Other relevant information (including evolution)
Yes - Please describe below
boolean
Date
date
IMD additional/ follow-up information
text
Investigator Signature
I confirm that I have reviewed the data in this Immune Mediated Disease report for this Patient. All information entered by myself or my colleagues is, to the best of my knowledge, complete and accurate, as of the date mentioned below.
text
Printed Investigator's name
text
Investigator's Signature Date
date