1. Please answer yes or no to the following questions:

	Yes	No
History of stomach ulcer?	Please answer yes or no to the following questions: History of stomach ulcer? Yes	No
History of hospitalization within one year prior to PN?	History of hospitalization within one year prior to PN? Yes	No
History of genital herpes?	History of genital herpes? Yes	No
History of fungal Infection?	History of fungal Infection? Yes	No
History of HIV?	History of HIV? Yes	No
History of cancer?	History of cancer? Yes	No
History of blood transfusion?	History of blood transfusion? Yes	No
History of dental surgery?	History of dental surgery? Yes	No
History of substance abuse or alcoholism?	History of substance abuse or alcoholism? Yes	No
History of depression?	History of depression? Yes	No
History of anxiety?	History of anxiety? Yes	No
History of insect bite?	History of insect bite? Yes	No
History of eczema?	History of eczema? Yes	No
History of psoriasis?	History of psoriasis? Yes	No
Other skin problem?	Other skin problem? Yes	No
History of seasonal allergies?	History of seasonal allergies? Yes	No
History of chronic allergies?	History of chronic allergies? Yes	No
History of parasites (scabies, lice etc) in your household?	History of parasites (scabies, lice etc) in your household? Yes	No
Serious illness prior to onset of PN?	Serious illness prior to onset of PN? Yes	No
Death of someone close to you prior to PN?	Death of someone close to you prior to PN? Yes	No
Anyone else in your family have PN?	Anyone else in your family have PN? Yes	No
Anyone else in your family have other skin condition?	Anyone else in your family have other skin condition? Yes	No
Do your drink alcohol less than once a week?	Do your drink alcohol less than once a week? Yes	No
Do your drink alcohol less than once a month?	Do your drink alcohol less than once a month? Yes	No
Do your drink alcohol less than 4 times a year?	Do your drink alcohol less than 4 times a year? Yes	No
Do you smoke at all?	Do you smoke at all? Yes	No
Do you smoke more than 3 packs a week?	Do you smoke more than 3 packs a week? Yes	No
Do you use hair color?	Do you use hair color? Yes	No
Do you have a cat?	Do you have a cat? Yes	No
Do you have a dog?	Do you have a dog? Yes	No
Do you have other pets?	Do you have other pets? Yes	No
Allergic to seafood?	Allergic to seafood? Yes	No