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! Take these CONTROL (PREVENTION) Medicines EVERY DayYou have ALLof these: Breathing is easy No cough or wheeze Can work and play Can sleep all night No control medicines required.
Asthma Action Plan Name School DOB Health Care Provider Provider’s Phone Parent/Responsible Person Parent’s Phone
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