Unassigned Epinephrine Program Forms (UEP)

Laws, documents and information provided to schools so they can implement an unassigned epinephrine auto-injector program as required by California state law.

• 2 Sample Board Policy
• 3 2016 CDE Training Standards
• 4 Physician Approved Standing Orders and Protocol for Treatment of Anaphylaxis
• 5 Annual Documentation of Competency
• 6 Staff Training Sign In 
• 7 Emergency Response Report 
• 8 Agreement for Physician Consultant Services 
• 9 Annual Notification of Parents
• 10 Epinephrine Auto-Injector Maintenance Form 
• 11 Recognizing Anaphylaxis Flow Sheet 
• 12 Certification for FREE Epi-Pens 
• 13 Annual Notification of Volunteer Agreement 
• 14 Epinephrine Indemnity Acknowledgement 
• 15 Acquisition and Disposition of Epinephrine Auto-Injectors 
• Components of Unassigned Epinephrine Programs 
• Instructions for Unassigned Epinephrine Program
• Ordering Epi-Pens at Discounted Price 
• Replenishment Supply Certification