The Food Allergy & Anaphylaxis Emergency Care Plan, formerly the Food Allergy Action Plan, outlines recommended treatment in case of an allergic reaction. Please fill out the following with your child's information. Once the physician has reviewed it, you will receive an email to the address you list on this form with a link to print out this document.
Don Brothers, MD
Jennifer Ker. MD, MS, FAAAAI
Keegan Smith, MD, FACAAI
(This will be used to retrieve your completed document.)
Date of Birth (MM/DD/YYYY): *
Picture of child:
No If yes, high risk for severe reaction.
(If your child is under 50 lbs, the junior dosage will be assigned)
Your child's physician will write in their correct Benadryl dosage
Parent / Guardian Name:*
By checking this box, you are agreeing that the above information is accurate and tosubmit this information to
a physician dated 05/24/2019.