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Improvid | COVID
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Pioneers | Alpha-1 and COPD
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HappyAir Pharmacies
Coaches
Coaches Course
Check@ir
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Training
HappyAir Alpha-1-Antitrypsin Deficiency Program
HappyAir COPD Program
HappyAir Cystic Fibrosis Program
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HappyAir Asthma Program
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HOW HAVE YOU BEEN FEELING? HTP Help Us Breathe
HOW HAVE YOU BEEN FEELING? HTP Help Us Breathe
Joud Abusalah
2025-07-07T10:48:30+02:00
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In this form I would like you to tell me what symptoms affect you in your daily life and how you deal with them.
I need to know your symptoms to help you keep them under control, thank you for your collaboration. Together we will achieve it!
Select the patient's name
wpf-coach-patients
Name and surname
Email
Today's date
*
SYMPTOM
What symptoms have you had today? Remember to tell me about any symptoms that are out of the ordinary or that have increased in intensity.
None
Changes in color and/or density of mucus/phlegm
Chest pain
dizziness
Mucus / Phlegm
Fluid retention in legs
Noises in the chest when breathing
Feeling of suffocation
Tight feeling in the chest
Syncope
Cough
Other
other symptoms
SECRETIONS
The amount of mucus and phlegm has been
Abundant
Moderate
little
None
Murray scale
The color of the phlegm has been:
Mucous
Muco-purulent
Purulent
DIZZINESS
How many times have you felt dizzy today without losing consciousness?
What other symptoms have accompanied this feeling of dizziness?
Cold sweat
Feeling of losing balance
Naus
Blurred vision
palpitations
ringing in the ears
Vision of bright spots
None, just dizziness
Other
other symptoms
SYNCOPE
How long were you unconscious? (HH:MM)
How many times have you fainted today, that is, how many times have you lost consciousness?
Comments
Tell us everything you consider relevant about the episode
RESCUE MEDICATION
How many rescue inhalations did you have to take to get rid of or relieve your symptoms?
None
1
2
3
4
5 or more
MEDICAL ASSISTANCE
Did you have to go to the doctor because of the symptoms?
Yes
No
Where did you go?
Family doctor or primary care doctor
Specialist doctor
Hospital / emergency
Other
other place
SUBMIT
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