formisoft

Pediatric Asthma Severity Assessment

Asks about date of birth / age, assessment date, and daytime symptom frequency. Built for pediatric primary care asthma severity classification and step therapy initiation.

Questions
14
Pages
2
Time
about 4 min

Includes

  • E-signature
  • Medication list
  • Conditions checklist
Use this templatePrint it instead

Your practice

Pediatric Asthma Severity Assessment

Page 1 of 2 · Your information

Live preview. Tap through it like a patient.

Who it is for

  • Pediatric primary care asthma severity classification and step therapy initiation
  • Pediatric pulmonology clinic serial asthma control monitoring and treatment adjustment
  • Emergency department acute asthma exacerbation evaluation and discharge planning
  • School-based health center asthma management and action plan documentation

Formisoft for Mental HealthFormisoft for Pediatrics

What's inside

Before you publish: Clinical review required: this worksheet does not calculate scores, diagnose, or recommend treatment. Confirm the questions and response options against your approved assessment protocol before use.

Page 1 · Your information

  1. Full NameText · Required
  2. Date of Birth / AgeDate
  3. Assessment DateDate
  4. Daytime Symptom FrequencyLong Text
  5. Nighttime AwakeningsLong Text

Page 2 · Additional details

  1. Peak Flow / SpirometryText
  2. Severity ClassificationLong Text
  3. Current MedicationsMedications
  4. Known TriggersLong Text
  5. Asthma Action PlanLong Text

From form to a ready patient

  1. The Formisoft form builder with editable questions and required toggles

    01

    Make it yours

    Reword, reorder, or add to the Pediatric Asthma Severity Assessment, and add your logo.

  2. A patient filling out a Formisoft form on a phone

    02

    Patients finish it at home

    A secure link by text or email, filled out on their phone before the visit. No app.

  3. The Formisoft dashboard showing how many of today's patients are ready

    03

    Your team sees who is ready

    Each visit shows as ready once its forms are in. Answers land on the patient record.

Related templates

All templates

Questions

Formisoft provides secure form collection and a Business Associate Agreement (BAA). Your practice must review the form content, access permissions, and sharing workflow for its requirements.

Yes. You can add, remove, reorder, or reword any of the 14 fields. You can also add conditional logic, new pages, file uploads, e-signatures, and payment fields.

Patients open a secure link from an email, a text, or a QR code and complete the form on their phone, tablet, or computer before their appointment. No app download required.

Yes, on Front Desk. Attach the form to a visit type and every patient who books gets it right away, with a reminder before the visit if it is not done. Your calendar shows which visits are ready.

Yes. The Pediatric Asthma Severity Assessment works on any device. Most patients complete intake forms on their phone, so every template is built for small screens first.

Send it before the visit, so patients arrive ready.

Add the Pediatric Asthma Severity Assessment to your account and make it yours in a few minutes.

Cancel anytime · BAA included

Use this templateBook a demo