In this section
Patient's name
UR number
DOB
Date:
Prednisolone
daily for 1 2 3 4 5 day/s with food.
GP
Paediatrician
Do you wish to include information on preventers?
Medication 1
Select medication 1 Alvesco (Ciclesonide 80ug) pMDI Alvesco (Ciclesonide 160ug) pMDI Flixotide (fluticasone 50 mcg) pMDI Flixotide (fluticasone 125 mcg) pMDI Flixotide (fluticasone 250 mcg) pMDI Flixotide (fluticasone 100 mcg) accuhaler Flixotide (fluticasone 250 mcg) accuhaler Flixotide (fluticasone 500 mcg) accuhaler Intal Forte (cromoglycate 5 mg) pMDI Oxis (eformoterol 6 mcg) Oxis (eformoterol 12 mcg) Pulmicort (budesonide 100 mcg) Pulmicort (budesonide 200 mcg) Pulmicort (budesonide 400 mcg) QVAR (beclomethasone 50 mcg) pMDI QVAR (beclomethasone 100 mcg) pMDI Seretide (50 salmeterol 100 fluticasone) accuhaler Seretide (50 salmeterol 250 fluticasone) accuhaler Seretide (50 salmeterol 500 fluticasone) accuhaler Seretide (25 salmeterol 50 fluticasone) pMDI Seretide (25 salmeterol 125 fluticasone) pMDI Seretide (25 salmeterol 250 fluticasone) pMDI Serevent (salmeterol 25 mcg) pMDI Serevent (salmeterol 50 mcg) accuhaler Singulair (montelukast) Symbicort Turbuhaler (Budesonide / Formoterol 100/6) Symbicort Turbuhaler (Budesonide / Formoterol 200/6) Symbicort Turbuhaler (Budesonide / Formoterol 400/12) Tilade (nedocromil 2 mg) pMDI
Medication 1 Dose
Select dose 1 puff 2 puffs 3 puffs 4 puffs 4mg 5mg 10mg
Medication 1 Frequency
Select frequency once per day at night twice per day 3 times per day
Medication 2
Select medication 2 Alvesco (Ciclesonide 80ug) pMDI Alvesco (Ciclesonide 160ug) pMDI Flixotide (fluticasone 50 mcg) pMDI Flixotide (fluticasone 125 mcg) pMDI Flixotide (fluticasone 250 mcg) pMDI Flixotide (fluticasone 100 mcg) accuhaler Flixotide (fluticasone 250 mcg) accuhaler Flixotide (fluticasone 500 mcg) accuhaler Intal Forte (cromoglycate 5 mg) pMDI Oxis (eformoterol 6 mcg) Oxis (eformoterol 12 mcg) Pulmicort (budesonide 100 mcg) Pulmicort (budesonide 200 mcg) Pulmicort (budesonide 400 mcg) QVAR (beclomethasone 50 mcg) pMDI QVAR (beclomethasone 100 mcg) pMDI Seretide (50 salmeterol 100 fluticasone) accuhaler Seretide (50 salmeterol 250 fluticasone) accuhaler Seretide (50 salmeterol 500 fluticasone) accuhaler Seretide (25 salmeterol 50 fluticasone) pMDI Seretide (25 salmeterol 125 fluticasone) pMDI Seretide (25 salmeterol 250 fluticasone) pMDI Serevent (salmeterol 25 mcg) pMDI Serevent (salmeterol 50 mcg) accuhaler Singulair (montelukast) Symbicort Turbuhaler (Budesonide / Formoterol 100/6) Symbicort Turbuhaler (Budesonide / Formoterol 200/6) Symbicort Turbuhaler (Budesonide / Formoterol 400/12) Tilade (nedocromil 2 mg) pMDI
Medication 2 Dose
Medication 2 Frequency
Other preventer instructions
Completing doctor -Select- Amy Gray Alissa Lim Amanda Griffiths Amanda Gwee Andrea Smith Andrew Steer Anisha Pillay Anton Harding Bronwyn Francis Colette Reveley Colin Robertson Danni Bao Daryl Efron Georgie Paxton Guiliana Antolovich Jo Harrison John Massie Jonathan Akikusa Julian Kelly Karen McLean Kathy Rowe Kirsten Perrett Lexie Frydenberg Lionel Lubitz Margaret Rowell Margie Danchin Margot Nash Michael Marks Mike South Mike Starr Nigel Crawford Nigel Curtis Noel Cranswick Penelope Bryant Phil Robinson Renata Kukuruzovic Robert Roseby Robert Sloane Roger Allen Sarah McNab Sarath Ranganathan Shaamini Lokuge-Hughes Steve Graham Sue Gibb Suzanne Boyce Teresa Lazzaro Valerie Sung Yolanda Arduca Zoe McCallum or
Provider Number
Date
RCH Parent Handout for asthma
RCH Parent Handout for spacers
RCH Asthma videos
Note that Initial Discharge Plan must be printed separately