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Allergies & Reactions Record

Record

Know it. Track it. Protect your family.

Family Member:Medical Conditions:Date of Birth:Primary Doctor:Phone:Insurance Provider / ID #:Allergies:Emergency Contact & Phone:

Known allergies

Allergen / what causes it	Typefood, medication, environmental, insect	Reaction / symptoms	Severitymild – life-threatening	Date first noticed	Last reacted	Avoid / carry

Reaction history

Date	Allergen / trigger	Exposure	Symptoms / reaction	Severity	Treatment given	Hospital / doctor visit	Notes

Reminders

Avoid known allergens as much as possible.
Read labels carefully — allergens hide in many foods and products.
Always carry prescribed medication such as an adrenaline pen.
Teach family and carers what to do during a reaction.
Seek help immediately for severe reactions.

Important notes