Bronchitis History

History provided by [text]
The patient has had symptoms for [text] days

Pertinent positives include: [checkbox value="cough|chest congestion|shortness of breath|wheezing|productive cough|non-productive cough"]

Sputum is [select value="clear|purulent|blood-tinged"]

Other recent symptoms include:  [checkbox value="sore throat|nasal congestion|earache|headache|myalgias|fever"]
Pertinent negatives include:  [checkbox value="sore throat|nasal congestion|earache|headache|myalgias|fever"]
Past History:
[select value="no|yes"] chronic respiratory problems
[select value="no|yes"] frequent pneumonia
[select value="no|yes"] frequent bronchitis
[select value="no|yes"] asthma
[select value="current|former|exposure to second hand"] tobacco use
[select value="no|yes"] occupational exposure to potentially harmful inhalants