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

• Less than 4 years old.

• Fever over 101.5 F.

• Symptoms which have gotten worse or new symptoms that have developed after beginning to self treat with OTC medications.

• Asthma, COPD or other respiratory condition.

• Heart conditions including congestive heart failure.

• Currently having chest pain, or shortness of breath.

• Immunosuppression (having a health condition or are taking drugs that can suppress the immune system).

• AIDS.

• Elderly and frail.

• Allergy or hypersensitivity to over the counter medications.

• A cough that has lasted more than 7 days.

• A cough that produces yellow, tan or green mucus or is secreting pus.

• Cough is likely a side effect from a drug such as lisinopril.

• The cough is from inhaling irritants or foreign material into lungs.

• A cough that is accompanied by chills, night sweats or weight loss.

• A rash.

• Swollen ankles or legs.

• Pregnancy.

• Taking drugs known as MAOI inhibitors or have taken them within 14 days. MAOI's include the following drugs: Zelapar (selegiline), Nardil (phenelzine), Marplan (isocarboxazid), and Parnate (tranylcypromine).


Yes

No



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