Sublingual Immunotherapy Forms

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The information form is intended to provide the patient/patient’s family background on sublingual immunotherapy efficacy, proper administration and safety. The forms provide patient guidance on when and how to treat a SLIT systemic reaction (SLIT action plan) and what to do before SLIT administration to ensure to optimal safety with this home based therapy (SLIT Pre-Dose Checklist). These recommendations are based on the FDA-approved sublingual immunotherapy tablet product information and multiple published studies.<br /> <br /> <strong>As an AAAAI members-only benefit, these forms can be edited and customized for individual practices. If you are a member, simply login with your username and password. The forms will open in Word/Excel document format for editing.</strong><br /> <br /> <em>By clicking on the forms, you agree that these forms are being provided for educational and informational purposes only and are not intended to be a substitute for your independent medical judgment. The AAAAI is not liable for any decision made, or action taken by you or anyone else, in reliance upon the information contained within these forms.</em><br /> <br /> <strong><em>These forms are available for personalization as a member benefit.</em></strong><br /> <br /> <a href="/Aaaai/media/MembersMedia/Member%20Secure%20Files/Clinical-Indications-Continuation-Allergen-Immunotherapy-more-than-5-yea.doc" target="_blank">Clinical Indications for Continuation of Sublingual Allergen Immunotherapy for Longer Than 5 Years (Long-Term Immunotherapy) »</a><br /> <br /> <a href="/Aaaai/media/MembersMedia/Member%20Secure%20Files/SLIT_Systemic_Reaction_Treatment_Record.docx" target="_blank">In-office Local and Systemic Reaction Grading and Treatment Record for Sublingual Allergen Immunotherapy »</a><br /> <br /> <a href="/Aaaai/media/MembersMedia/Member%20Secure%20Files/SLIT_local_reaction_tracking_log.xlsx" target="_blank">Office Tracking Log for Patient Reactions to Sublingual Allergen Immunotherapy »</a><br /> <br /> <a href="/Aaaai/media/MembersMedia/Member%20Secure%20Files/SLIT_Local_Reaction_and_Systemic-Reaction_Emergency_Plan.docx" target="_blank">SLIT Local Reaction and Systemic Reaction Emergency Plan »</a><br /> <br /> <a href="/Aaaai/media/MembersMedia/Member%20Secure%20Files/SLIT_patient-consent-for-immunotherapy.doc" target="_blank">Sublingual Allergen Immunotherapy Patient Consent Form »</a><br /> <br /> <a href="/Aaaai/media/MembersMedia/Member%20Secure%20Files/Spanish-SLIT_patient-consent-for-immunotherapy.doc" target="_blank">Spanish Sublingual Allergen Immunotherapy Patient Consent Form »</a><br /> <br /> <a href="/Aaaai/media/MembersMedia/Member%20Secure%20Files/Health-record-SLIT.DOCX" target="_blank">Sublingual Immunotherapy Health Screen & Dosing Record »</a><br /> <br /> <a href="/Aaaai/media/MembersMedia/Member%20Secure%20Files/SLIT_pre-dose_checklist.docx" target="_blank">Sublingual Immunotherapy Pre-Dose Checklist »</a><br /> <br /> <a href="/Aaaai/media/MembersMedia/Member%20Secure%20Files/Spanish-SLIT_pre-dose_checklis.doc" target="_blank">Spanish Sublingual Immunotherapy Pre-dose Checklist »</a><br /> <br /> <a href="/Aaaai/media/MembersMedia/Member%20Secure%20Files/Background-SLIT.DOCX" target="_blank">Sublingual Immunotherapy Tablets - Background Information for Patients »</a><br /> <br /> <a href="/Aaaai/media/MembersMedia/Member%20Secure%20Files/Spanish-Sublingual-Immunotherapy-Tablets-Background-Information-for-Patients.doc" target="_blank">Spanish Sublingual Immunotherapy Tablets - Background Information for Patients »</a><br />  </p> <div> <div class="c-social-sharing"> <h4 class="c-social-sharing__heading">Share this page:</h4> <ul class="c-links"> <li class="c-link__item"> <a id="p_lt_ctl03_pageplaceholder_p_lt_ctl02_AAAAI_SocialSharing_faceBook" rel="noreferrer noopener" class="c-social-sharing__link hide-ext-link" 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