<p> Asthma Emergency Care Plan/504 PLAN</p><p>Name: Birth date: Teacher: Grade: Parent/Guardian: Address: Home Phone: Work Phone: Doctor/HCP: Preferred hospital: DIAGNOSIS: Asthma Medication: Location: Triggers: Home medication:</p><p>IF YOU SEE THIS DO THIS • Wheezing Contact health room • Coughing Do not send student to health room alone • Shortness of breath/dyspnea Give medication as prescribed • Complaining of chest tightness Keep student sitting up and reassure student Encourage student to drink warm fluids</p><p> If student's symptoms do not Call 911 improve in 5-10 minutes Notify parent  If cough becomes productive Call school nurse:  exhalation longer than inhalation Pager number:  Retractions seen in area below rib cage or in neck  Student becomes pale and sweaty. </p><p> If student is in severe Call 911. distress Notify parent, principal and school nurse.  Unable to speak in full sentence  Bluish color  Severe restlessness  Decrease level of consciousness </p><p>Nurse signature:______Date:______</p><p>Physician signature:______Date:______INDIVIDUAL HEALTH/EMERGENCY CARE PLAN CONTACT INFORMATION</p><p>STUDENT:</p><p>E-MAIL: ______</p><p>NAME/Relationship #1 PHONE (Type) #2 PHONE (Type) #3 PHONE (Type)</p><p>Updated: </p><p>Parent signature:______Date:______</p>