Transcription of DAILY ASTHMA/ALLERGY MANAGEMENT PLAN …
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DAILY ASTHMA/ALLERGY MANAGEMENT PLAN …
child CARE ASTHMA/ALLERGY action CARD Name: _____ _____ DAILY ASTHMA/ALLERGY MANAGEMENT PLAN ID Photo Grade: _____ DOB:_____ Identify the things that start an ASTHMA/ALLERGY episode Parent/Guardian Name: _____ (Check each that applies to the child ) Address:_____ Animals Bee/Insect Sting Chalk Dust Change in Temperature Phone (H): _____ (W): _____ Dust Mites Exercise Latex Molds Parent/Guardian Name: _____ Pollens Respiratory Infections Smoke Strong Odors Address: _____ Food: _____ Phone (H): _____ (W): _____ Other: _____ Other Contact Information: _____ Comments: _____ Emergency Phone Contact #1 _____ _____ Name _____ _____ Peak Flow Monitoring (for children over 4 years old) Relationship Phone Emergency Phone Contact #2 _____ Personal Best Peak Flow reading: _____ Name _____ _____ Monitoring Times: _____ _____ _____
ASTHMA EMERGENCY PLAN ALLERGY EMERGENCY PLAN Emergency action is necessary when the child has symptoms such as _____ • Child is allergic to:
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