Test1

Subject ID :
Initials :

What is the subject's GENDER

Female

Male

What is the subject's Ethnicity?

What is the subject's date of birth?

Does the subject have any of the following pre-existing conditions?

Date of SLE Diagnosis?

Duration of SLE-attributable symptoms prior to diagnosis

<4 weeks

4-6 weeks

6-12 weeks

>12 weeks

Describe the onset of the initial episode relative to SLE diagnosis

>6 weeks prior

At time of diagnosis

>6 weeks following