Patient details:	Doctor’s contact details:	
<<Patient Demographics:Full Name>>
<<Patient Demographics:Address>>
Ph: <<Patient Demographics:Phone (Home)>> Mob: <<Patient Demographics:Phone (Mobile)>>	<<Doctor:Name>>
<<Practice:Address>>
Ph: <<Practice:Phone>>	
Emergency contact:  Name: 	Phone: 	Relationship:	

FEEL GOOD	No Short Wind (easy to breathe)
- Feeling well        - Have lots of energy        - Taking normal medicine
- Sleeping well      - No headaches, not dizzy   - Normal amounts of spit	

My Regular Medication	Colour of Device	How many puffs or tablets	How often	

				

FEELING A LITTLE SICK	More Short Wind (harder to breathe)
Call or see your Health Worker / Nurse or Doctor
- More coughing      - More spit or thicker than usual   - Loss of appetite
- Not sleeping well    - Change of colour of spit         - Not much energy
- Can’t walk as far    - Taking more reliver medicine than usual	
   
My Regular Medication	Colour of Device	How many puffs or tablets	How often	

				

NOT GOOD	Worse Short Wind (trouble breathing and wheezing)
CALL AMBULANCE  000  IMMEDIATELY
- Very short wind at rest  - Blood in your spit       - Afraid/Scared
- Chest Pain             - Drowsy                 - Woken easily
- Ankle swelling          - Confused, slurring of speech	

CALL AMBULANCE  000  IMMEDIATELY

Show them this plan and say you have a flare up of your COPD

Caution QAS / Paramedics:  CO2 Retainer 򪪪 No 򪪪 Yes 򪪪 N/A
Please keep SpO2 between 88-92%