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Data entered into this eCRF are automatically saved
The contributor will also be able to return at a future date to view and/or edit the eCRF should new information regarding the patient/family become available
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Part 3
Part 4
Part 5
Part 6
Upload Family Pedigree
Part 5 - COVID-19 Infection
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"Minimal" (mandatory)
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"Core" (some items can be missing)
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"Extended" (ideal/optional)
Warning:
The minimal dataset is not complete yet. Please be reminded that to complete the minimal dataset is mandatory in order to have samples processed for genetic analysis. Please continue or come back when you can complete at least the minimal dataset.
1. Has the patient been diagnosed with COVID-19 infection?
no
yes
unknown
Year of COVID-19 infection:
Year
2022
2021
2020
2019
Month of COVID-19 infection:
Month
Jan
Feb
Mar
Apr
May
June
July
Aug
Sept
Oct
Nov
Dec
Was this associated with:
Intensive care unit (ICU) admission
no
yes
unknown
Requirement for mechanical ventilation
no
yes
unknown
New onset of hyposmia
no
yes
unknown
Obvious worsening of PD features
no
yes
unknown
Please specify nature of deterioration:
Other neurological feature(s)
no
yes
unknown
Please specify nature of deterioration:
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