Get Brief Respiratory Questionnaire (brq) - Hudson Valley Asthma ... - Hudsonvalleyasthmacoalition

Filling out the Brief Respiratory Questionnaire (BRQ) is an important step in assessing respiratory health for children. This guide provides clear instructions on completing the form efficiently and accurately online, ensuring that you have all necessary information ready at hand.

Follow the steps to fill out the Brief Respiratory Questionnaire online:

1. Press the ‘Get Form’ button to access the form, making sure to open it in your preferred editing interface.
2. Begin by entering the interviewer's name and the date of the interview in the provided fields.
3. For the child’s information, fill in their first name, last name, date of birth, and select their ethnic group from the options listed.
4. Provide the name of the childcare center and specify the child’s gender.
5. Next, enter the guardian's first name and last name. Indicate their relationship to the child by selecting from the options available.
6. Proceed to answer section 1 by indicating if the child experienced wheezing or a persistent cough in the last 12 months.
7. In section 2, enter the number of times this occurred in the last year, recording '0' if none.
8. For section 3, specify how many nights the child had sleep disturbances related to respiratory issues, again recording '0' if none.
9. Section 4 consists of a series of yes/no questions about medical conditions as diagnosed by a healthcare provider. Answer each condition thoroughly.
10. In section 5, mark whether any medications or treatments were prescribed for respiratory conditions in the last 12 months.
11. For section 6, indicate how many urgent appointments or emergency room visits the child had due to respiratory issues over the past year.
12. In section 7, record how many nights the child was hospitalized for asthma or related respiratory conditions, marking '0' if none.
13. Finally, in section 8, confirm whether the child is currently under the medical care of a provider for any respiratory issues.
14. After completing the form, review all your answers for accuracy before saving your changes, downloading, or printing the form.

Get started now to complete the Brief Respiratory Questionnaire online.