Asthma Action Plan

Clinic: CHAMP                                                  

Phone Number: 901.287.6100 (24/7 line) / 901.305.1891 (cell)

Asthma Triggers: ______________________________________________

Daily Controller:

Dulera (Mometasone and             (  ) 1 puff   (  ) 2 puffs           (  ) once a day (  ) twice a day

Formoterol) 200mcg/5mcg                                                                                                                                      

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