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eCRF compilation for new case
Part 2 - Genotyping & Family History
Year of sample collection:
Genotyping done?
Please give detailed description of positive findings (including details at cDNA and protein level, and zygosity, e.g., LRRK2, c.6055G>A, p.G2019, heterozygous):
Family member(s) with PD (Have any members of your immediate or Extended family been diagnosed with Parkinsons by a doctor?):
Other family member(s) with symptoms suggestive of PD (Are there any other family members with symptoms or signs suggestive of Parkinsons?):
Please list:
Relationship to index case:
Year of birth:
Year of symptom onset:
Genetic diagnosis achieved:
Genetic diagnosis achieved:
Family members with other neurological disorders ("Have any members of your immediate or extended family been diagnosed with neurological disorders other than Parkinson's, such as a Parkinson-plus syndrome, dementia, motor neuron disease, cerebellar ataxia, dystonia, spastic paraplegia, epilepsy, or intellectual disability?"):
Fathers father:
White/ Caucasian/ European:
Country where fathers father has lived most of his life:
Fathers mother:
White/ Caucasian/ European:
Country where fathers mother has lived most of her life:
Mothers father:
White/ Caucasian/ European:
Country where mothers father has lived most of his life:
Mothers mother:
White/ Caucasian/ European:
Country where mothers mother has lived most of her life:
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