
Get the free My Asthma Action Plan for Ages 6 and Older
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Patient Name: ___
DOB: ___My Asthma Action PlanHealthcare Providers Name: ___
Healthcare Providers Phone #: ___Ages 6 and Older: Review and update at each Doctors visit feel goodPREVENT asthma symptoms
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How to fill out my asthma action plan

How to fill out my asthma action plan
01
Make sure you have a copy of your asthma action plan with you at all times.
02
Review your asthma action plan with your healthcare provider to ensure you understand the instructions.
03
Fill out the personal information section with your name, address, emergency contact, and healthcare provider's contact information.
04
Fill out the details of your daily asthma medications, including the name, dosage, and frequency of each medication.
05
Fill out the details of your rescue inhaler, including how and when to use it in case of an asthma attack.
06
Review and update your asthma action plan regularly with your healthcare provider.
Who needs my asthma action plan?
01
Anyone who has been diagnosed with asthma needs to have an asthma action plan.
02
It is especially important for people with moderate to severe asthma, children with asthma, and those who have frequent asthma attacks to have an asthma action plan.
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What is my asthma action plan?
Your asthma action plan is a written document that outlines your daily treatment plan for managing your asthma, as well as instructions for how to handle worsening symptoms or asthma attacks.
Who is required to file my asthma action plan?
Your healthcare provider is responsible for creating and updating your asthma action plan.
How to fill out my asthma action plan?
Your healthcare provider will fill out your asthma action plan based on your individual asthma triggers, symptoms, and treatment plan.
What is the purpose of my asthma action plan?
The purpose of your asthma action plan is to help you manage your asthma effectively, prevent asthma attacks, and know when to seek medical help.
What information must be reported on my asthma action plan?
Your asthma action plan should include details about your medications, triggers, symptoms, peak flow readings, and instructions for taking action in case of worsening symptoms.
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