| a. Constitutional | Yes | No |
| Fever |
|
|
| Headache |
|
|
| Body ache |
|
|
| Conjunctivitis |
|
|
| Chills and rigor |
|
|
| Malaise |
|
|
| Weakness |
|
|
| Sweating |
|
|
| Others, specify |
|
|