Clinical experience - pbserum - The cutting-edge world of enzymes

Clinical experience example

1. Name of the doctor(Required)

2. Date of treatment - Session no. 1(Required)

3. Name of the patient (initials)(Required)

4. Does the patient meet all inclusion and exclusion requirements?(Required)

Select one answer

5. Gender of the patient(Required)

Select one answer

6. Age of the patient(Required)

Please enter a number from 0 to 122.

7. Weight of the patient (in kg)(Required)

8. Height of the patient (in cm)(Required)

9. Relevant addictions (alcohol, tobacco, drugs, etc.)(Required)

10. Relevant medical history or current medicantion that should be highlighted(Required)

11. Is there any additional comment?(Required)

12. Choose patient's jowl degree according to the following scale(Required)

13. Jowl measurement (mm)(Required)

Using a plicometer take a horizontal and vertical measurement of the jowl . As a recommendation, take the measurement 3 times, since values may vary. Please write the measurement (mm), i.e. 5 mm

Horizontal	Measurement 1 (mm)(Required) Measurement 2 (mm)(Required) Measurement 3 (mm)(Required)
Vertical	Untitled(Required) Untitled(Required) Untitled(Required)

14. Please confirm application details(Required)

Fill all following fields

	Application details
Final volume (mL)	Untitled(Required)
Number of points per jowl	Untitled(Required)

15. Is there any medical comments of the visit?(Required)

16. Basic information on Data Protection(Required)

I have read the terms and conditions

I accept the terms and conditions

Responsible: PROTEOS BIOTECH SL; Purpose: Research and statistical purposes; Legitimation: Legitimate interest of the Responsible; Recipients: No data will be transferred to third parties, unless legally required; Rights: You have the right to access, rectify and delete the data, as well as other rights, indicated in the additional information, which can be exercised by contacting dpo@smart-informatica.es; Origin: The interested party; Additional information: https://www.proteosbiotech.com/es/rgpd/

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