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ASTHMA EMERGENCY ACTION PLAN MEDICATION ADMINISTRATION AUTHORIZATION FORM (CONTINUED) Asthma Action Plan // to // (not to exceed 12 months) Students Name: D.O.B.: Peak Flow Personal Best: Parent(s)/Legal

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How to fill out asthma emergency action plan

01

Consult with your healthcare provider to get an asthma action plan tailored to your needs.

02

Ensure you have all necessary information including emergency contacts, list of triggers, daily medications, and peak flow readings.

03

Understand the specific instructions for each zone (green, yellow, red) including when to use rescue medication and when to seek medical help.

04

Review and update the action plan regularly with your healthcare provider.

Who needs asthma emergency action plan?

01

Individuals diagnosed with asthma, especially those with moderate to severe symptoms or a history of asthma attacks.

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What is asthma emergency action plan?

An asthma emergency action plan is a written plan that outlines specific steps to take in case of an asthma attack.

Who is required to file asthma emergency action plan?

Individuals with asthma, their caregivers, and schools or workplaces where the individual spends a significant amount of time are required to have an asthma emergency action plan on file.

How to fill out asthma emergency action plan?

To fill out an asthma emergency action plan, one should work with their healthcare provider to customize the plan based on their individual needs and asthma triggers.

What is the purpose of asthma emergency action plan?

The purpose of an asthma emergency action plan is to guide individuals on how to manage their asthma symptoms and respond appropriately in case of an asthma attack.

What information must be reported on asthma emergency action plan?

An asthma emergency action plan should include the individual's personal information, asthma triggers, specific medications, dosage instructions, symptoms of worsening asthma, and emergency contact information.

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