Rheumatology COVID-19 Registry

Thank you for agreeing to take part in this important effort on behalf of the global rheumatology community. Our hope is that the information you and others provide will help us understand how the novel COVID-19 virus impacts patients with rheumatologic conditions or those taking immunosuppressive drugs. We hope to better understand their risk of infection, track outcomes, and use this data to inform treatment.

Please note, this survey is for health care professionals caring for adult rheumatology patients.

For providers who wish to enter reports on pediatric patients, please open the COVID-19 Global Pediatric Registry: https://carragroup.org/research-registry/projects/covid-19-global-pediatric-rheumatology-database.

For patients wishing to report their own symptoms, please use this link to the Patient Experiences Survey: https://rheum-covid.org/patient-survey/

In addition, if your country is part of EULAR (European League Against Rheumatism), please do not use this registry. Here is the link to the EULAR (GDPR-compliant) registry for both pediatric and adult rheumatology: https://www.eular.org/eular_covid19_database.cfm

The case report form should take about 7-10 minutes to complete. You can enter all the data at one time, or come back to the registry later to update or compete the entry. Patients identifiers such as name or date of birth are not collected. All information will be kept strictly confidential and will only be shared with researchers compiling information. Information and updates will be shared via the COVID-19 Global Rheumatology Alliance website: https://rheum-covid.org.

The success of this collaborative effort depends on active participation by the international rheumatology community to obtain accurate and reliable information. We ask that you share this site with your colleagues and encourage them to report any cases of COVID-19 in rheumatology patients.

As a final reminder, please do NOT use this registry to enter 'test' data, data about yourself (as a patient), data from pediatric patients, or from EULAR countries.

Publications using data from this registry include an appendix with the names of providers who have submitted 10 or more cases under the same provider ID. If you do not wish to be included in that appendix, please contact RheumCOVIDRegistry@ucsf.edu

The COVID-19 Global Rheumatology Alliance

If you have questions about the survey, you may send them to: RheumCOVIDregistry@ucsf.edu

Provider Identifier: ______

Lattitude

reset

Longitude

reset

Start date/time

Y-M-D H:M

The link to the survey queue is ______
(please copy this value into the field if it is not already present )

Family name/last name of reporting provider

* must provide value

Given name/first name of reporting provider

* must provide value

Email address

* must provide value

Role of reporting provider (e.g., physician, nurse, etc.)

Specialty of reporting provider

Hospital or clinic name

Hospital or clinic name (drop down)

* must provide value

Hospital/clinic, not listed above

City of hospital/clinic

* must provide value

State or province of hospital/clinic

Country of hospital/clinic

* must provide value

You have selected an option that triggers this survey to end right now.

To save your responses and end the survey, click the 'End Survey' button below. If you have selected the wrong option by accident and/or wish to return to the survey, click the 'Return and Edit Response' button.