Respiratory History	Yes / No
Do you have seasonal allergies?	N
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?	Y
Have you had a pneumonia vaccine?	Y
When was your last chest x-ray?	3 yr. ago
Do you use tobacco products? What types? How often?	N

---