Asthma Evaluation Template 2

MedicalTemplates has developed a 1 page asthma patient evaluation template. This template is suitable for pulmonologists and any health care provider that manages patients with asthma.


The asthma patient template contains prompters and space for the following required elements for a E&M encounter -

Chief complaint
History of present illness
Past medical and surgical history
Social history
Family history
Review of systems
Review of data (labs, tests, imaging)
Physical exam
Assessment and plan
This one page template contains detailed checklists for the severity of asthma symptoms, current and planned asthma therapy, and other features helpful for a comprehensive asthma treatment plan.

The asthma patient encounter template was designed to include Clinical Performance Measures for asthma developed by the Physician Consortium for Performance Improvement.


MedicalTemplates are in the Adobe PDF format, which requires the free Adobe Reader. With Adobe Reader, these templates can be printed as many times as needed on paper meeting your specifications or the specifications of any clinic, hospital, or other health care facility.