Advocacy Charts and Forms

As a service to its members the Advocacy Council of ACAAI has compiled a few enduring materials to aid in day to day office activities.  Click the Tabs below  and browse each category of enduring materials.

Immunotherapy Forms

Immunotherapy Pre-injection Health Screen Questionnaire

APPENDIX 1 – American College of Medical Quality’s policy on the development and use of practice parameters for medical quality decision-making

APPENDIX 2 – Examples of possible abbreviations for allergen immunotherapy extract components

APPENDIX 3 – Example of a build-up schedule for weekly immunotherapy

APPENDIX 4 – Example of immunotherapy dose adjustments for unscheduled gaps in allergen immunotherapy injection intervals (modiļ¬cation of the AAAAI skin testing and immunotherapy consent and instruction forms: immunotherapy administration instruction form, which can be found at

APPENDIX 5 – Example of a cluster immunotherapy schedule 22,26

APPENDIX 6 – Recommended documentation for allergen immunotherapy prescription forms

APPENDIX 7 – Allergen immunotherapy extract prescription form

APPENDIX 8 – Maintenance concentrate prescription form

APPENDIX 9 – Labels for allergen immunotherapy extracts

APPENDIX 10 – Allergen immunotherapy administration form recommended documentation

APPENDIX 11 – Allergen immunotherapy administration form

APPENDIX 12 – Health screen record

APPENDIX 13 – Allergen immunotherapy informed consent

APPENDIX 14 – Allergen immunotherapy systemic reaction/anaphylaxis treatment record