Demography
Date of Birth
date
Sex
text
Ethnicity
integer
Select all that apply
integer
Medical Conditions
Alcohol intake
Does the subject consume alcohol?
boolean
Average number of units of alcohol consumed per week
integer
History of Tobacco Use
What is the subject's history of tobacco use?
integer
If former smoker, when did the subject last smoke?
date
If former smoker, enter number of pack years
integer
Serology
Date sample taken
date
HIV antibody
integer
Hepatitis B surface antigen
integer
Hepatitis C antibody
integer