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Patient Name: Form 33.25 rev 11/09 Date of Birth: Parent Name: Cell Phone: My Asthma Action Plan Home Phone: Use traffic light colors to help control asthma. School Name: Asthma Severity Intermittent:

How to fill out my asthma action plan

How to fill out my asthma action plan:

1. Start by obtaining a copy of your asthma action plan from your healthcare provider. This plan will outline specific instructions and guidelines for managing your asthma symptoms.
2. Carefully read through the entire action plan, familiarizing yourself with the various sections and their corresponding instructions.
3. Pay close attention to the symptoms, triggers, and peak flow readings outlined in the plan. Make sure to understand the recommended actions for each scenario.
4. Consult with your healthcare provider if you have any questions or require clarification on any aspect of the plan. It's crucial to have a clear understanding of your asthma management strategies.
5. Fill in the necessary personal information on the action plan, such as your name, emergency contact details, and healthcare provider's contact information. This ensures that the plan is personalized and easily identifiable.
6. Record your current medications, including their names, dosages, and frequencies, on the action plan. It's essential to keep this information updated as changes are made to your medication regimen.
7. Work with your healthcare provider to determine your personal best peak flow measurement and write it down on the action plan. This will help you monitor your lung function and take appropriate action when necessary.
8. Use the action plan as a reference guide to categorize your asthma symptoms into three zones: green, yellow, and red. Follow the instructions outlined in each zone to address your symptoms effectively.
9. Keep your asthma action plan in a readily accessible location, such as your wallet, purse, or school bag, so that it is easily available in case of an asthma emergency.
10. Remember to review and update your asthma action plan regularly, particularly when there are changes in your symptoms, triggers, or medication. It's essential to ensure that the plan remains current and reflects your unique needs.

Who needs my asthma action plan:

1. Individuals diagnosed with asthma, regardless of age, should have their own asthma action plan.
2. Children and teenagers with asthma should have their action plans shared with their parents or guardians, as they may need assistance in managing their condition.
3. Schools, daycare centers, and other educational institutions should have a copy of a student's asthma action plan on file to ensure appropriate care and management during school hours.
4. Coaches, trainers, and sports instructors should be aware of their athletes' asthma action plans to provide appropriate support and guidance during physical activities.
5. Close family members, friends, or roommates should be familiar with your asthma action plan in case of an emergency situation when you may be unable to communicate your needs effectively.

Remember, it's essential to regularly communicate and share your asthma action plan with the relevant individuals to ensure your safety and effective asthma management.

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What is my asthma action plan?

Your asthma action plan is a personalized written plan that outlines how to manage and treat your asthma, including medications, triggers to avoid, and steps to take in case of an asthma attack.

Who is required to file my asthma action plan?

Your healthcare provider is responsible for creating and updating your asthma action plan, but it is important for you to follow the instructions and carry it with you at all times.

How to fill out my asthma action plan?

Your healthcare provider will fill out your asthma action plan based on your individual needs, including medication dosages, peak flow measurements, and specific instructions for managing your asthma symptoms.

What is the purpose of my asthma action plan?

The purpose of your asthma action plan is to help you effectively manage your asthma, reduce the risk of asthma attacks, and know what steps to take in emergency situations.

What information must be reported on my asthma action plan?

Your asthma action plan should include your personal information, medication dosages, peak flow measurements, triggers to avoid, and step-by-step instructions for managing asthma attacks.