1 2 7 8 T H E Q U E E N S W A Y , E T O B I C O K E , O N , M 8 Z 1 S 3 P H O N E 4 1 6 8 4 8 9 7 9 5 • F A X 4 1 6 5 2 1 7 2 1 6 I R E N E F U N G , M D , F R C P C A L L E R G Y , A S T H M A A N D I M M U N O L O G Y
**Note: for skin prick testing to be done at the clinic visit, the patient must refrain from
taking oral antihistamines for at least 3 days prior to their appointment (eg. Azelastine, Cetirizine, Chlorpheniramine, Cyproheptadine, Desloratadine, Diphenhydramine, Doxepin, Hydroxyzine, Imipramines, Ketotifen, Levocetirizine, Loratadine, Terfenadine, Tripelennamine) Surgical Procedures Are immunizations up to date? Yes
Penicillin/Amoxicillin Other Drugs: ______________________________ Food: ____________________________________ Latex Other: ____________________________________
Family member (eg. Mother, brother, etc)
Environmental allergies Drug allergy Food allergy Patient lives with (Circle all that apply): Mother Father Spends time between parents’ homes Grandparents ___ Brothers ____ Sisters ____ Children Others: _________________ Circle any cooling system in home: Central air conditioning Window air conditioning Is there carpeting in the home? If “Yes”, where is the carpeting? ________________________________ Environment (circle all that apply): Babysitter’s home In-home baby-sitter Home with parent/family member Preschool Work; Occupation: _________________
General Health Review (Circle all that apply):
Chest pain Mucus in chest Bronchitis Shortness of breath Cough that won’t go away Cough, wheeze or shortness breath with exercise, emotional upset, or cold air HEART & BLOOD PRESSURE Abnormal or rapid heart rate Heart murmur High blood pressure EYE, EAR, NOSE & THROAT Eye: Swelling Blurry vision Balance problems Frequent ear infections Tympanostomy tubes Hearing loss Recurrent fluid in ears Runny nose Stuffiness Sinusitis Mouth breathing Post nasal drip Throat clearing Large tonsils or adenoids Frequent sore throat Tingling Swelling Inflamed Oozing/infected Prior eczema DIGESTIVE SYSTEM
Failure to thrive Poor appetite Frequent spit-up Heartburn Choking/gagging Vomiting Diarrhea Constipation Abdominal pain DEVELOPMENT
Global delays Delayed speech Delayer motor skills MUSCULOSKELETAL
Swollen joints Fractures Joint pain Recurrent fevers Number of antibiotic course in the last year: __________
The properties and applications of chlorhexidine inendodonticsZ. Mohammadi1,2 & P. V. Abbott31Department of Endodontics, School of Dentistry, Hamedan University of Medical Sciences, Hamedan, Iran; 2Iranian Centre forEndodontic Research (ICER); and 3School of Dentistry, University of Western Australia, Perth, WA, Australiaaction of CHX, its antibacterial and antifungal activity,its effect on
American Geriatrics Society Updated Beers Criteria forPotentially Inappropriate Medication Use in Older AdultsThe American Geriatrics Society 2012 Beers Criteria Update Expert PanelPotentially inappropriate medications (PIMs) continue tocomes. Estimates from past studies in ambulatory and long-be prescribed and used as first-line treatment for the mostterm care settings found that 27% of adve