Asthma Emergency Action Plan Form

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Asthma Emergency Action Plan

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Max. file size: 2 MB.
Parent/Guardian Name(Required)
Emergency Contact Name(Required)

Other Instruction

It is parent responsibility to notify the facility of any change in the child's condition

Danger Zone

1) Medicine is not helping

2) Breathing is hard & fast

3) Trouble Speaking

Call doctor, if cannot contact take child to emergency 911 inform parent

Sign below

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