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Get PH Pru Life U.K. Respiratory Disorder Questionnaire 2009-2024

Uency of episodes Date of Birth (mm/dd/yy) Date of Onset Date of First Consultation Date of Last Attack 1. Given the classifications overleaf, would you describe your patient s condition as mild, moderate or severe? 2. Please give details of treatment, particularly steroid theraphy? 3. Is there any limitations of functional capacity including ability to work? 4. Please give the dates and results of any investigations, including pulmonary function tests and chest X-rays. 5. Are you awa.

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