[textarea columns=80 rows=25 default="History provided by ***mother/father/grandparent/daycare provider***
Patient has had symptoms for *** days.
Symptoms are ***cough/barky cough/stridor/dyspnea/irritability/decreased activity/poor feeding/emesis/nasal congestion***
These symptoms are worse ***at night/during the day***
Symptoms have been ***worsening/improving/stable/intermittent/waxing and waning***
Patient ***has had/has not had*** respiratory distress, currently ***not in distress/in respiratory distress/anxious/dyspneic***
There ***has/has not*** been exposure to others with similar symptoms.
There ***has/has not*** been fever.
Parents have tried ***steaming/cool air/OTC decongestants/bronchodilators/antihistamines/antipyretics*** with ***some relief/no relief***
History ***of croup in the past/of hospitalization with similar symptoms/of similar symptoms/of asthma/of pneuomonia/of respiratory problems/of no similar problems/***
Patient ***has/has not*** been seen for current illness. Patient ***has/has not*** been ***given steroids/given racemic epi neb/hospitalized***."][/html][/conditional]
There are 3 form elements.
Result - Copy and paste this output: