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 10 business days 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
  • agency of Higher Education

We currently do not require private institutions of higher education to submit reports. 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

Select if you are reporting for a K-12 school or an institution of higher education:

Recipient Information

Person who received the epinephrine auto-injector injection:

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)
Type of dosage administered:

Other Information

(Examples: 6th grade teacher, school librarian, basketball coach, school volunteer, etc.)
Did the person who received the epinephrine auto-injector injection have a known history of anaphylaxis or allergies requiring epinephrine auto-injectors?
Was the school's unassigned epinephrine auto-injector utilized?
Texas Administrative Code §37.605(e) requires schools to notify local emergency medical services when an individual is suspected of experiencing anaphylaxis and when an epinephrine auto-injector is administered. For information on this requirement, please read EMS Evaluation After Administering Epinephrine in Schools (PDF).
Were local emergency medical services (EMS) notified about the individual who received the injection from the epinephrine auto-injector?
(Examples: 9-1-1 was called, individual was transported by local EMS to hospital, 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."
Central Nervous System
Cardiovascular System
Please list signs or symptoms not listed above, if applicable:

Suspected Cause

Please indicate the suspected cause or trigger of the anaphylaxis:
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