Asthma Management Recommendations For Child …Asthma can be controlled by being aware of its...

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City and County of San Francisco Edwin M. Lee, Mayor A healthcare provider can prescribe an extra set of medications, spacer and mask to be stored at the center. Asthma Management Recommendations For Child Care Centers These recommendations are intended to help provide a safe child care environment for children with asthma. Management of worsening asthma or an asthma emergency should be in accordance with each child’s specific Asthma Emergency Care Plan. Section A Responsibilities of PARENTS/GUARDIANS of each child with asthma: o Return the ASTHMA INFORMATION PACKET to the child care center manager at the beginning of the year. o Ensure that all information in the child’s medical file is kept up-to-date. o Communicate regularly with childcare providers about the child’s asthma (e.g.. quick- relief medication usage, symptoms, and current coughs, colds or other illnesses). o Ensure that asthma medication is: Always available. Clearly labeled with the name of the medication, name of the child, dosage, and special instructions. Removed promptly and replaced when expired. Administered with a spacer and mask stored at the center. Section B Responsibilities of CHILD CARE PERSONNEL: o Provide the ASTHMA INFORMATION PACKET to parents/guardians of children with asthma at the beginning of the year. o Understand: o Which children at the center have asthma. o How to recognize and respond to worsening asthma and asthma emergencies. Each child with asthma should have an ASTHMA INFORMATION PACKET, which contains the following: 1) ASTHMA EMERGENCY CARE PLAN and MEDICATION FORM These forms contains information about the child’s asthma, triggers, symptoms, asthma medications, and emergency contact numbers. The child’s healthcare provider should sign these forms. There should be 2 copies at the child care center: one copy should be stored in the child’s medical file and the other copy should be stored with the child’s medications so that it can be easily referenced during an exacerbation. These should be updated as needed but no less than annually. 2) NEBULIZER CONSENT FORMS (LIC 9166) This form should be provided to the parents by the child care center after the parent has demonstrated how to administer medication to his/her child to all staff members who may be responsible for administering medication to the child. The parent should sign 1 copy of this form for every staff member who has received instruction. This form should be stored at the center in the child’s medical file. You can obtain the ASTHMA INFORMATION PACKET from your child care health consultant.

Transcript of Asthma Management Recommendations For Child …Asthma can be controlled by being aware of its...

Page 1: Asthma Management Recommendations For Child …Asthma can be controlled by being aware of its warning signs and symptoms, using medicines properly to treat and prevent asthma episodes,

City and County of San Francisco Edwin M. Lee, Mayor

A healthcare

provider can

prescribe an

extra set of

medications,

spacer and mask

to be stored at

the center.

Asthma Management Recommendations For Child Care Centers

These recommendations are intended to help provide a safe child care environment for children

with asthma. Management of worsening asthma or an asthma emergency should be in

accordance with each child’s specific Asthma Emergency Care Plan.

Section A – Responsibilities of PARENTS/GUARDIANS of each child with asthma:

o Return the ASTHMA INFORMATION PACKET to the child care center manager at

the beginning of the year.

o Ensure that all information in the child’s medical file is kept up-to-date. o Communicate regularly with childcare providers about the child’s asthma (e.g.. quick-

relief medication usage, symptoms, and current coughs, colds or other illnesses).

o Ensure that asthma medication is:

Always available.

Clearly labeled with the name of the medication, name of

the child, dosage, and special instructions.

Removed promptly and replaced when expired.

Administered with a spacer and mask stored at the center.

Section B – Responsibilities of CHILD CARE PERSONNEL:

o Provide the ASTHMA INFORMATION PACKET to

parents/guardians of children with asthma at the beginning of the year.

o Understand:

o Which children at the center have asthma.

o How to recognize and respond to worsening asthma and asthma emergencies.

Each child with asthma should have an ASTHMA INFORMATION PACKET, which

contains the following:

1) ASTHMA EMERGENCY CARE PLAN and MEDICATION FORM These forms contains information about the child’s asthma, triggers, symptoms,

asthma medications, and emergency contact numbers. The child’s healthcare

provider should sign these forms. There should be 2 copies at the child care center:

one copy should be stored in the child’s medical file and the other copy should be

stored with the child’s medications so that it can be easily referenced during an

exacerbation. These should be updated as needed but no less than annually.

2) NEBULIZER CONSENT FORMS (LIC 9166) This form should be provided to the parents by the child care center after the parent

has demonstrated how to administer medication to his/her child to all staff members

who may be responsible for administering medication to the child. The parent should

sign 1 copy of this form for every staff member who has received instruction. This

form should be stored at the center in the child’s medical file.

You can obtain the ASTHMA INFORMATION PACKET from your child care health

consultant.

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o How to administer quick-relief asthma medications. o Meet with the child’s parents/guardians upon enrollment to discuss the child’s particular

asthma triggers and tips for administering asthma medications.

o Ensure that quick-relief (albuterol) medication:

Is available in the classroom or with the provider if the child is outside of

classroom.

Use is recorded in the Medication

Administration Log.

Is disposed of appropriately when expired or

when the child is no longer present. o Communicate with their supervisors and

parents/guardians about observed asthma symptoms and administered medications.

o Undergo annual asthma training in-person or online. o Allow children with asthma to participate in physical

activities unless medically contraindicated.

Section C – Additional considerations

o CLEANING THE INHALER: Inhalers should be cleaned at least once a week,

depending on frequency of use. Talk to the child's parent/guardian about cleaning.

o ENROLLMENT: A child with a known diagnosis of asthma should not be present at a

child care center without the appropriate forms, medications, and equipment. A new

enrollee’s start date may be delayed until the requested information is made available to

the child care center manager, at the manager’s discretion.

o ENVIRONMENTAL TRIGGERS: Steps should be taken to minimize asthma triggers

at the center. Child care personnel should be aware of the asthma triggers for children

with asthma and take special steps to minimize exposure for these children. Please see the

attached checklist for information about common asthma triggers in child care settings.

Your child care health consultant can help connect you with an environmental health

expert at the San Francisco Department of Public Health if you have specific concerns. o EXERCISE: Some children with asthma need asthma medication prior to physical

activity. This information should be provided by the child’s healthcare provider on the Asthma Emergency Care Plan and discussed with the parent/guardian. Alternate or indoor activities should be made available to children with asthma, if necessary.

o FIELD TRIPS: Children with asthma should be able to participate in field trips as long

as asthma triggers are anticipated and minimized and medications are available.

o FLU SHOTS: Annual flu shots are recommended for children who are 6 months and

older because viral infections are the primary cause of flare-ups in young children. o SMOKE: The center should be smoke-free at all times. Smoking is prohibited within 20

feet of a child care center entrance, exit or operable window. Centers experiencing repeated incidents of smoke should post “No Smoking” signs outside the center. If the incidents continue, notify your child care health consultant.

o QUESTIONS: Please talk to your child care health consultant if you have any

questions or concerns about general asthma management or care for specific children.

Asthma cannot be cured, but it can be controlled!

The San Francisco Department

of Public Health can provide

annual in-person trainings. For

online training, we recommend

the California Department of

Public Health (California

Breathing) child care training

video:

http://californiabreathing.org/r

esources/childcare-training-

video

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City and County of San Francisco Edwin M. Lee, Mayor

Dear Parent/Guardian,

It has come to our attention that your child has a diagnosis of asthma or uses asthma medications,

but certain important items are missing or expired. Please provide the following to the child care

center as soon as possible so that we can be sure your child is receiving the best possible care:

Current Physical Exam

Asthma Emergency Care Plan and Medication Form

Nebulizer Consent Form (LIC-9166)

Quick-Relief or Rescue (Albuterol) Medication

Spacer

Mask

Other:

You can expect the child care center to do the following to help your child:

o Minimize exposures to asthma triggers at the center

o Keep a log of asthma medications administered at the center

o Communicate with you about asthma symptoms observed at the center

o Undergo regular training to be prepared to prevent and manage asthma flare-ups

o Talk to me – a certified nurse – if there are any questions or concerns

Let’s work together to make sure your child can thrive!

Sincerely,

Your Child Care Health Consultant

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Medication Log

Child Name:

Date Time Medication Dose/Amount Reason Given Staff

Initials

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How to Use an Inhaler with Spacer and Mask

PRIMING A METERED DOSE INHALER

Priming a metered dose inhaler is important before using it for the first time to be sure it provides the right amount of medicine. It may need to be primed again if it has not been used in a while.

To prime most inhalers, take the cap off the mouthpiece, shake the inhaler well and spray it into the air.

Check the instructions to see how many times you need to spray the inhaler to prime it, and when you need to prime it again. The inhaler is now ready to use.

USING A SPACER WITH A MASK

If your health care provider has prescribed a holding

chamber with a mask for your child, follow these steps:

1. Insert the mouthpiece of the plastic holder into the holding chamber.

2. Shake the inhaler well. Keep the inhaler upright.

3. Place the mask on the child’s face covering both the nose and mouth firmly.

4. Press the canister only once.

5. Have the child breathe in and out slowly for at least five breaths. Then remove the mask from the face.

If your health care provider has prescribed more than one spray, wait at least one minute and repeat these steps again.

This is general information. Read the instructions that come with the inhaler prescribed by your health care provider and follow them carefully. Also ask your health care provider to show you how to use the inhaler and to watch you use it.

This handout was adapted and

modified from the original

developed by the Pediatric

Asthma Coalition of New Jersey.

Information in this handout is not intended to

diagnose health problems or take the place of

medical advice. For asthma or any medical condition,

seek medical advice from your child’s or your health

care professional.

Updated 12/3/2013

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Quick Relief Medication Medicamentos de Efecto

Inmediato

Should always be available at child care center Siempre tenga disponible en la guardería

Controller Medication

Medicamentos de

Efecto Prolongado

For use by the family each day at home Para uso de la familia todos los días en casa

ProAIR® HFA Advair® HFA

Proven.l® HFA

Flovent® HFA

Ventolin® HFA

Pulmicort® Flexhaler®

Xopenex® HFA

Updated 1/21/2014

QVAR®

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Asthma is the most common chronic childhood disease. Children with asthma have sensitive airways. They are

bothered by many things that start (or “trigger”) their symptoms and make their asthma worse. The most

common asthma triggers are allergies to dust mites, cockroaches, animal dander, mold, and pollens, and

exposure to irritating smoke, smells, or very cold air. Children's asthma can also be triggered by excessive

exercise or an upper respiratory infection. The airways of people who have asthma are “chronically" (almost

always) inflamed or irritated, especially if they are exposed to their triggers every day. This makes it hard for

them to breathe.

Asthma can be controlled by being aware of its warning signs and symptoms, using medicines properly to treat

and prevent asthma episodes, and avoiding the things that trigger asthma problems. Each child's asthma is

different, so it is important to know the asthma triggers and treatment plan of each individual.

Use this checklist to learn how to make your child care setting a safe and healthy environment for children with

asthma and allergies, or to help you choose a health child care placement for your child.

Avoiding or Controlling Allergens Dust mites

Needs

Improvement

O.K.

Surfaces are wiped with a damp cloth daily. (No aerosol "dusting" sprays are used.)

Floors are cleaned with a damp mop daily.

Small area rugs are used, rather than wall-to-wall carpeting. Woven rugs that can be

washed in hot water are best. (Water temperature of at least 130. F/54. C kills dust mites.)

If wall-to-wall carpeting can't be avoided, children are prevented from putting their faces,

nap mats, blankets or fabric toys directly on the floor.

Children's bed linens, personal blankets and toys, are washed weekly in hot water.

Fabric items (stuffed toys or "dress up" clothes) are washed weekly in hot water, to kill

dust mites.

Furniture surfaces are wiped with a damp cloth.

Soft mattresses and upholstered furniture are avoided.

Beds and pillows that children sleep or rest on are encased in allergy-proof covers.

Curtains, drapes, fabric wall hanging and other "dust catchers" are not hung in child care

areas.

If light curtains are used they are washed regularly in hot water.

If window shades are used, they are wiped often with a damp cloth.

Books, magazines and toys are stored in enclosed bookcases, closed boxes, or plastic

bags.

Supplies and materials are stored in closed cabinets; piles of paper and other clutter are

avoided.

ASTHMA – FRIENDLY CHILD CARE

A Checklist for Parents and Providers

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Animal substances: (both pets and pests shed dander, droppings and other proteins which cause allergic responses and trigger

asthma symptoms)

Needs

Improvement O.K.

Furry or feathered pets are not allowed anywhere on the premises (cats, dogs, gerbils,

hamsters, birds, etc.).

Cockroaches and mice infestation are aggressively controlled, using preventive practices

and least toxic extermination methods.

Feather-stuffed furnishings, pillows or toys are not used.

Mold and mildew:

Needs

Improvement O.K.

Exhaust fans are used in bathrooms, kitchens and basement areas to help remove humidity.

Wet carpeting and padding are removed if not dry within 24 hours to prevent mold growth.

Mats that are placed on carpeted floors (especially in basement areas) are vinyl-covered,

and wiped regularly with diluted chlorine bleach and water (1/4 cup bleach in 1 gallon

water).

Mildew growth in bathroom and other damp areas (such as refrigerator drip pans) is

prevented by regular wiping with diluted chlorine bleach and water.

Indoor houseplants and foam pillows, which can develop mold growth, are not used.

Outdoor pollen and mold spores:

Needs

Improvement O.K.

If ventilation is adequate, windows are kept closed during periods of high pollen count

Air conditioners with clean filters are used during warm seasons, if possible.

Outdoor yard and play areas are kept clean of fallen leaves, compost piles, and cut grass.

Latex: (products made with natural rubber)

Needs

Improvement

O.K.

Avoid latex gloves. If gloves are used, only non-powdered, non-latex gloves.

Avoid latex balloons, pacifiers, koosh balls and other latex products (if child or staff

member has latex sensitivity).

Avoiding or Controlling Irritants Tobacco Smoke: (triggers asthma symptoms; causes children to have more respiratory and ear infections, and to

need more asthma medication)

Needs Improvement

O.K.

Smoking is not allowed anywhere on the premises. This rule is strictly enforced.

Staff and parents are encouraged to participate in smoking cessation programs, and given

referrals and assistance.

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Chemical Fumes, Fragrances, and Other Strong Odors:

Needs

Improvement

O.K.

Arts and crafts materials with fragrances or fumes are avoided (e.g., markers, paints,

adhesives). If they are used, extra ventilation is provided.

Staff does not wear perfume or other scented personal products. (Use products labeled

"fragrance-free" whenever possible.)

Personal care products (such as hair spray, nail polish, powders) are not used around the

children.

Air fragrance sprays, incense, and "air fresheners "are not used. (Open the windows

and/or use exhaust fans instead.)

New purchases (such as pressed-wood furnishings or plastic laminated products) are

checked for formaldehyde fumes, and aired out before installation.

Cleaning supplies and home repair products with strong smells are not used when

children are present; indoor spaces are carefully ventilated during and after their use.

Office equipment that emits fumes (e.g., photocopy) are in vented areas away from

children.

Other Irritants:

Fireplaces and wood or coal stoves are not used.

Policies and Practices Asthma Management and Care:

Needs

Improvement

O.K.

All staff are trained to watch for symptoms of asthma, warning signs that asthma is flaring

up, and how to recognize emergency situations. New staff receive this training when

hired.

Every child with asthma has a written plan on file, listing allergies and asthma triggers,

medication schedule, and emergency instructions.

Staff is trained to administer medication, and in the use and care all of nebulizers,

inhalers, spacers and peak flow meters.

Parents and providers communicate regularly about child's asthma status.

Outdoor time is adjusted for cold-sensitive children, and alternative indoor activities are

offered (after an asthma episode or viral infection, they are also more sensitive.)

Staff and children wash hands frequently; toys and surfaces are wiped often, to prevent

the spread of viral infections that can trigger asthma.

This checklist was developed by the Asthma & Allergy

Foundation of America, New England Chapter, with the

support of a grant from the U.S. Environmental Protection

Agency, Region. I.

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General Physical Site/Space: Needs

Improvement

O.K.

Ventilation provides good air flow in all rooms and halls in every season. There is no

stale or musty smell. Outdoor intake and inside supply vents are checked for blockages.

Heating or cooling system filters are properly installed and changed often; other service

guidelines and routine maintenance procedures are followed.

Heating or cooling ducts are professionally cleaned once a year.

Outdoor fumes (such as from car exhaust, idling vans or buses, or nearby businesses) are

prevented from entering the building through open windows or doors.

The building is checked periodically for leaks and areas of standing water.

Plumbing leaks are fixed promptly.

Humidity level is monitored, using a humidity gauge, if possible. Humidifiers are not

used; dehumidifiers are used if necessary. (Dust mites and mold thrive on humidity.)

Wet boots and clothing are removed and stored where they don't track wetness into

activity space.

Doormats are placed outside all entrances, to reduce tracking in of allergens.

Cleaning and Maintenance:

Needs

Improvement O.K.

If rugs or carpets must be used, they are vacuumed frequently (every day or two).

High efficiency vacuum cleaner (ideally with the "HEPA" filter) is used. (Others blow

tiny particles back into the air.)

Dusting is done often, with a damp cloth, to avoid stirring up the dust.

Vacuuming and other cleaning is done when children are not present.

Integrated pest management techniques are used, to limit amount of pesticide needed

(e.g., seal all cracks in walls, floors and ceilings; eliminate clutter; keep food in air tight

containers).

Pesticides are applied properly, with adequate ventilation, when children are not present.

Garbage is kept in tightly covered containers, and removed promptly to outdoor enclosed

trash area that is not accessible to children.

Painting, repairs or construction work is done when children are not present. Indoor

spaces are protected from construction dust, debris, strong odors and fumes.

Shampooing of rugs and upholstery is done with low emission, fragrance-free products.

They are dried thoroughly to prevent growth of mold and dust mites.

This checklist was developed by the Asthma & Allergy

Foundation of America, New England Chapter, with the

support of a grant from the U.S. Environmental Protection

Agency, Region. I.

Page 11: Asthma Management Recommendations For Child …Asthma can be controlled by being aware of its warning signs and symptoms, using medicines properly to treat and prevent asthma episodes,

TO BE COMPLETED BY PARENT/CAREGIVER

------------------------------------TO BE COMPLETED BY THE HEALTH CARE PROVIDER-------------------------------------

ACTIONS TO TAKE

Reduce exposure to the following asthma triggers:

□ Dust/dust mites □ Cockroaches □ Pollen □ Animal fur

□ Smoke □ Strong smells

□ Temperature changes □ Having a cold/being sick □ Mold □ Air pollution

Stay with student, remain calm and speak softly.

Seat student in an upright position.

Encourage slow and deep breaths.

Assist with quick-relief medication:

(name of the medication)

If symptoms resolve completely, student may return

to class.

Call parent/guardian to inform.

I authorize school personnel to implement this Asthma Emergency Care Plan as described.

I have completed a medication form for the quick relief medication.

Health Care Provider Signature Date

I give my consent for school authorities to take appropriate action for the safety and welfare of my child. I give my

consent to communicate with the authorized health care provider when necessary.

Parent/Caregiver Signature Date

Available @ http://healthiersf.org/Forms/index.php SFUSD Student, Family, and Community Support Department

2013-2014 School Health Manual

CALL 911 if student has Difficulty speaking

Flared or enlarged nostrils

Rapid or shallow breathing

Struggling or gasping for breath

Continuous spasmodic coughing

Skin pulling in around neck with breathing

Gray, dusky or bluish color around mouth or

under nails

Administer CPR if Breathing Stops!

Continue Until Paramedics Arrive!

Health Care Provider Treating Student for Asthma:_ ________________ Ph: ________________

Other asthma medication used at home:___________________________________________________________

Does student require inhaler before exercise: ❏ No ❏ Yes

If yes, please specify: medication to be given_________________________ and # _____minutes before exercise

Name: Date of Birth: __ ____ __ School: ___ ____ ____ __

Grade: Homeroom Teacher: ____ ____ ____ ____ __ Room: ____ ___

Parent/Caregiver Name: Phone (home): __ ____ ____ ___ (cell):_____ _____

Address: _ ____ ____ ____ ____ ____ _____ Phone (work): _____________ Email:__________________

San Francisco Unified School Distirct

Student, Family, and Community Support Department

School Health Programs

1515 Quintara Street

San Francisco, CA 94116-1273

Tel: 415.242.2615 | Fax: 415.242.2618

STUDENT

PHOTO

ASTHMA

EMERGENCY CARE PLAN

For School Use Only

Location of Medication:

____________________

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San Francisco Unified School District - Student, Family, and Community Support Dept.

MEDICATION FORM (One Medication Per Form)

Dear Parent/Guardian/Caregiver:

California Education Code 49423 provides that students required to take medically prescribed or over-the-counter

medications during the school day MAY be assisted by school personnel ONLY if the school district receives a specific

written statement from the health care provider AND the parent/guardian/caregiver of the student. Please complete this

entire form and return it to the Principal. ,, IF POSSIBLE, PLEASE SCHEDULE MEDICATION OUTSIDE OF SCHOOL HOURS. II

P l e a s e p r i n t l e g i b l y i n a l l s e c t i o n s

Student Name: Last First Middle Date of Birth (Month/DayNear)

HEALTH CARE PROVIDER SECTION

Health Condition for which medication is prescribed: Medication :

Dose:

Frequency :

Duration:

How is medication to be given?

LI By mouth LI Inhalation CJ Injection LI Topical

LI Other:

About what time does medication need to be given at school? AM / PM

The medication is to be continued as above until :

(please be as specific as possible about date)

Any precautions that school personnel need to know?

Contraindications?

What are possible reactions/side effects? What should be done in the event of reaction/side effect?

Check annronriate boxes below:

0 I authorize this student to self-administer the above medication .

0 I authorize designated school personnel to administer the above medication .

Print name, address & phone number of Health Care Provider Signature of Health Care Provider

PARENT I GUARDIAN I CAREGIVER SECTION

Parent/Guardian/Caregiver Name Home Language Daytime Phone ( )

Address -Number and Street Apt No. City Zip Code Evening Phone ( )

School Children's Center I Elementarv I Middle I Hi2h

School Hours

Check annronriate boxes below:

0 I permit my child to give himself7herself the above medication.

0 I permit designated school personnel to give my child the above medication.

1. I agree to hold the San Francisco Unified School District (SFUSD) and its employees harmless from any and all

liability for the results of taking the medication or the manner in which the medication is given.

2. I will reimburse the SFUSD and its employees for any liability arising out of these arrangements.

3. I will notify the Principal of the school immediately if there is a change in my child's medication. 4. I understand it is my responsibility to send the medication to school in the original pharmacy co nta ine r

labeled with my child's name and the health care provider's instructions.

s. I understand that this form automatically expires at the end of each school year. 6. I give my consent for school authorities to take appropriate action for the safety and welfare of my child.

Parent/Guardian/Caregiver Signature ---------------- Date----------

SFUSD-SFCSD MEDICATION FORM Revised June 2010 available @ http ://health jersf.org/Fonns/index pdp

SFUSD Student, Family, and Community Support Department c-2 2012-2013 School Health Manual

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STATE OF CALIFORNIA-HEALTH AND HUMAN SERVICES AGENCY CALIFORNIA DEPARlMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION

NEBULIZER CARE CONSENTNERIFICATION CHILD CARE FACILITIES

This form may be used to show compliance with Health and Safety Code Section 1596.798 before a child care licensee or staff person administers inhaled medication to a child in care. A copy of the completed form should be filed in the child's

record and in the personnel file. A separate form must be filled out for each person who administers inhaled medication to the child.

I,, -,-- _, give my consent for _ (PRINT NAME OF AUTHORIZED REPRESENTATIVE) (PRINT NAME OF LICENSEE OR STAFF PERSON)

who work{s) at (PRINT NAME AND ADDRESS OF CHILD CARE FACILITY)

to administer inhaled medication to my child, ,and to contact my child's health care

provider. (PRINT NAME OF CHILD)

In addition, I certify that I have personally instructed the above-named licensee or staff person on how to administer inhaled medication to my child.

I have also provided the child care facility with written instructions from my child's physician, or from a health care provider

working under the supervision of my child's physician {for example, a physician's assistant, nurse practitioner or registered

nurse). These instructions include:

• Specific indications {such as symptoms) for administering the inhaled medication in accordance with the physician's

prescription.

• Potential side effects and expected response.

• Dose form and amount to be administered in accordance with the physician's prescription.

• Actions to be taken in the event of side effects or incomplete treatment response in accordance with the physician's

prescription. This includes actions to be taken in an emergency.

• Instructions for proper storage of the medication.

• The telephone number and address of the child's physician.

SIGNATURE OF AUTHORIZED REPRESENTATIVE DATE

ADDRESS OF AUTHORIZED REPRESENTATIVE

HOME TELEPHONE NUMBER WORK TELEPHONE NUMBER

UC 9166 (2/01)