---
title: Asthma Action Plan Compliance Form Template with Peak Flow Tracking | Paperform
description: Pre-visit asthma symptom tracker for healthcare providers. Monitor peak flow, triggers, rescue inhaler use, and medication adherence with this comprehensive patient assessment form.
url: "https://paperform.co/templates/asthma-action-plan-compliance-symptom-tracker"
type: static
generatedAt: "2026-03-28T00:43:05.113Z"
---

[← Back to free form templates](/templates/)    ![Asthma Action Plan Compliance & Symptom Tracker](https://img.paperform.co/fetch/f_webp/https://d3gw2uv1ch7vdq.cloudfront.net/content/form_templates/assets/asthma-action-plan-compliance-symptom-tracker.png)
    [Preview](https://_preview.paperform.co/ai-template/asthma-action-plan-compliance-symptom-tracker) [Use this template for free](/create?ai-template=asthma-action-plan-compliance-symptom-tracker)    [Healthcare & Medical Forms](/templates/category/healthcare/) [Healthcare](/templates/industry/healthcare/)[Telehealth](/templates/industry/telehealth/) [Physician](/templates/role/physician/)[Nurse](/templates/role/nurse/)[Healthcare Administrator](/templates/role/healthcare-admin/)     About this free form template
### Monitor Your Asthma Control with a Comprehensive Tracking Form

Managing asthma effectively requires consistent monitoring of symptoms, lung function, triggers, and medication use. This **Asthma Action Plan Compliance & Symptom Tracker** from Paperform helps patients and healthcare providers work together to maintain optimal asthma control and prevent exacerbations.

#### Why Asthma Tracking Forms Matter

For pulmonologists, allergists, primary care physicians, and respiratory therapists, understanding a patient's day-to-day asthma management between visits is crucial. Traditional paper logs are often lost, incomplete, or difficult to review quickly. This digital form creates a clear, organized record of:

 - **Peak flow meter readings** to objectively measure lung function
 - **Symptom frequency and severity** including nighttime awakenings and activity limitations
 - **Trigger exposure** to identify patterns and avoidance strategies
 - **Rescue inhaler usage** as a key indicator of asthma control
 - **Controller medication adherence** to ensure patients follow their prescribed regimen

#### How This Form Supports Better Asthma Care

This template is designed for **pre-visit symptom assessment**, allowing patients to complete their asthma diary before appointments so providers can review the data and make informed treatment decisions. It can also be used for:

 - Weekly or monthly asthma control check-ins
 - Post-hospitalization follow-up monitoring
 - Pediatric asthma tracking (completed by parents or caregivers)
 - School nurse reporting for students with asthma
 - Workplace health monitoring for employees with occupational asthma

The structured format helps identify when patients are in the green (well-controlled), yellow (caution), or red (medical alert) zones of their asthma action plan, making it easier to intervene before symptoms escalate to an emergency.

#### Built for Healthcare Workflows with Paperform

Paperform makes it simple for **healthcare practices, clinics, and telehealth providers** to collect patient-reported outcomes in a HIPAA-friendly, professional format. While Paperform itself is not HIPAA compliant, it provides the tools and security features needed to create forms that can fit into compliant workflows when properly configured.

Key features for healthcare providers include:

 - **Conditional logic** to show relevant questions based on symptom severity or medication changes
 - **Calculation fields** to automatically score asthma control tests or calculate average peak flow
 - **Custom branding** to match your practice's look and feel, building patient trust
 - **Email notifications** to alert care teams when patients report concerning symptoms
 - **Integration with your systems** via Stepper (stepper.io) to route submissions into your EHR, patient portal, or care management platform

#### Streamline Follow-Up with Stepper Workflows

After a patient submits their asthma tracker, you can use **Stepper** to automate what happens next:

 - Automatically categorize submissions by control level (green/yellow/red) and route to the appropriate care team member
 - Send personalized follow-up instructions or educational materials based on reported triggers
 - Update patient records in your EHR or practice management system
 - Schedule urgent appointments or telehealth visits when rescue inhaler use exceeds threshold
 - Generate summary reports for providers to review before appointments

This reduces manual data entry for your staff and ensures that no patient falls through the cracks between visits.

#### Designed for Patients and Providers

The form uses clear, patient-friendly language while capturing the clinical details providers need. It's structured to take just 5-10 minutes to complete, reducing patient burden while gathering comprehensive information.

For **pulmonologists and respiratory therapists**, this tool helps you:

 - Assess action plan adherence and understanding
 - Identify patients at risk for exacerbations
 - Make evidence-based adjustments to controller medications
 - Document patient education and shared decision-making

For **patients and caregivers**, it provides:

 - A simple way to track symptoms consistently
 - Clear questions that help you understand your asthma better
 - A record you can review with your provider at each visit
 - Confidence that your care team has the information they need

#### Professional, Secure, and Scalable

With over 500,000 teams worldwide trusting Paperform, you get SOC 2 Type II compliance, data residency controls, and robust security features. Whether you're a solo practitioner or a multi-location respiratory clinic, Paperform scales with your practice while maintaining the professional experience your patients expect.

Start with this template and customize it to match your specific asthma action plan zones, peak flow targets, and medication protocols. Your patients will appreciate the convenience of digital submission, and your team will save hours on data collection and chart prep.

**Ready to improve asthma outcomes?** Use this template to keep patients engaged in their care between visits and catch warning signs before they become emergencies.
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