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

• Less than 2 years old.

• Using a laxative for 7 days with no relief.

• Symptoms have lasted for 2 weeks or more.

• Symptoms are recurring within a time span of 3 months.

• Abdominal pain, nausea, or vomiting.

• Recent surgery.

• An intestinal health condition (such as IBS, intestinal obstruction or appendicitis).

• Rectal bleeding or dark tarry stools.

• Constipation is from another health condition such as thyroid disorders, diabetes, multiple sclerosis, dementia, depression, or other conditions.

• Worsening of constipation after laxative use.

• Constipation that is induced by prescription drugs including but not limited to pain medicines (opiates), antidepressants, oxybutynin, tolterodine, zolpidem, anxiety medicines, cholestyramine, statins, seizure medicines, or blood pressure medicines.

• Kidney conditions or kidney impairment.

• Heart failure.

• Fever.


Yes

No






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