Dose the patient being treated have any of the following conditions?

• Less than 6 months old.

• 6 or more unformed stools per day.

• Dizziness upon standing.

• Signs of severe dehydration such as: Has not urinated in 8 hours, has no tears when crying, has lost over 9% of body weight, unconsciousness, bluish coloration of the skin, lips or fingernails.

• Fever over 102.2 F.

• Blood, pus or mucus in stools.

• Severe pain of any kind.

• Recent antibiotic usage.

• Persistent diarrhea (diarrhea happening regularly or that has not responded to an over the counter treatment).

• Excessive vomiting.

• Diabetes.

• Severe cardiovascular disease (uncontrolled health conditions including severe high blood pressure, heart failure, heart arrhythmias, or other conditions of the heart and blood vessels).

• Kidney disease.

• Multiple chronic health conditions.

• A health condition or are taking medications which suppress the immune system (taking medicines such as methotrexate, cyclosporine, cancer drugs, other immunosuppressive drugs).

• Pregnancy.

• Intestinal obstruction or ileus


Yes

No



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