Respiratory History

Yes / No

Do you have seasonal allergies?

Y

Do you ever cough up blood?

N

Do you have a morning cough?

N

Do you produce sputum with the cough?

N

If so, what color?

N/A.

How many pillows do you sleep on?

1

Have you had a flu vaccine?

N

Have you had a pneumonia vaccine?

N

When was your last chest x-ray?

N/A


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