Asthma action plan.pdf - All For Kids Pediatric Clinic - afkpeds 2026

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  1. Click ‘Get Form’ to open the Asthma action plan in our editor.
  2. Begin by entering the child's Name, Date of Birth, and Date at the top of the form. This information is crucial for identifying the patient.
  3. Fill in the Health Care Provider's name and phone number, along with the Parent/Responsible Person's details. Ensure that all contact information is accurate for emergencies.
  4. Identify asthma severity by checking the appropriate box under 'Asthma Severity'. This section helps determine daily medication needs.
  5. List any identified asthma triggers in the designated area. This will assist in managing and avoiding potential exacerbations.
  6. Complete the sections on Asthma Control, detailing both CONTROL and RESCUE medicines as prescribed. Be sure to note dosages and frequency.
  7. Finally, ensure that both required signatures are obtained at the bottom of the form before submission.

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Your asthma action plan will include your medicines and instructions for what to do when you are feeling well, what to do when you have asthma symptoms and what to do when your asthma symptoms are getting worse. It should include the names of your medicines, how much to take and when to take it.
If you have a printed copy, stick it on the fridge or pin it to a noticeboard. You can also save a digital copy on your phone.
An asthma action plan is designed to help families manage their childs asthma. The goal is to avoid asthma emergencies. The plan can guide parents and caregivers on what medications to use, and when to use them, to prevent and control flare-ups.

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