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CLINICAL Rash Assessment - v2

Questions About a New Rash

This is a list of questions that your doctor may want to know the answer to in helping you assess the meaning of a rash.
Who is it who has asked you to fill out this form? - choose one
(So we can contact you) This question requires a valid email address.
Have you had any similar skin problems in the past, with or without an associated medication exposure *This question is required.
List the medications that you are currently taking and for each medication please write down the dose of the last increase in dose. The answers should look like this - "Prozac. January 1, 1995."
Have you varied the dose of the medicine(s) you have been taking *This question is required.
Have you stopped the medicine to see what happens *This question is required.
Most drug rashes start within 1 to 6 weeks of initiation of therapy, however patients previously exposed to a drug may have a rash that develops within hours after taking the medicine again
Do you have any skin signs of a potentially serious adverse drug reaction: swollen face, rash that involves the middle of the face (nose, mouth, etcetera), tongue swelling, bruises that are swollen, blisters, flaking skin, or erosions on the lips or mouth
If so please describe.
For most patients with a drug rash, no laboratory test is necessary. However, fever indicates a potentially serious reaction. If you have a fever, your doctor may want to order a complete blood count, with differential, a c reactive protein, and/or liver enzymes and/or  kidney function tests and a urinalysis (depending on presence or absence of symptoms suggesting involvement on liver or kidney, such as change in color of urine, yellow jaundice, etcetera). 
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