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


• Very severe symptoms of PMS.

• The symptoms are likely a response to a medication that has recently been started (such as an oral contraceptive).

• The symptoms do not begin within the time frame between one week before menstruation begins and one week after menstruation begins. The symptoms do not occur cyclically, every month around the time of menstruation.

• Allergies to over the counter medications.


Yes

No



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