Current Date:
Gender: M/F
Current Age:
Age at Diagnosis:
Familial or Spontaneous:
(Did you inherit the condition, or are you the first one in your family to be affected?)
Others affected in family:
(Can you provide a similar set of entries for them?)
Current Height and Weight:
Current Cranial Circumference:
(With a tape measure, measure the distance around your head at the forehead)
Treatment :
Medications and dosage of each:
(how much and how often)
Number of teeth abscessed/extracted:
Number of osteotomies:
(and whether tibial or femural)
Final Height and Weight for those who have matured:
Geographical info:
(such as type of area living in and that of parents if familial)
Occupational info:
(Occupations of parents of spontaneous cases or at the point it became known to be familial
eg: your great grandmother was first known to have the disease, and her parents were coal miners)
Any other information that you feel might be important in the database: