Respiratory History 

Yes / No

Do you have seasonal allergies? 
N
Do you ever cough up blood? 
Y; today 
Do you have a morning cough? 
Y
Do you produce sputum with the cough? 
Y
If so, what color?
yellow with red streaks
How many pillows do you sleep on? 
0
Have you had a flu vaccine? 
N
Have you had a pneumonia vaccine? 
N
When was your last chest x-ray? 
3 months ago* 
*X-rays available upon request.
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©1998,  Neal R. Chamberlain, Ph.D.. All rights reserved.