Patient's Data
sex
integer
Geburtsjahr
integer
geoesse
integer
Gewicht
float
Multiple Sclerosis specific information
Please select a day of the respective month. It is applied to only the month and year
date
Unbekannt
integer
Please select a day of the respective month. It is applied to only the month and year
date
Unbekannt MS-Diag
integer
mslauf
integer
Andere Verlaufsform
text
Schübe anzahl
integer
Schub
integer
EDSS-Score 12 month ago
Please enter the current score for the different function systems.
Please specify a value between 0 and 10.
float
Unbekannt EDSS
integer
Pyramidal
integer
Sensibilität
integer
Zerebral
integer
Kleinhirn
integer
BlaseMastdarm
integer
Gehfähigkeit
integer
Hirnstamm
integer
Visuell
integer
Score
float
Past medication of MS
Previous disease-modifying MS-Medication
Wirkstoff
integer
Wirkstoff anderer
text
Please select a day of the respective month. It is applied to only the month and year
date
Please select a day of the respective month. It is applied to only the month and year
date
HauptgrundTherapieende
integer
Text Anderer Grund
text
Current MS therapy
Wirkstoff
integer
curth1a
text
Please select a day of the respective month. It is applied to only the month and year
date
Therapieschema
integer
andere
text
If Yes, please specify all disease a disease group and each month and year of diagnosis. Please indicate also, if these are treated with medicines.
Heart / cardiovascular disease
Heart / cardiovascular disease
Kreislauferkrankungen
integer
Please select a day of the respective month. It is applied to only the month and year
date
Datum unbekannt
integer
MediBehandlung
integer
Metabolic diseases
Metabolic diseases
Stoffwechsel
integer
Please select a day of the respective month. It is applied to only the month and year
date
Datum unbekannt
integer
MediBehandlung
integer
Infectious diseases
Infectious diseases
Infekt
integer
Welche opportunistische Infektion
text
Ort der Herpes-Infektion
text
Please select a day of the respective month. It is applied to only the month and year
date
Datum unbekannt
integer
MediBehandlung
integer
Gastrointestinal diseases
Gastrointestinal diseases
Gastro
integer
Please select a day of the respective month. It is applied to only the month and year
date
Datum unbekannt
integer
MediBehandlung
integer
Neurological / psychiatric disorders
Neurological / psychiatric disorders
Neurologische / Psychiatrische Erkrankungen
integer
Please select a day of the respective month. It is applied to only the month and year
date
Datum unbekannt
integer
MediBehandlung
integer
Allergies
Allergies
Allergien
integer
Medikamentenallergien
text
Please select a day of the respective month. It is applied to only the month and year
date
Datum unbekannt
integer
MediBehandlung
integer
Genitourinary Disorders
Genitourinary Disorders
Uro
integer
Please select a day of the respective month. It is applied to only the month and year
date
Datum unbekannt
integer
MediBehandlung
integer
Auto-immune diseases
Auto-immune diseases
Autoimmunerkrankungen
integer
Please select a day of the respective month. It is applied to only the month and year
date
Datum unbekannt
integer
MediBehandlung
integer
Blood Count / laboratory
Blood Count / laboratory
BlutLabVer
integer
Please select a day of the respective month. It is applied to only the month and year
date
Datum unbekannt
integer
MediBehandlung
integer
General Symptoms
General Symptoms
AllgemSympt
integer
Please select a day of the respective month. It is applied to only the month and year
date
Datum unbekannt
integer
MediBehandlung
integer
Operation
Operation
Operation
text
Please select a day of the respective month. It is applied to only the month and year
date
Datum unbekannt
integer
MediBehandlung
integer
Cancer
Cancer
Cancer Treatment?
Operation
integer
Bestrahlung
integer
Chemotherapie
integer
Substanzen
text
nicht bekannt
integer
Other diseases?
Other diseases?
Andere
text
Please select a day of the respective month. It is applied to only the month and year
date
ubk
integer
MediBehandlung
integer
FYI: after selecting it may take a few seconds, because the closed fields are checked.
Pregnancy
Biologic Material (for example blood)