A two-page plan, formerly called the Food Allergy Action Plan, that tells school, child care, camp or workplace staff how to recognize and treat an allergic reaction. The physician or other provider records the allergens, the epinephrine and antihistamine orders and signs it; the family keeps it where others can find it and shares it with the people who supervise the patient.
The patient's physician or other health care provider completes the medications and doses, any additional comments, and signs the Physician/HCP Authorization line. The patient or parent/guardian supplies personal details, a photo and emergency contacts and signs the Patient or Parent/Guardian Authorization line.
Name, D.O.B., Allergic to, and Weight in pounds, followed by Asthma (yes, marked as higher risk for a severe reaction, or no) and History of anaphylaxis (yes or no). A photo box sits at the top right. Staff who may not know the child rely on the photo and the allergen list, so name every food the plan covers.
If the child's physician checks this box, the child has an extremely severe allergy to the food written in the blank and should be given epinephrine at the first sign of any symptoms, even if mild. Fill in the specific allergen whenever the box is checked; the box changes the plan's mild-symptom instructions for that exposure.
Preprinted signs by body area: lung, heart, throat, skin, gut, mouth and other, or a combination from different areas. The steps are to give epinephrine immediately, call 911, consider an antihistamine or an inhaler if wheezing, position the person, give more epinephrine about 5 minutes or more after the last dose if needed, alert contacts and transport to the ER even if symptoms resolve.
Itchy or runny nose, itchy mouth, a few hives or mild itch, and mild nausea. Mild symptoms from more than one system area call for epinephrine and 911. For a single area, antihistamines may be given only if ordered by a healthcare provider, and staff stay with the person and watch closely, giving epinephrine if symptoms worsen.
Enter the epinephrine brand or generic and check one dose: 0.1 mg, 0.15 mg or 0.3 mg IM, or 1 mg or 2 mg IN. Add the antihistamine brand or generic and dose, and any other medication, such as an inhaler (bronchodilator) if wheezing. Check whether the patient may self-carry and whether the patient may self-administer.
Use the comments box for anything the treatment steps don't cover for this patient. Below it, the patient or parent/guardian and the physician/HCP each sign and date. The provider signature authorizes the medication choices above; without it, the epinephrine and antihistamine orders on page 1 are unsigned.
Preprinted how-to steps for Auvi-Q, EpiPen and EpiPen Jr with their authorized generic, the Impax authorized generic of Adrenaclick, Teva's generic EpiPen, and neffy nasal spray, plus safety notes for all auto-injectors. Nothing is filled in here, but the device named in Medications/Doses should match one of these so staff follow the right steps.
Lines for the rescue squad, the doctor with phone, the parent or guardian with phone, and up to three other emergency contacts with name, relationship and phone. The plan tells staff to treat the person before calling emergency contacts, so these lines are for follow-up after epinephrine and 911.
Download the current version from the source each time; forms change without notice.
Food Allergy & Anaphylaxis Emergency Care Plan
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Sources for this guide
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It takes two dated signatures: the patient or parent/guardian authorization and the physician/HCP authorization. The provider signs beneath the medications and doses selected on page 1, so the signed plan carries the treating clinician's epinephrine and antihistamine orders for the school, camp or employer.
Yes. FARE publishes a Spanish version dated Agosto de 2025 alongside the English plan dated 8/2025, both linked from FARE's emergency care plan page. Families who need the Spanish copy for a caregiver can ask the provider to complete that version so the signed orders appear in the language the caregiver reads.
Yes. The medications section now lists 1 mg and 2 mg intranasal (IN) epinephrine doses, and page 2 gives step-by-step instructions for neffy epinephrine nasal spray, alongside Auvi-Q, EpiPen and EpiPen Jr, the Impax authorized generic of Adrenaclick, and Teva's generic EpiPen auto-injectors.
It was formerly the Food Allergy Action Plan. FARE revised it with its Education Advisory Council, which includes support group leaders, experienced parents, adults with food allergies, a dietitian and a psychologist. The current edition, revised in August 2025, keeps a two-page layout with treatment steps on page 1 and device instructions on page 2.