Purpose of Allergy Skin Testing:
Allergy skin testing is a procedure used to identify substances (allergens) that may cause an allergic reaction. This test involves applying small amounts of potential allergens to the skin, usually on the forearm or back, and observing the reaction.

 

Types of Allergy Skin Testing:
Prick/Puncture Test: A small drop of allergen is placed on the skin, and a tiny needle (called OMNI skin test) is used to prick the skin through the drop.

 

Risks and Discomforts:
Mild itching, redness, or swelling at the test site. Rarely, a more severe allergic reaction, including hives, difficulty breathing, or anaphylaxis, may occur. If a severe reaction occurs, it will be treated immediately.
Precautions:
Inform your healthcare provider of any medications you are taking, as some may interfere with the test results. Notify your provider if you are pregnant or have a history of severe allergic reactions. Avoid antihistamines for a period of time before the test, as advised by your healthcare provider. I understand that while the test may cause some discomfort, it is generally well-tolerated. I acknowledge that there is a small risk of a severe allergic reaction, which may require emergency treatment. I consent to undergo allergy skin testing and to receive any necessary treatment in the event of a reaction.

CONSENT
I, the legal representative of the Patient identified HERE, acknowledge that I have been informed about the purpose, procedure, and potential risks of allergy skin testing. I understand that this test is designed to identify allergens that may be causing allergic reactions. I have had the opportunity to ask questions and have received satisfactory answers.

By signing this form, I represent that I am the legal representative of the Patient identified above and will provide written proof (e.g., Power of Attorney, living will, guardianship papers, etc.) that I am legally authorized to act on the Patient’s behalf with respect to this authorization form.