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

• Less than 5 years old.

• Dry, flaky, scaly skin that has not improved after 2 weeks of treatment with over the counter products.

• Red, itchy, flaky skin that involves more than 5% of the body surface area. You can estimate this by considering your hand (the palm and extended digits) as 1% of the body surface area, therefore a space the size of 5 of your hands is around 5%.

• Allergic to over the counter skin care products.


Yes

No



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