Pediatric Asthma Initiative: Environmental History Form

QualityTool

Pediatric Asthma Initiative: Environmental History Form

Description

This form, for health care practitioners, gathers initial information on triggers commonly overlooked with children already diagnosed with asthma. It can help physicians and families make possible connections between behavior, conditions in the home and school, and pediatric asthma. The questions on the form related to the child's home also apply to other indoor environments where the child spends time, including school, daycare, car, school bus, work, and recreational facilities.

This tool is also available in Spanish.

Developer:

National Environmental Education Foundation

Funding Sources:

Centers for Disease Control and Prevention; Environmental Protection Agency; National Institute of Environmental Health Sciences (NIEHS)

History

Release Date: 2009
Original Summary: April 2012
Last Updated: 05/09/12

QualityTool Classification

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