Get the free Asthma Action Plan 12 Years & Older - CT.gov
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Asthma Action Plan 12 Years & Older Name:Birth Date:Parent/Guardian Phone #s:STATE OF CONNECTICUT DEPARTMENT OF PUBLIC HEALTH www.ct.gov/dph/asthma Date:Provider Phone #: Fax #: (or stamp)Important!
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How to fill out asthma action plan 12
How to fill out asthma action plan 12
01
To fill out asthma action plan 12, follow these steps:
02
Start by entering your personal information such as your name, date of birth, and contact information.
03
Next, provide details about your asthma triggers. This may include things like pet dander, pollen, or smoke.
04
Indicate your current medications and their dosages. Be sure to include both preventer and reliever medications.
05
Specify your asthma symptoms and how frequently you experience them.
06
Describe any emergency contact information, including the names and phone numbers of your emergency contacts.
07
Finally, review the completed action plan with your healthcare provider to ensure accuracy and understanding.
Who needs asthma action plan 12?
01
Asthma action plan 12 is generally recommended for individuals who have been diagnosed with asthma.
02
It is particularly important for people with moderate to severe asthma, as well as those who have a history of asthma attacks or hospitalizations.
03
Children with asthma and their parents or caregivers should also have an asthma action plan to help manage their symptoms.
04
If you experience frequent asthma symptoms or have difficulty controlling your asthma, it is recommended to have an asthma action plan in place.
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What is asthma action plan 12?
Asthma action plan 12 is a written document that outlines how to manage asthma symptoms and respond to asthma attacks.
Who is required to file asthma action plan 12?
Individuals with asthma, particularly those diagnosed with moderate to severe asthma, are required to have an asthma action plan 12.
How to fill out asthma action plan 12?
Asthma action plan 12 can be filled out by a healthcare provider in collaboration with the individual with asthma. It includes information on triggers, medications, symptoms, and emergency contacts.
What is the purpose of asthma action plan 12?
The purpose of asthma action plan 12 is to provide clear instructions on how to manage asthma symptoms, recognize worsening symptoms, and take appropriate actions in case of an asthma attack.
What information must be reported on asthma action plan 12?
Asthma action plan 12 must include information on triggers, medications, dosage instructions, symptoms, peak flow readings, and emergency contacts.
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