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Visit
Date of visit
Month
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Unknown (nk)
*
/
/
*
Subject ID
In Project ID
Gender
M
F
Other
Age
Inclusion
Page
Site
Status
1. Patient information and declaration of consent
Please pass the patient information on to the patient and collect the declaration of consent.
Information for the physician in charge
The fax with the declaration of consent is to be sent directly to the data protection officer at Cvderm in charge of patient data and the pseudonymised patient number (ID).
All further data transmissions are based solely on the patient number (ID) - please do not enter any patient identification features (DOB, name) in the CRF.
Any queries the patient may have are only made by stating the patient number (ID).
2. In/exclusion criteria
Yes
No
Age
>
18 Years
Age
>
18 Years
Yes
No
Diagnosis
Clinically proven psoriasis
vulgaris
with or without arthritis.
Diagnosis
Clinically proven psoriasis
vulgaris
with or without arthritis.
Yes
No
Treatment
Initial application of planned system therapeutic or biologics (other previous therapies irrelevant)
Treatment
Initial application of planned system therapeutic or biologics (other previous therapies irrelevant)
Yes
No
Understanding
The patient understands the survey and is expected to be able to fill in the questionnaire.
Understanding
The patient understands the survey and is expected to be able to fill in the questionnaire.
Yes
No
Consent
The patient has provided written consent.
Consent
The patient has provided written consent.
Yes
No
The patient can only be included in the trial if all the inclusion criteria have been fulfilled and none of the exclusion criteria apply.
3. Patient questionnaire
Please hand the patient questionnaire for visit 1 to the patient
The document has to be returned to the practice/outpatient clinic on the same day.
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