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SGP_varicella_zona

1. Identification
(This question is mandatory)
GP code
(This question is mandatory)
Startdate of consultation week (monday)
Open date/time selector
(This question is mandatory)
Sex patient
(This question is mandatory)
Is the patient pregnant?
(This question is mandatory)
Agegroup patient
(This question is mandatory)
Which type of IDcard your patient possess?
(This question is mandatory)
Does the patient has access to OMNIO/BIM statute, urgent medical aid, CPAS/OCMW or other financial help?
2. Reason of consultation
(This question is mandatory)
Reason of consultation
3. Varicella
(This question is mandatory)
Vaccinated against varicella?
(This question is mandatory)
Does the patient have immunosuppression?
(This question is mandatory)
Treatment with antivirals?
(This question is mandatory)
Which antiviral treatment?
(This question is mandatory)
Antiviral treatment: how long after the onset of symptoms were they prescribed? number of days
(This question is mandatory)
Complications?
(This question is mandatory)
Which complications?
(This question is mandatory)
Hospitalization due to varicella?
3. Zona
(This question is mandatory)
History of varicella?
(This question is mandatory)
Vaccinated against varicella?
(This question is mandatory)
Does the patient have immunosuppression?
(This question is mandatory)
Treatment with antivirals?
(This question is mandatory)
Which antiviral treatment?
(This question is mandatory)
Antiviral treatment: how long after the onset of symptoms were they prescribed? number of days
(This question is mandatory)
Vaccinated against herpes zoster (shingles)? 
(This question is mandatory)
Vaccinated against herpes zoster (shingles): which?
(This question is mandatory)
Vaccinated against herpes zoster (shingles): how many years ago?
(This question is mandatory)
Hospitalization due to zona?
(This question is mandatory)
Ophthalmic shingles?
3. Postherpetic neuralgia
(This question is mandatory)
History of varicella?
(This question is mandatory)
Vaccinated against varicella?
(This question is mandatory)
Does the patient have immunosuppression?
(This question is mandatory)
Vaccinated against herpes zoster (shingles)? 
(This question is mandatory)
Vaccinated against herpes zoster (shingles): which?
(This question is mandatory)
Vaccinated against herpes zoster (shingles): how many years ago?
(This question is mandatory)
Which treatments are prescribed?
(This question is mandatory)
Hospitalization due to postherpetic neuralgia?