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Asthma Action Plan Name Date of Birth Date GREEN means Go! / / Use CONTROL medicine daily Health Care Provider Providers Phone Parent/Responsible Person Parents Phone School Add RESCUE medicine Additional
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How to fill out dc asthma action plan
How to fill out a DC Asthma Action Plan:
01
Start by obtaining a copy of the DC Asthma Action Plan form. This form can be obtained from your healthcare provider or downloaded from the official website of the DC Department of Health.
02
Fill in your personal information on the form, including your name, date of birth, and contact information. This is important to ensure that the plan is specific to you and can be easily identified in case of emergencies.
03
Provide information about your healthcare provider, including their name, contact information, and their preferred method of communication (such as phone or email).
04
Indicate any allergies or sensitivities you have that may trigger your asthma symptoms. This information will help healthcare professionals tailor their treatment to your specific needs.
05
List all of your current asthma medications, including the names, dosages, and frequencies of use. It is important to accurately include all prescribed medications to ensure that the plan reflects your current treatment.
06
Describe your typical asthma symptoms and identify any factors that may worsen your condition. This can include triggers such as exercise, allergens, or environmental factors.
07
Specify the steps to take in case of an asthma attack or worsening symptoms. This may include using your rescue inhaler, seeking immediate medical attention, or using additional prescribed medications.
08
Include emergency contact information for a trusted individual who can be reached in case of an asthma emergency. This can be a family member, friend, or neighbor who can assist you if needed.
09
Review the completed DC Asthma Action Plan with your healthcare provider to ensure its accuracy and discuss any additional concerns or questions you may have.
10
Keep a copy of the filled-out DC Asthma Action Plan in a readily accessible place at home, school, or work. Make sure that relevant individuals, such as school nurses or family members, are aware of the plan's location and how to use it in case of an emergency.
Who needs a DC Asthma Action Plan?
01
Individuals diagnosed with asthma should have a DC Asthma Action Plan. This includes both adults and children.
02
People with a history of asthma symptoms or those who have received a diagnosis, even if they haven't recently experienced symptoms, can benefit from having an action plan.
03
The DC Asthma Action Plan is particularly important for individuals with moderate to severe asthma or those who have a history of asthma attacks. This plan helps guide them and others in managing their condition and responding appropriately to worsening symptoms.
Note: It is essential to consult with a healthcare provider to obtain a personalized DC Asthma Action Plan and to discuss any specific questions or concerns regarding asthma management.
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What is dc asthma action plan?
The DC asthma action plan is a detailed document outlining steps to manage asthma symptoms and respond to asthma attacks effectively.
Who is required to file dc asthma action plan?
Schools, daycares, and other facilities with students or children with asthma are required to file a DC asthma action plan.
How to fill out dc asthma action plan?
The DC asthma action plan can be filled out by following the guidelines provided by the Department of Health.
What is the purpose of dc asthma action plan?
The purpose of the DC asthma action plan is to ensure that proper precautions and protocols are in place to address asthma emergencies.
What information must be reported on dc asthma action plan?
The DC asthma action plan must include information about the individual with asthma, their triggers, medications, emergency contacts, and steps to be taken during an asthma attack.
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