The CE provider will describe and discuss, as appropriate:

a. Dyspnea at rest and with exertion;

b. Palpation, wheezing, cough, sputum production, chest discomfort, symptoms of hyperventilation, paroxysmal nocturnal dyspnea, and orthopnea;

c. Characteristics of severe respiratory attack or persistent pulmonary infection;

d. History of hospitalizations or emergency department visits; and

e. Episodic disorders, such as asthma:

1. Onset and precipitating factors;

2. Frequency and intensity;

3. Duration;

4. Mode of treatment and response; and

5. Description of severe attack(s).

The CE provider will describe and discuss, as appropriate:

1. a. 

   Assistive devices: presence of tracheostomy, central venous catheter, supplemental oxygen, or gastrostomy;

2. b. 

   Respiratory rate: whether respirations are labored, and use of any accessory muscles of respiration;

3. c. 

   Lungs:

   1. 1. 

      Occurrence of cough, audible wheezing, pallor cyanosis, hoarseness, clubbing of fingers, chest wall deformity, and any abnormal curvature of the spine;

   2. 2. 

      Whether there is prolongation of the expiration phase of respiration;

   3. 3. 

      Quality of breath sounds (or air exchange), whether normal or diminished;

   4. 4. 

      Presence or absence of adventitious sounds (such as wheezing, rhonchi, or rales); and

   5. 5. 

      Diaphragmatic motion.

4. d. 

   Heart and vascular:

   1. 1. 

      Description of heart sounds;

   2. 2. 

      Presence of any lifts, heaves, or thrills;

   3. 3. 

      Heart size;

   4. 4. 

      Point of maximal impact of cardiac apex;

   5. 5. 

      Presence of any murmurs, rubs or gallops;

   6. 6. 

      Distention of neck veins; and

   7. 7. 

      Presence, type, and extent of any peripheral edema and any associated skin discoloration or ulceration;

5. e. 

   Pulmonary Function Tests. The CE provider will obtain pulmonary function tests only after receiving proper authority from the DDS. Perform spirometry testing for children age six and older as specified in section 103.00E of the respiratory listing (see DI 34005.103).