AUDIT OF ANTIBIOTIC PRESCRIBING
Severity of Symptoms: Please (√) rate. ... Amoxicillin Augmentin Avelox Bactrim Ceftin/Cefzil Cipro Levaquin Omnicef (Cefdinir) Zithromax (Z-Pack) Other ... -Please list relative(s) and condition(s) ( please limit to allergy, asthma, eczema, immune deficiency, etc.) • • • Social History (Adult) Occupation ................
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