Free Student Allergy List Template
Student Allergy List
INSTUTION NAME |
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[YOUR INSTUTION NAME] |
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NAME: |
[YOUR NAME] |
DATE: |
[DATE] |
Overview
This comprehensive list is designed to track, record, and manage student allergies to ensure their safety and well-being in school. It includes information about the student's specific allergies, emergency contact information, and an allergy management plan. The goal of this list is to provide key information to staff and faculty for proper understanding and prompt response to potential allergic reactions.
Student Allergy List
Student 1:
Student Information |
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NAME: |
John Doe |
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CLASS: |
Grade 9 |
Roll NO: |
012 |
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Allergies: |
Penicillin |
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Bee stings |
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Emergency Contact Information |
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Parent/Guardian Name |
Relationship to Student |
Contact Number |
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Jane Doe |
Mother |
(123) 456-7890 |
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John Smith |
Father |
(987) 654-3210 |
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Allergy Management Plan |
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Allergy |
Triggers |
Symptoms |
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Peanuts |
Consumption of peanuts |
Hives, Difficulty breathing |
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Bees |
Bee sting |
Swelling at sting site, Difficulty breathing |
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Student 2:
Student Information |
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NAME: |
Allen Johnson |
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CLASS: |
Grade 10 |
Roll NO: |
205 |
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Allergies: |
Penicillin |
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Bee stings |
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Emergency Contact Information |
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Parent/Guardian Name |
Relationship to Student |
Contact Number |
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Michael Johnson |
Mother |
(123) 456-7898 |
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Emily Johnson |
Father |
(787) 654-3210 |
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Allergy Management Plan |
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Allergy |
Triggers |
Symptoms |
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Dairy |
Ingestion |
Stomach cramps, nausea, diarrhea |
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Eggs |
Consumption |
Skin rash, swelling, difficulty breathing |
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Student 3:
Student Information |
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NAME: |
Emily White |
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CLASS: |
Grade 6 |
Roll NO: |
45 |
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Allergies: |
Dairy |
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Shellfish |
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Emergency Contact Information |
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Parent/Guardian Name |
Relationship to Student |
Contact Number |
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David White |
Father |
555-123-4567 |
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Sarah White |
Mother |
555-987-6543 |
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Allergy Management Plan |
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Allergy |
Triggers |
Symptoms |
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Pollen |
Exposure to pollen |
Sneezing, runny nose, itchy eyes |
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Dust |
Exposure to dust |
Coughing, wheezing, nasal congestion |
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Notes:
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Keep this list updated regularly.
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Ensure all staff members are aware of students' allergies.
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Communicate allergy management plans to relevant staff and faculty.
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In case of an allergic reaction, follow the provided treatment instructions promptly.
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Notify parents/guardians immediately in case of an allergic reaction.
