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

• Less than 4 years old.

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

• Symptoms have gotten worse or new symptoms have developed after trying a treatment with over the counter products.

• Chest pain.

• Shortness of breathe.

• Asthma, COPD or other respiratory conditions.

• Cardiovascular conditions such as heart failure, uncontrolled high blood pressure (current blood pressure over 140/90), or other heart or blood vessels conditions.

• Allergies to OTC medications.

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

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

• The cough is likely a side effect of a drug such as lisinopril or other drugs that are ACE inhibitors.

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

• The cough is accompanied by chills, night sweats, weight loss or a rash.

• Swollen ankles or 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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