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

• Less than 2 years old.

• Fever is 103 F or greater.

• An infection is likely (abdominal pain, nausea, vomiting, diarrhea, cuts that are inflamed or exuding pus, possible recent exposure to bacteria etc).

• Immunosuppression from a health condition or from medications such as hydrocortisone, budesonide, methylprednisolone or other steroids, cyclosporine, methotrexate, azothioprine or other medications.

• HIV.

• Congestive Heart Failure.

• COPD or other respiratory conditions.

• Child with a history of seizures.

• A fever that has persisted for more than 3 days.

• Children who: Will not consume fluids, are vomiting or can't keep down fluids, have excessive sleepiness, irritability or are difficult to wake up.

• Rash or skin spots.

• History of any kind of brain injury.


Yes

No






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