COVID-19 Self-Management Plan: Know Your Zones

Introduction

The COVID-19 Self-Management Plan uses a simple traffic light system (Green, Yellow, and Red Zones) to help you monitor your symptoms and know exactly when to take action, contact your healthcare provider, or seek emergency medical care. This plan provides clear steps and guidelines for managing your health while recovering from COVID-19 at home.

COVID-19 Self-Management Plan

Name _________________________________________________________ Date ____________________________

Do not smoke and avoid secondhand smoke.

Green Zone: In Control

I can breathe easily without shortness of breath.
I am not experiencing chest tightness.
My energy level is nearly normal.
I can think clearly.

Green Means I Should:

Use oxygen if prescribed by my doctor/healthcare provider.
Check my oxygen level (pulse oximetry) if ordered by my doctor/healthcare provider.
Keep a diary of my oxygen levels so I can review with my doctor/healthcare provider.

Yellow Zone: Caution

My breathing is fast.
I have a new or worsening cough.
I am having trouble catching my breath.
My heartbeat feels much faster than usual.
I have a fever.
I feel cold and am shivering—I can’t get warm.
My thinking is slow—my head feels “fuzzy.”

Yellow Means I Should:

Be evaluated by my doctor/healthcare provider.
Call or message my doctor or healthcare provider. (Do not go to the doctor’s office unless instructed to do so.)
Share my symptoms and follow their directions.

If receiving home healthcare services: Agency: ________________________________________________________ Phone: ________________________________

My doctor/healthcare provider: Name: ________________________________________________________ Phone: ________________________________

Red Zone—Medical Alert!

My breathing is very fast.
I can’t catch my breath and can’t speak an entire sentence.
My fingernails or my lips are pale or blue.
I am having chest pain.
I can’t eat or drink.
I am confused.
I can’t stay awake.

Red Means I Must:

Take action!
Call 9-1-1 immediately!
Tell the operator that I am showing severe symptoms of COVID-19!

Sources

Sources: Centers for Disease Control and Prevention (CDC). Coronavirus Disease 2019 (COVID-19): Symptoms of Coronavirus. Available at: https://www.cdc.gov/coronavirus/2019-ncov/symptoms-testing/symptoms.html. CDC. COVID-19: How to Protect Yourself and Others. Available at: https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/prevention.html. Accessed: Dec. 4, 2020.

This material was developed by Health Services Advisory Group (HSAG). The contents presented do not necessarily reflect CMS policy.

Disclaimer: Intended for educational purposes only. HSAG does not monitor or guarantee that this information is applicable to any specific patient’s care or treatment. This content does not constitute medical advice from a physician and is not to be used as a substitute for treatment or advice from a practicing physician or other healthcare provider.

Daily Living Tips, Senior Education