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Medication Asthma

Before completing this form you must agree that all medication given by the staff at Bonneygrove Primary School is done so with 'loco parentis responsibility'. Please indicate you agree by clicking the box below.*
Is your child's asthma - please select one.*
Does your child have disrupted sleep due to his/her asthma? PLEASE SELECT ONE.
How many times (if any) has your child attended the accident and emergency (A&E) department with an acute asthma attack in the past year?
Who monitors your child's asthma?
How often is your child seen by the Hospita/ GP/ Nurse?*
What inhalers / medications has your child been prescribed?*
Can the family GP be contacted should we need additional information?*
Does your child need their reliever/ inhaler before PE?
How many pumps do they need?*
Does your child need support taking their inhaler?*
Does your child have a clear understanding on how to use their inhaler?*
Does your child require a spacer for their inhaler?*
In the event of my displaying symptoms of asthma, and if their inhaler is not available or unavailable, I consent for my child to receive salbutamol from an emergency inhaler held by the school for emergencies.*
Does your child attend Kool KIdz?*
Parent / Carer signature. By clicking 'yes' you agree to the terms of the asthma medical policy.*