What is an Asthma Treatment (Action) Plan?
It is a written plan prepared by your Health Care Provider to
control your asthma.

Your Asthma Treatment Plan tells you:

  • What medicine to take
  • How much medicine to take
  • When to take your medicine
  • What to do in an emergency
  • What things trigger your asthma –
    like dust, mold, pets, odors

For Parents of Children with Asthma
New Jersey Law requires students with asthma to have an
Asthma Treatment Plan on file with the School Nurse.

The PACNJ Asthma Treatment Plan is the only written plan
approved by the New Jersey Department of Health and Senior
Services as meeting the requirements of the New Jersey Law.

For students to carry their inhaler in school, your Health Care Provider must check off approval at thebottom of the PACNJ Asthma Treatment Plan.

Print the PACNJ Asthma Treatment Plan
Print the PACNJ Asthma Treatment Plan to discuss with your Health Care Provider and
take a signed copy to the school nurse.

Asthma Treatment Plan – Adult Form

Asthma Treatment Plan – Student Form

Parent Tool

Save and Print the Fillable PACNJ Asthma Treatment Plan

Fillable Asthma Treatment Plan – Adult Form

Fillable Asthma Treatment Plan – Student Form

English to Spanish Fillable Asthma Treatment Plan – Adult Form

English to Spanish Fillable Asthma Treatment Plan – Student Form