icmr

ICMR MYCONET IN-PATIENT REGISTRY

Division of ECD, ICMR & ICMR- National Institute of Medical Statistics, New Delhi
(Indian Council of Medical Research)

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Case Report Form
   ADMIN : nims(1)  

SECTION 2: CLINICAL PRESENTATION

Information to be retrieved from hospital records of this admission

Q201. Clinical signs and symptoms according to the main sites of fungal infection :
Q201a Pulmonary involvement * Yes No
Q201b Rhino-cerebral and/or Orbital involvement* Yes No
Q201c Central nervous system involvement * Yes No
Q201d Skin and soft-tissue involvement (For All IFIs/Mycetoma/Chromoblastomycosis) * Yes No
Q201e Eye involvement * Yes No
Q201f Gastrointestinal System involvement * Yes No
Q201g Disseminated infection * Yes No
Q201h Joint involvement * Yes No
Q201i Any other rare sites involved * Yes No
Q203 Date of transfer from the ICU to any other ward *
Q204 H/o admission due to a similar condition at this institute * Yes No
Remarks