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

• Less than 2 years old.

• Episodes of severe nausea and vomiting with no known cause, occurring regularly every 1 - 5 weeks.

• Stiff neck with increased light sensitivity.

• Excessive drowsiness.

• Vomiting for more than 8 hours.

• Red, black, or green vomit.

• Suspected poisoning.

• Nausea that has occurred after a head or bodily injury.

• Swollen abdomen.

• Diabetes and currently have high blood sugar, increased thirst, dry mouth or other symptoms.

• Pregnancy or breastfeeding with severe symptoms (excessive vomiting, unable to keep down fluids or food, has lost 5 pounds or more, dark colored urine, severe cramping, dizziness when standing).

• Nausea from cancer treatments or from a co-existing health condition.

• Nausea is a side effect from a medication.

• Skin or eyes have a yellowish color, and the urine is a darkened color.

• Severe pain of the upper right abdominal region.

• Severe pain of the right lower, or middle abdominal region.

• Allergies to OTC medications.

• Fever and diarrhea with nausea.

• The cause of the nausea is another, coexisting health condition.


Yes

No



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