Asthma Patient Questionnaire

This one-page asthma questionnaire, developed by theOregon Department of Human Services, Oregon Asthma Program, can be completed by the patient before a visit to the physician’s office or used for case management of high-risk asthma patients. This tool is available in English and Spanish and can be printed in black and white or color. This tool contains 12 questions on topics such as overall rating of condition, activity limitations, symptoms, hospital visits/stays, and medications. The patient is also asked to indicate his/her interest in receiving additional information on specific asthma-related topics. Also available in Spanish, Russian, and Vietnamese.