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Asthma
Will you be taking this medication
*
Yes, this medication is for me
No, this medication is for someone else
What is the age of the person who will be using this product?
What symptoms are going to be treated with this medication?
Does the intended user have any other medical conditions?
*
Yes
No
What other medical conditions does this user have?
Is the intended user taking any other medication?
*
Yes
No
What other medications are being taken by the user?
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