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Name:_____________________________

Date:______________________________

Diagnosis:

  • Cold or Flu
  • Middle ear fluid (Otitis Media with Effusion, OME)
  • Cough
  • Viral Sore Throat
  • Other:

You have been diagnosed with an illness caused by a virus. Antibiotics do not cure viral infections. If given when not needed, antibiotics can be harmful. The treatments prescribed below will help you feel better while your body’s own defenses are fighting the virus.

General Instructions:

  • Drink extra water and juice.
  • Use cool mist vaporizer or saline nasal spray to relieve congestion.
  • For sore throats, use ice chips or sore throat spray; lozenges for older children and adults.

Specific medicines:

  • Fever or aches:
  • Ear pain:

Use medicines according to the package instructions or as directed by your doctor. Stop the medication when the symptoms get better.

Follow up:

  • If not improved in days, if new symptoms occur, or if you have other concerns, please call or return to the office for a recheck.
  • Other:

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Signed:______________________________

For More Information call 1-800-CDC-INFO or visit www.cdc.gov/getsmart

Department of Health and Human Services
Centers for Disease Control and Prevention

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