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Historical Clinical Characteristics
This form captures information about historical clinical characteristics surrounding the patient’s glomerular disease.
The historical time frame in question for this form is any time before one year (or 365 days) before the index diagnosis date.
For example, if a patient was diagnosed on April 1, 2023, only enter information about the patient’s historical clinical characteristics prior to April 1, 2022.
For each historical clinical characteristics, first select the level of documentation found in the patient’s chart. There are three options:
Documented as Present = If you find mention of the sign or symptom BEING present
Documented as Not Present = If you find mention of the sign or symptom NOT being present
Not Documented = If you DO NOT SEE ANY MENTION of the sign or symptom in the patient’s chart.
Enter only the date of the most recent diagnosis of each historical clinical characteristic.
For example: If a patient has a history of hypertension 370 days before the index diagnosis and 500 days before the index diagnosis, select the date corresponding to 370 days before the index diagnosis.
Leave the date field blank if a sign or symptom is not seen.
Guidelines:
If an exact date is unavailable, use July 1 with the approximate year of diagnosis.
If an exact year is not available, an approximation is acceptable. If any approximations are used, please make a note in the comments section at the end of this form.
If the options provided do not capture some important information about the patient’s historical clinical characteristics, please use the table at the bottom of the form by adding a new row for each other historical clinical characteristics.
If the date of any historical clinical characteristic signs and symptoms is unavailable, use July 1 with the approximate year of diagnosis. If an exact year is not available, an approximation is acceptable. If any approximations are used, please make a note in the comments section.
Once the date is entered, please click on the calculator to calculate the days from the INDEX diagnosis date.
*Please not fields for: Microscopic and Macroscopic Hematuria, NephrItic and NephrOtic syndrome
