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Department of Human Services

Oregon Asthma Resource Bank
Materials you can print
What is OARB?
Permitted use of materials
Developing & testing

Tools for providers:

Patient questionnaire

The Patient Questionnaire can be completed in the waiting room by patients with asthma when they come for an office visit. This questionnaire can help give information to a clinician during the annual asthma visit, or can be used for case management of high-risk asthma patients.

  

      Color - download and print the pdf in color

Patient questionnaire (English)

Patient questionnaire (Spanish)

Black and white - download and print the pdf in b/w

Patient questionnnaire (English)

Patient Questionnaire (Spanish)

 
Page updated: July 14, 2008

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