This form is for authorized representatives of TK-12 educational organizations to request a standing order for epinephrine. This form will generate an epinephrine standing order that local education agencies can use as a prescription to a pharmacist to ensure the safety and well-being of students and administrators with severe allergies.

Please follow the instructions in the form to provide the required information. When you click "Next", our system will generate your standing order. Please leave your browser open – you will automatically be redirected once your standing order is generated. You will also receive an email confirmation with your standing order PDF attached for your records.

Let's get started and ensure that every student and administrator has access to life-saving epinephrine when they need it most.

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