We use cookies to improve security, personalize the user experience, enhance our marketing activities (including cooperating with our marketing partners) and for other business use.
Click "here" to read our Cookie Policy. By clicking "Accept" you agree to the use of cookies. Read less
Read more
Accept
Loading
Form preview
  • US Legal Forms
  • Form Library
  • More Forms
  • More Uncategorized Forms
  • Da-41102015154act12over Asthma Control Test Act - Adult For People 12 Years And Older - Provider Ghc

Get Da-41102015154act12over Asthma Control Test Act - Adult For People 12 Years And Older - Provider Ghc

Patient 's Name Date Patient 's DOB GHC MRN FOR PATIENTS: Take the Asthma Control TestTM (ACT) for people 12 years and older. Know your score. Share your results with your doctor. Step 1 Write the.

How it works

  1. Open form

    Open form follow the instructions

  2. Easily sign form

    Easily sign the form with your finger

  3. Share form

    Send filled & signed form or save

How to fill out the Da-41102015154act12over Asthma Control Test ACT - Adult For People 12 Years And Older - Provider Ghc online

Filling out the Da-41102015154act12over Asthma Control Test (ACT) can be a straightforward process that helps monitor asthma management. This guide will walk you through the steps needed to complete the test online, ensuring you can effectively communicate your results with your healthcare provider.

Follow the steps to fill out the Asthma Control Test online.

  1. Click ‘Get Form’ button to obtain the form and open it in the editor for completion.
  2. Take the Asthma Control Test by answering each question based on your experience during the past four weeks.
  3. In the score box provided for each question, write the corresponding score based on your answers.
  4. Add all scores from the score boxes to get your total score.
  5. If your total score is 19 or less, make a note to discuss your asthma control with your doctor.
  6. Once completed, you can save the changes, download the form, print it, or share it for your records.

Start filling out your Asthma Control Test online today for better asthma management.

Get form

Experience a faster way to fill out and sign forms on the web. Access the most extensive library of templates available.
Get form

Related links form

Rite Aid Flu Shot Form 2020 Myacuvuerewards 2020 Conference And Events Sales Coordinator 2020 Stokstad Art History 6th Edition Pdf 2020

Questions & Answers

Get answers to your most pressing questions about US Legal Forms API.

Contact support

An asthma control test involves questions relating to daytime and nighttime asthma symptoms. This test helps determine if a person is controlling their asthma well. The asthma control test helps someone identify how their symptoms interfere with their day-to-day life.

There are four key symptoms that you should monitor to help you keep your asthma under control: Daytime Symptoms. How often do you have asthma symptoms during the day, such as coughing, wheezing, chest tightness or shortness of breath? Nighttime Symptoms. ... Quick-Relief or Rescue Inhaler Use. ... Activity Level.

A simple questionnaire to measure the adequacy of asthma control and change in asthma control which occurs either spontaneously or as a result of treatment. Scores range between 0 (totally controlled) and 6 (severely uncontrolled).

The scores range from 5 (poor control of asthma) to 25 (complete control of asthma), with higher scores reflecting greater asthma control. An ACT score >19 indicates well-controlled asthma.

Conclusion: Changes in TRACK scores of 10 or more points represent clinically meaningful changes in respiratory control status in individual young children with respiratory symptoms consistent with asthma and should alert health care providers to re-evaluate asthma management.

CPT code 96160 allows allergists to get reimbursed when they make use of certain standardized asthma assessment instruments. Specifically, CPT code 96160 describes the administration of patient-focused health risk assessment instruments with scoring and documentation, per standardized instrument.

A maximum score of 25 points indicates complete asthma control. A score between 20 and 25 represents well controlled asthma, while a score of 19 or below represents not well controlled asthma, and a score less than 16 indicates very poorly controlled asthma.

Score 25: WELL DONE Your asthma appears to have been UNDER CONTROL over the last 4 weeks. However, if you are experiencing any problems with your asthma, you should see you doctor or nurse.

Get This Form Now!

Use professional pre-built templates to fill in and sign documents online faster. Get access to thousands of forms.
Get form
If you believe that this page should be taken down, please follow our DMCA take down processhere.

Industry-leading security and compliance

US Legal Forms protects your data by complying with industry-specific security standards.
  • In businnes since 1997
    25+ years providing professional legal documents.
  • Accredited business
    Guarantees that a business meets BBB accreditation standards in the US and Canada.
  • Secured by Braintree
    Validated Level 1 PCI DSS compliant payment gateway that accepts most major credit and debit card brands from across the globe.
Get Da-41102015154act12over Asthma Control Test ACT - Adult For People 12 Years And Older - Provider Ghc
Get form
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
Privacy Notice
Legal Hub
Content Takedown Policy
Bug Bounty Program
About Us
Help Portal
Legal Resources
Blog
Affiliates
Contact Us
Delete My Account
Site Map
Industries
Forms in Spanish
Localized Forms
State-specific Forms
Forms Kit
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate WorkFlow
DocHub
Instapage
Social Media
Call us now toll free:
+1 833 426 79 33
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
Privacy Notice
Legal Hub
Content Takedown Policy
Bug Bounty Program
About Us
Help Portal
Legal Resources
Blog
Affiliates
Contact Us
Delete My Account
Site Map
Industries
Forms in Spanish
Localized Forms
State-specific Forms
Forms Kit
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate WorkFlow
DocHub
Instapage
Social Media
Call us now toll free:
+1 833 426 79 33
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232