SBHC Asthma Control Test ages 4-11

  • Asthma Control Test Ages 4-11 Years Old

  • Date Format: MM slash DD slash YYYY
  • Date Format: MM slash DD slash YYYY
  • This form will provide a score that will help your nurse practitioner determine if your child’s asthma treatment plan is working or if it might be time for a change.

    Let your child respond to the first four questions (1 to 4). If your child needs help understanding the question, you may help, but let your child select the response. Complete the remaining three questions (5 to 7) on our own and without letting your child’s responses influence your answers. There are no right or wrong answers.

  • Have your child answer the following questions:

  • Please answer the following questions on your own:

  • Calculated - do not edit
  • If your child’s score is 19 or less, it may be a sign that your child’s asthma is not controlled as well as it could be. Your nurse practitioner will discuss these results with you and your child.