Acute Group A Streptococcal Pharyngitis Infection
Evaluation and Treatment Form
Name
DOB
Age
Phone
Format: (000) 000-0000.
Allergies
Temp
Weight
PCP
Symptoms (check all that apply)
Sore throat
Pain on swallowing
Fever >100.4
Headache
Swollen or tender cervical lymph nodes
Inflamed or swollen tonsils or uvula
Cough
Hoarseness
Rhinorrhea
Conjunctivitis
Diarrhea
Submit
Should be Empty: