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5335 F2/Page 1 of 2SHEBOYGAN AREA SCHOOL DISTRICT Department of Student and Instructional ServicesSchool Year___STUDENT ASTHMA HEALTH ACTION PLAN Students Name___Birthdate___ School___Grade___Teacher/HR___
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How to fill out student asthma health action

01
Gather necessary information about the student's asthma condition, including any triggers, symptoms, and medications.
02
Create a document or form that includes sections for personal information, emergency contact information, asthma triggers, symptoms, medication instructions, and emergency action plan.
03
Fill out the personal information section with the student's name, date of birth, contact details, and any relevant medical history.
04
Provide emergency contact information, including the names and phone numbers of parents or guardians, as well as the student's primary care physician.
05
List any known asthma triggers, such as allergens or exercise, and specify what precautions should be taken to avoid them.
06
Describe the student's typical asthma symptoms, such as coughing, wheezing, or shortness of breath, and indicate how severe they usually are.
07
Include detailed instructions for the student's medication, including the name, dosage, and frequency of use. Specify if any special equipment or techniques are required for administering the medication.
08
Develop an emergency action plan that outlines step-by-step instructions for managing an asthma attack, including when to administer medication, when to seek medical help, and who to contact.
09
Complete the document by reviewing all the information for accuracy and ensuring that it is easily understandable.
10
Make copies of the student asthma health action form for the student's school, parents, and any other relevant parties.
11
Update the form as necessary to reflect any changes in the student's asthma condition or treatment.

Who needs student asthma health action?

01
Students with asthma of any age can benefit from having a student asthma health action.
02
It is particularly important for students who experience moderate to severe asthma symptoms or have a history of frequent asthma attacks.
03
Schools, daycare centers, and other educational institutions should have student asthma health actions on file for any student with asthma.
04
Parents or guardians of students with asthma should also have a student asthma health action so they can inform relevant parties about their child's condition and provide necessary instructions for managing asthma episodes.
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Student asthma health action is a documented plan that outlines the necessary steps and procedures to manage and support students with asthma in a school setting.
Schools are required to have a designated individual, often a school nurse or administrator, file the student asthma health action for each student diagnosed with asthma.
To fill out the student asthma health action, one must provide the student's personal information, asthma triggers, medication details, and emergency action steps, alongside any specific instructions from healthcare providers.
The purpose of the student asthma health action is to ensure that students with asthma receive appropriate care and that potential asthma-related emergencies are prevented.
Information such as student's name, date of birth, asthma diagnosis, prescribed medications, emergency contacts, and specific treatment plans must be reported on the student asthma health action.
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