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

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 – STUDENT MAY 2017

Asthma Treatment Plan-ADULT MAY 2017

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

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 the bottom of the PACNJ Asthma Treatment Plan.