_______________________________ has asthma and takes the following medications on a regular basis:
___________________________________
___________________________________
___________________________________

You may reach me at:   __________________________________

If you cannot reach me, contact:
___________________________
___________________________
___________________________

Early warning signs are:
________________________________
________________________________

Special instruction if any early signs should develop:
__________________________________________________________

If he/she should have an asthma flare, remain calm and follow the above instructions.

IN CASE OF EMERGENCY
Doctor’s Phone #
_____________________________
Emergency Room #:
_____________________________
Health Insurance:
_____________________
ID#:
_____________________