Get Asthma Action Plan Symptom Based - West High School - Whs Tusd

Filling out the Asthma Action Plan Symptom Based form is essential for ensuring the safety and health of students with asthma. This guide provides clear instructions on how to complete the form accurately and efficiently to provide the necessary information for school staff.

Follow the steps to complete and submit your Asthma Action Plan online.

1. Press the 'Get Form' button to access the Asthma Action Plan. This will allow you to open the form for completion.
2. Begin by filling in the student's personal information. Enter the student’s name, date of birth, and school in the designated fields.
3. Next, provide the parent or guardian's contact details. Include home phone and cellular numbers so that the school can reach them if necessary.
4. The physician must complete the next sections. They will need to list any medications prescribed for the student, including those taken at home and school. Specify the medication name, dosage, route, and frequency for each. Make sure to differentiate between the quick-relief and controller medications.
5. Indicate if the student is allowed to self-carry or self-administer their inhaler medication. This requires the student to demonstrate competence, and if applicable, the Contract to Carry Form should also be noted.
6. Check the box for any known asthma triggers. This includes items such as tobacco, dust, cold air, and various allergens.
7. Using the symptoms listed, determine which zone the student typically falls into: Green, Yellow, or Red Zone. Document the symptoms the student experiences.
8. For each zone selected, indicate the actions to be taken by the school staff in response to the symptoms noted. This should include the administration of quick-relief medication.
9. Complete the School Emergency Plan sections accurately. Outline the steps to be followed if the student's symptoms do not improve.
10. Lastly, enter the physician's name, signature, and date in the relevant fields. Provide the physician’s contact information to facilitate communication if needed.
11. The parent or guardian must sign to give permission for school staff to contact the physician for consultation and information exchange as necessary. Make sure this is completed.
12. Once all fields are filled, save the changes, and select your preferred option to download, print, or share the completed document.

Complete your Asthma Action Plan online today to ensure the health and safety of students with asthma.