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Systemic Lupus Erythematosus Study Survey
Please complete this short survey to see if you qualify to participate in this study.
1.
Please leave your name, phone number, and email for us to contact you should you qualify for this trial.
Name:
Phone #:
Email:
2.
Are you at least 18 years old?
Yes
No
3.
Do you have a diagnosis of systemic lupus erythematosus (SLE)?
Yes
No
4.
Have you tried anti-malarial therapy, oral corticosteroids, or an immunosuppressant as treatment for SLE?
Yes
No
I'm not sure
5.
Are you taking 20 mg or more oral prednisone daily?
Yes
No
I'm not sure
6.
Do you have a history of or positive test for HIV?
Yes
No
I'm not sure
7.
Have you been diagnosed with heart failure?
Yes
No
I'm not sure