Get Maryland State School Asthma Medication Administration Authorization Form 12 Asthma Action Plan

Filling out the Maryland State School Asthma Medication Administration Authorization Form 12 Asthma Action Plan is essential for ensuring that students with asthma receive the appropriate care at school. This guide provides a step-by-step approach to completing the form online, making the process easier and more efficient for parents and guardians.

Follow the steps to complete the form accurately and effectively.

1. Press the ‘Get Form’ button to acquire the form and open it in your digital workspace.
2. Begin by filling in the child's name, date of birth, and asthma severity. Clearly indicate the child's asthma triggers in the designated section.
3. In the 'Green Zone' section, record the controller medication details, including dosage, route, and frequency of administration. Ensure accuracy to guarantee effective management of your child's condition.
4. Next, address the 'Yellow Zone' for medication usage when symptoms arise. List the medications, doses, and the conditions under which they should be administered, such as during wheezing or tightness in the chest.
5. Complete the 'Red Zone' section to detail the emergency medications. Note the medications, dosages, and specific symptoms that necessitate emergency assistance.
6. Provide the healthcare provider's authorization by including their name and signature. Ensure that the date is also completed.
7. Then confirm the parent/guardian authorization by signing and dating the form. Indicate whether the student is authorized to self-carry their medications.
8. Review the entire form for completeness and correctness. After ensuring that all relevant sections are filled, save your changes, and download or print the completed form for submission.

Complete your documents online today to ensure your child's asthma management plan is in place.