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Medical History Form Do you have a fever, difficulty breathing or a cough? YES NO Have you returned from travel in the last 14 days? YES NO Have you been in contact with a suspected or confirmed case

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Identify any underlying medical conditions such as asthma or COPD that may be causing the breathing difficulties.

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Breathing difficulties causes and can be caused by various factors such as asthma, pneumonia, bronchitis, allergies, or respiratory infections.

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Information such as the patient's age, gender, symptoms, medical history, test results, and any relevant medications must be reported on breathing difficulties causes and.

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