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

• Fever over 103 F (for adults), fever over 102 F (for ages 4-17).

• Symptoms which have gotten worse, or new symptoms have developed, after trying an OTC product.

• Asthma, COPD or other respiratory conditions.

• Under 4 years of age.

• Allergic or hypersensitive to OTC cough medications.

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

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

• The cough is likely a side effect of a drug such as lisinopril.

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

• The cough is accompanied by chills, night sweats, weight loss, rash, swollen ankles or swollen legs.

• 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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