Skip to main content
More Search Options
A member of our team will call you back within one business day.
Name: Personal Best Peak Flow: Date:
Provider’s Telephone: After-hours Telephone:
Personal Best Peak Flow: _____________________________________________
Peak flow is greater than
See provider every ______ months.
No cough or wheeze
Breathing is good
Sleep through the night
Can work and play
Take your daily preventive medicines:
How much to take_______________
Take this medicine 5 minutes before exercise:
Peak flow is between
Call provider if in YELLOW ZONE
Shortness of breath
Continue taking your daily preventive medicines.
Add quick-relief medicines for symptoms:
If you go back to the GREEN ZONEafter one hour, continue to watchyour symptoms.
If your symptoms do not return toGREEN ZONE after one hour of treatment,take: ___
Add for days:
Peak flow is less than
Call Provider’s Office!
Medicine is not helping
Breathing is hard and fast
Nose opens wide
Constant coughing or wheezing
Can't talk well
Any severe symptoms
Take quick-relief : How much:
Add______________ How much
Go to the hospital or call 911 if you are still in theRED ZONE after 15 minutes and you have notreached your doctor.
Call 911 if your child:
Is breathing hard or fast
Is sucking in chest or abdomen
Can’t walk or can’t talk
Has blue lips or fingers