Transcription of CNMC Asthma Action Plan UPO
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CNMC Asthma Action Plan UPO
Asthma Action PlanName SchoolDOBH ealth Care ProviderProvider s PhoneParent/Responsible PersonParent s PhoneAdditional Emergency ContactContact PhoneAsthma Severity(see reverse side) Asthma Triggers Identified (Things that make your Asthma worse): Intermittent orPersistent: Mild Moderate SevereAsthma Control Well-controlled Needs better control Colds Smoke (tobacco, incense) Pollen Dust Animals_____ Strong odors Mold/moisture Pests (rodents, cockroaches) Stress/emotions Gastroesophageal reflux Exercise Season: Fall, Winter, Spring, Summer Other:_____ /___ /___Green Zone: Go!
Asthma Action Plan Name School DOB Health Care Provider Provider’s Phone Parent/Responsible Person Parent’s Phone
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CDC’s National Asthma, CDC’s National Asthma Control Program, Asthma, Asthma Control Program, Asthma Treatment Plan, Diagnosis and treatment of asthma in childhood, Global Strategy for Asthma Management and, Global Strategy for Asthma Management and Prevention, Incentives Program, Blue Cross Blue Shield of Illinois