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/^((29([-\/])02\3(\d{2}([13579][26]|[2468][048]|04|08)|(1600|2[048]00)))|((((0[1-9]|1\d|2[0-8])([-\/])(0[1-9]|1[012]))|((29|30)([-\/])(0[13-9]|1[012]))|(31([-\/])(0[13578]|1[02])))(\11|\15|\18)\d{4}))$/

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/^(((\d{2}([13579][26]|[2468][048]|04|08)|(1600|2[048]00))([-\/])02(\6)29)|(\d{4}([-\/])((0[1-9]|1[012])(\9)(0[1-9]|1\d|2[0-8])|((0[13-9]|1[012])(\9)(29|30))|((0[13578]|1[02])(\9)31))))$/

/^(((\d{2}([13579][26]|[2468][048]|04|08)|(1600|2[048]00))([-\/])02(\6)29)|(\d{4}([-\/])((0[1-9]|1[012])(\9)(0[1-9]|1\d|2[0-8])|((0[13-9]|1[012])(\9)(29|30))|((0[13578]|1[02])(\9)31)))) (\d|[0-1]\d|[2][0-3]):[0-5]\d$/

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/^[-+]?\b\d+\b$/

/^[a-z]+$/i

/^\d{10}$/

/^[a-z0-9-_]+$/i

/^[-+]?[0-9]*\.?[0-9]+([eE][-+]?[0-9]+)?$/

/^-?\d+,\d$/

/^-?\d+\.\d$/

/^-?\d+,\d{2}$/

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/^-?\d+,\d{3}$/

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/^-?\d+,\d{4}$/

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/^[-+]?[0-9]*,?[0-9]+([eE][-+]?[0-9]+)?$/

/^($0[2-8]$|0[2-8])\s*\d{4}\s*\d{4}$/

/^(?:$?([2-9]0[1-9]|[2-9]1[02-9]|[2-9][2-9][0-9])$?)\s*(?:[.-]\s*)?([2-9]\d{2})\s*(?:[.-]\s*)?(\d{4})(?:\s*(?:#|x\.?|ext\.?|extension)\s*(\d+))?$/

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/^[ABCEGHJKLMNPRSTVXY]{1}\d{1}[A-Z]{1}\s*\d{1}[A-Z]{1}\d{1}$/i

/^(0[1-9]|[1-9]\d)\d{3}$/

/^\d{3}-\d\d-\d{4}$/

/^([0-9]|[0-1][0-9]|[2][0-3]):([0-5][0-9])$/

/^[0-5]\d:[0-5]\d$/

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7IfQRJA4hnkF7gnNENc4okhiQxIacs8DZ9NMZv9TEbPyh8P5FNqkBAWgEPoM7CEHFeme8CzH4xrnu9

PsoProtect
Psoriasis Patient Registry for Outcomes, Therapy and Epidemiology of COVID-19 infecTion

Returning?

This form is to be completed by a health care professional caring for a patient with psoriasis and COVID-19.

This form should be completed after the patient has had COVID-19 for a long enough duration to experience partial or complete recovery, hospitalization or death.

It is not the project’s intention to collect or process any personal data so please do not volunteer any information which could be used to identify a living individual. Any such information will be permanently deleted prior to data analysis.

The option "" can only be selected by itself. Selecting this option will clear your previous selections for this checkbox field. Are you sure?

Privacy Notice: Only de-identified data is permitted in PsoProtect; the data fields included in the PsoProtect case report form have been carefully selected to prevent traceability of the collected data to the identities of individual people. To further guard the anonymity of individuals, the data collected in PsoProtect is housed in secure servers that are built and hosted by UKCloud at King’s College London (KCL), in compliance with best practice.

If personal data is inadvertently provided it will not be processed, it will be deleted. KCL will not attempt to reidentify individuals from the data provided or combined with any other data sources. The data is collected and processed solely for the purpose of academic, scientific and medical research undertaken in the public interest and all resulting outcomes will apply robust aggregation techniques before being publicised and shared, as described below, for the advancement of scientific and medical knowledge and its translation into clinical practice. KCL shall not use or permit the use of the data for any commercial purposes.

The outcomes from the use of the data shall be publishable by KCL and research collaborators in accordance with normal academic practice. The data entered in the PsoProtect case report form shall be shared with research collaborators/third-parties for current and future, non-commercial academic research. The data will be shared under an appropriate data sharing agreement. Any use of the data by KCL or a research collaborator/third-party, including future research, will be subject to obtaining favourable ethical approval from the appropriate research ethics committee, where applicable. See our FAQ for further details.

You will be provided with a copy of your completed case report form upon submission. This can be shared with existing pharmacovigilance psoriasis registries, if appropriate. We are committed to sharing data with researchers; please Contact us for further information. A PDF of the PsoProtect case report form can be downloaded here for your reference.

KCL will comply with all applicable laws and legislation in relation to the handling, storage and use of the data. KCL has no liability for the provision of this data. In the event of any issue arising, English law will apply.

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PsoProtectPsoriasis Patient Registry for Outcomes, Therapy and Epidemiology of COVID-19 infecTion

Please return at least 7 days after the onset of symptoms to complete this form.

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PsoProtect
Psoriasis Patient Registry for Outcomes, Therapy and Epidemiology of COVID-19 infecTion