Tobias - Asthma Update for Nurse Ashley
Please keep me updated through the school year regarding your child's asthma so I can better care for them. Feel free to email me at Ashley.Armstrong@hayscisd.net 
Email *
Child's first and last name (legal name) *
How many days a week does your child require their rescue medication, ex. Albuterol (ProAir HFA, Proventil HFA, Ventolin HFA), Levalbuterol (Xopenex HFA), Metaproterenol Terbutaline?
 *
Is your child receiving a daily medication for their asthma, such as  Flovent, Advair, Pulmicort, Symbicort and QVAR *
How many days has your child been treated in the emergency room for their asthma over the last 12 months? *
How many days has your child been hospitalized overnight or longer for asthma in the past 12 months? *
What are your child's usual symptoms during an asthma attack? Check all that apply. Feel free to elaborate on next question. *
Required
Please describe other symptoms of your child's asthma attack or elaborate on the above question. *
What triggers your child's asthma? Check all that apply. *
Required
Please describe other triggers of your child's asthma attack or elaborate on the above question. *
Months of the year when your child's asthma flares? *
Does your child know when they need their rescue medication? *
Does your child have an Asthma Action Plan? If so please provide a copy to the school nurse - this helps us give your child the best care. *
Will you be sending an inhaler to school? If yes we will need a Medication Authorization form and updated Asthma Action Plan to be completed by parent/guardian and the child's physician. (Note: Nebulizer meds are still discouraged for on campus use due to the risks of Covid.) ** also please if able, provide a spacer** *
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