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Trial-IN Pharma Ltd
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Data (שדה חובה)
<p dir="ltr" style="text-align: left;"><strong>Patient’s details:</strong><br></p>
Imię i nazwisko (שדה חובה)
Nr ident. (PESEL) (שדה חובה)
Rodzaj nowotworu (שדה חובה)
Imię i nazwisko (שדה חובה)
Relacja z pacjentem (שדה חובה)
E-mail (שדה חובה)
<p dir="ltr" style="text-align: left;">Mark the sentence that best describes the patient's current performance abilities as it is <strong>TODAY</strong>[1]:<br></p>
Mark:: Grade 1 - Restricted in physically strenuous activity but ambulatory and able to carry out work of a light or sedentary nature, e.g., light housework, office work (שדה חובה)
Mark:: Grade 0 - Fully active, able to carry on all pre-disease performance without restriction (שדה חובה)
Mark:: Grade 2 - Ambulatory and capable of all self-care but unable to carry out any work activities. Up and about more than 50% of waking hours (שדה חובה)
Mark:: Grade 3 - Capable of only limited selfcare, confined to bed or chair more than 50% of waking hours (שדה חובה)
Mark:: Grade 4 - Completely disabled. Cannot carry on any self-care. Totally confined to bed or chair (שדה חובה)
<p dir="ltr" style="text-align: left;"><span style="font-size:11px;">[1] Adapted from: WHO Performance status</span></p>
I have read and understood the topic of the performance status questionnaire (שדה חובה)
Notes:
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