Sinus Registry for SinusOutcomes.org
Please submit data on procedures performed from April 1, 2020 to present
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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
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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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