Sample Letter for Carrying Self-Injectable Epinephrine Aboard Commercial Airplanes
DATE
To Whom it May Concern:
PATIENT FULL NAME is a AGE/GENDER who suffers from a life-threatening allergy
to SPECIFIC ALLERGENS LISTED. This is a severe allergic reaction that makes it
medically necessary for HIM/HER to carry an antihistamine and EpiPen®, which is an
autoinjector of epinephrine, at all times. EpiPen® autoinjectors are prescribed by a
licensed medical professional. PATIENT NAME should have this life-saving medication
with HIM/HER at all times, especially during times of travel away from home. In the
event of an exposure to even a minute amount of ALLERGEN a severe allergic reaction
may occur. Every minute is critical in using this medication to treat the allergic reaction
and to prevent a life-threatening reaction. Use of the EpiPen® can be life saving. Please
allow PATIENT NAME to have the EpiPen®(s) with HIM/HER on board the airplane.
{{SUGGESTED TEXT FOR ASTHMATICS}}
PATIENT NAME is also asthmatic and requires the use of an albuterol inhaler in the
event of an asthma attack or allergic reaction. Please allow PATIENT NAME to carry
HIS/HER albuterol inhaler on board the airplane. Additional information may be
obtained from PHYSICIAN NAME at PHONE or FAX.
Respectfully signed,
____________________________________________, M.D.
M.D. OFFICE STAMP
Download Word Document:
doctorsLetter.doc
