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Intro
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Chief Complaint(s)
• • •
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Other Chief Complaint
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Cough
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Cough Quality
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Cough Duration
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Cough Comments
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Other Respiratory Symptoms
• • •
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Nasal Congestion
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Nasal Congestion Duration
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Nasal Congestion Comments
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Fever
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TMax
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Fever Duration
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Ocular Symptoms
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Ocular Symptoms
• • •
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Ocular Symptoms Duration
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Ocular Symptoms Comments
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Rash
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Rash Location
• • •
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Rash Itchy?
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Abdominal Pain
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Abdominal Pain Location
• • •
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Abdominal Pain Quality
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Radiation?
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Radiates To
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Association with food
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Stools
• • •
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Abdominal Pain Comments
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Vomiting
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Number of Episodes
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Vomiting Quality
• • •
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Vomiting Comments
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Diarrhea
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Number of Episodes
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Diarrhea Quality
• • •
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Diarrhea Comments
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Appetite
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Other Symptoms
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ROS negative
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Assessment
• • •
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Supportive Care
• • •
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Antibiotic Concentration
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Antibiotic
• • •
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Antibiotic Dose
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Ear
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