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

• Less than 6 years old.

• Fever over 101.5 F.

• Symptoms have gotten worse or new symptoms have developed after beginning an over the counter treatment.

• Asthma, COPD or other respiratory conditions.

• Cardiovascular conditions including congestive heart failure.

• Chest pain or shortness of breath.

• Immunosuppression from a health condition or from medications that suppress the immune system.

• HIV.

• Elderly and frail.

• Allergic or hypersensitive to over the counter medications.

• A cough that has lasted for more than 7 days.

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

• Cough is from inhaling irritants or foreign material into the lungs.

• Rash.

• Swollen ankles or legs.

• Pregnancy.

• A child who is recovering from chicken pox or a viral illness.

• 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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