Microsoft word - asthma_emergencycare_planps 6.1.doc
To Be Completed by the Health Care Provider San Francisco Unified School District School Health Programs Department 1515 Quintara Street San Francisco, CA 94116-1273 TEL: 415.242.2615 FAX: 415.242.2618
Age: ____ Date of Birth:___________________
School: ______________________________ Homeroom Teacher:_______________ Grade: _______ Room:___________
Parent/Caregiver Name: _________________________Phone (home)______________(cell):_____________ (work): ___________
Health Care Provider Treating Student for Asthma____________________________ Phone: __________________________
To provide assistance to a pupil experiencing asthma symptoms. If you see or hear this Actions to Take
1. Stay with student, speak softly, and stay calm
2. Keep person sitting upright and encourage slow deep
breathing—in through the nose & out through puckered lips.
3. Give quick relief medication: (circle or write in)
If symptoms improve, may repeat in 4 hours.
Other:____________________________________________
Location of med: __________________________________ Factors that may cause an If symptoms continue, repeat in 5-10 minutes and have asthma episode include: cold helper call 911. May repeat with 3-4 puffs every 20min x3 until medical help arrives.
4. Have helper call parents/guardian/ and school nurse or Nurse
mold, foods and/or OTHER: _____ *A completed and signed Medication Form must be on file at the school for ________________________________
each medication before medication can be administered at school. CALL 911 IF YOU SEE
• Breathing difficulty remains or worsens
• Skin pulling in around collarbone and ribs
• Student stopping play and not able to start
activity again, due to breathing problems
• Lips or fingernails turning (darkening) grey
• Student having trouble talking or walking
Administer CPR if breathing stops! Continue until paramedics arrive! Does student need medicine before PE/ recess? ❏ No ❏ Yes Med Location ____________ As Needed? ❏ No ❏ Yes Always use before exercise? ❏ No ❏ Yes (school to complete) Med: (circle or write in)Albuterol Inhaler – 2 puffs with spacer, 15-20 minutes before exercise Other _______________________________________________________________________ I authorize school personnel to implement this Asthma Emergency Plan as described. ________________________________________________ _______________________________
Doy mi consentimiento para que las autoridades escolares tomen la acción apropiada para la seguridad y bienestar de mi hijo/a. Doy mi consentimiento para que las autoridades escolares se comuniquen con el médico de mi hijo/a, cuando sea necesario. Mi hijo/a no necesita los servicios. ________________________________________ _______________________________ Available @ http://portal.sfusd.edu/template/default.cfm?page=chief_dev.health.MedicalForms 5/05
ANA/NJ Newsletter Vol X, No. 2 April 2006 Meeting at East Brunswick Public Library, February 19, 2006 This was a meeting for sharing experiences, conducted by Kathie Belonger, who also provided the delicious refreshments. There were 15 people in attendance. In the course of an informal and wide-ranging discussion, we learned about (1) coping with an AN back in the 1970s, and dea
"LOS DERECHOS ECONÓMICOS SOCIALES Y CULTURALES EN UN MUNDO GLOBALIZADO DR. ALIRIO URIBE MUÑOZ CORPORACIÓN COLECTIVO DE ABOGADOS - COLOMBIA 1- Base constitucional colombiana para la estrategia de exigibilidad 2- Acciones judiciales en el plano nacional que nos sirven para exigir los derechos económicos, sociales y culturales - Experiencias y expectativas 2.1- La acción de
To Be Completed by the Health Care Provider