Sinus Registry for SinusOutcomes.org
Please submit data on procedures performed from April 1, 2020 to present
1. Physician ID# (please go to SinusOutcomes.org if you need an ID or forgot your ID) *
2. Procedure Date of Service *
MM
/
DD
/
YYYY
3. Patient Age *
4. Patient Sex *
5. What State was the procedure performed in *
6. Roughly what percent of the economy was open at the time of the procedure (best estimate) *
7. Where was the case performed *
8. What type of Anesthesia was used *
Required
9. What PPE was used during the procedure by the Doctor *
Required
10. What PPE was used during the procedure by the Staff *
Required
11. What PPE was used during the procedure by the Patient *
Required
12. What additional safety measures were used if any with the patient, procedure, or surgical suite *
Required
13. Procedures Performed *
Required
14. COVID-19 Patient Status on the day of surgery *
15. Did the patient develop a COVID-19 infection in the 30 days after the procedure *
16. If YES in question 15, what was the presumed source of the infection? ... if NO go to question 17
Clear selection
17. Was there presumed disease transmission to the doctor as a result of the procedure *
18. Was there presumed disease transmission to the staff as a result of the procedure *
19. This is an open comment field if you would like to add any information to your submission. Thank you!
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