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Use this chart daily to record the symptoms that you are experiencing. Rate the symptoms according to severity using a scale of 1 to 4 (see below). Under Interventions, record what you did for relief, and under Comments, whether or not it helped. Share this log with your nurse or doctor each week.
Codes for symptoms:
NC=Nasal congestion or cough
Severity rating for symptoms:
1=Able to carry on daily activities normally
2=Symptoms mildly affect my day
3=Severe symptoms, but gained relief after intervention
4=Severe symptoms with no relief gained
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