MD DHMH Form 4643 2004-2025 free printable template

MARYLAND DEPARTMENT OF HEALTH AND MENTAL HYGIENE ASTHMA ACTION PLAN Check Asthma Severity: Mild Intermittent Mild Persistent Moderate Persistent Severe Persistent Patient s Name DOB Effective Date

How to fill out maryland asthma action plan

How to fill out MD DHMH Form 4643

1. Start by downloading the MD DHMH Form 4643 from the official website.
2. Read the instructions provided on the form carefully.
3. Fill out the applicant's personal information in Section 1, including name, address, and contact information.
4. In Section 2, specify the type of service requested and any relevant details.
5. Provide any necessary documentation that supports your application in the designated area.
6. Review all entries for accuracy and completeness.
7. Sign and date the form at the bottom.
8. Submit the completed form via the specified method (online, by mail, or in person) as indicated in the instructions.

Who needs MD DHMH Form 4643?

1. Individuals seeking certain public health services or assistance from the Maryland Department of Health.
2. Healthcare providers submitting requests for patient services on behalf of their patients.
3. Organizations or entities involved in programs that require official documentation from the Maryland Department of Health.

People Also Ask about

What is included in an asthma action plan?

Your asthma action plan will include your medicines and instructions for what to do when you are feeling well, what to do when you have asthma symptoms and what to do when your asthma symptoms are getting worse. It should include the names of your medicines, how much to take and when to take it.

Is Maryland good for asthma?

High rates of ED visits, hospitalizations, and death suggest that asthma is often poorly controlled in Maryland.

How many people in Maryland have asthma?

State or Territory Adult Current Asthma1 Prevalence by State or Territory (2020) State or TerritoryNumber With Current AsthmaPercent With Current Asthma (SE)Maryland420,6868.9 (0.34)Massachusetts592,04810.7 (0.50)Michigan859,53411.0 (0.50)Minnesota369,2388.5 (0.28)49 more rows

What is 4 4 4 asthma action plan?

Tell the operator that someone is having an asthma emergency. Keep giving the person 4 separate puffs, taking 4 breaths for each puff, every 4 minutes until emergency assistance arrives.

Are asthma action plans effective?

Several studies have shown the benefits of providing action plans to asthma patients, both in the adult (14, 15) and pediatric population (16), resulting in reduced frequency of exacerbations, fewer visits to the Emergency Department, and an overall improvement of the quality of life.

What is the Maryland asthma Control plan?

The Maryland Asthma Control Program (MACP) has implemented the statute's requirements to develop an asthma surveillance system, develop a statewide asthma plan and implement interventions in collaboration with the Maryland Asthma Coalition and under the guidance of the MACP.

What is the purpose of a asthma action plan?

An asthma action plan (or management plan) is a written plan that you create with your child's doctor to help control your child's asthma. The goal of an asthma action plan is to reduce or prevent flare-ups and emergency department visits.

What is the asthma plan?

An Asthma Action Plan (also called a management plan) is a written plan that you develop with your doctor to help control your asthma." The Asthma Action Plan (AAP) lists all medications with instructions on when they should be taken.

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What is MD DHMH Form 4643?

MD DHMH Form 4643 is a form used in Maryland for reporting incidences of communicable diseases and conditions as mandated by public health regulations.

Who is required to file MD DHMH Form 4643?

Health care providers, laboratories, and institutions that diagnose or treat persons with reportable communicable diseases are required to file MD DHMH Form 4643.

How to fill out MD DHMH Form 4643?

To fill out MD DHMH Form 4643, you need to provide information about the patient's identity, the diagnosis, the date of diagnosis, and any relevant laboratory results. Follow the instructions on the form carefully to ensure accurate reporting.

What is the purpose of MD DHMH Form 4643?

The purpose of MD DHMH Form 4643 is to ensure that the Maryland Department of Health receives timely information regarding communicable diseases in order to monitor public health trends and implement control measures.

What information must be reported on MD DHMH Form 4643?

The information that must be reported on MD DHMH Form 4643 includes patient demographics, the nature of the disease or condition, the date of diagnosis, and any relevant laboratory data related to the case.