• Required Reporting of Administered Epinephrine
    Auto-Injectors to DSHS

    If you are a school district, open-enrollment charter school, private school, or institution of higher education, there are reporting rules. The rules apply to unassigned epinephrine auto-injectors. The rule says you must report the administration of unassigned epinephrine auto-injectors. This requirement is in the Texas Education Code, §38.209 and §51.883.

    You must report no later than the 10th business day after the date of an unassigned epinephrine auto-injection is administered in accordance with the Texas Administrative Code, Title 25, Part 1, Chapter 37, Section 37.608 and Texas Administrative Code, Title 25, Part 1, Chapter 40, Section 40.7.

    School districts, open-enrollment charter schools, and private schools must report to the:

    • school district,
    • charter holder if the school is an open-enrollment charter school,
    • governing body of the school if the school is a private school,
    • prescribing physician
    • commissioner of the Department of State Health Services (DSHS)

    Institutions of higher education must report to the:

    • prescribing physician
    • commissioner of DSHS

    NOTE: Texas Education Code, Chapter 61, §61.003 defines institution of higher education as a:

    • Technical Institute,
    • Junior College or Community College,
    • College or University,
    • Medical or Dental School,
    • Public State College, and an
    • Agency of Higher Education.

    We do not require private institutions of higher education to submit reports at this time. DSHS encourages all institutions of higher education to report the use of epinephrine auto-injectors.


    Please fill out the entire form and provide detailed information.
    All fields with an asterisk (*) must be completed.

    School Information

     
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    Recipient Information

     

                                                                     

     

    Location and Dosage Information


    (Examples: cafeteria, classroom, school bus, hallway, football field, etc. You do not need to include mailing address.)

     


    (1 dose = 1 epinephrine auto-injector)

     

                                                                    

    Other Information

     

     [None] Select a Date Delete the Date


    (Examples: 6th grade teacher, school librarian, basketball coach, school volunteer, etc.)

     

     

                                                               

     

                                                             

     

                                                                             

    Symptom Information

    A person experiencing anaphylaxis may have many signs and symptoms. Please select the symptoms that the individual who received the auto-injector injection was exhibiting. Please mark all that apply. If no symptoms for a particular group occurred, choose "N/A."*

    Respiratory

                                                                                

    Skin

                                                                                

    Gastrointestinal

                                                                                

    Central Nervous System

                                                                            

    Cardiovascular System

                                                                                

    Other

     

     

    Suspected Cause

     

                                                                             

     

     
     

     

     

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Last updated January 26, 2021