Pathophysiology/aetiology:

🔍 Symptoms

🚩 Referral points:

💭 Differential diagnosis:

❓Specific questions: (in addition to WWHAMMA + pregnancy/breastfeeding)

💊 Treatment I = indication/mode of action, D = Directions for use, A = Adverse effects, R = Referral points, L = lifestyle counselling

Option 1: _________________________

I

D

A

R

L

Option 2: _________________________

I

D

A

R

L

🤰🏻 Pregnancy?

👶🏻 Children?

Provide CMI + self care information Specify which information you are going to give