Please complete the section below. Bring all your medicines and inhalers along with a complete list to doctor’s office visits. Think about your ability to perform these activities on a typical “green” day. Place one check mark in each column. In the last (blank) column write in an activity you would like to be able to do again. Check the box below it to show how difficult it is to do that activity now. Share this goal with you healthcare team and your family.