should be filled out by your child’s physician for any food allergies. In order for PISD to offer your child a food substitution, United States Department of Agriculture rules require documentation by your child’s physician. 

Authorization to Self-Carry/Self-Administer an EpiPen
A physician may request that a student be able to self-carry and self-administer an emergency medication (EpiPen). The physician must state that the student has exhibited the knowledge and capability necessary to responsibly self-carry and self-administer. This form must be signed by the physician, parent, and school nurse.

All forms should be returned to the campus clinic. New forms must be completed each school year.

Please see the following links for helpful allergy and anaphylaxis information. - See this website for the CARE course. This course was completed by PISD staff to increase their knowledge and awareness of students with severe food allergies.

Food Allergy Research & Education (FARE)

Allergy and Asthma Network, Mothers of Asthmatics (AANMA)

Winning Strategies for Athletes with Asthma and Allergies (AANMA)

EpiPen information