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Patient {{ $iPatientNo }}

Lulifin Phase 1 24-25

Patient’s Details

Initials *

OPD/IPD Registration No *

Gender *

Male Female

Age (in Years) *

City/Town *

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State *

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State *

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Diagnosis *

How many % of patients in your daily OPD are daignosed with Dermatophytosis *

5%-10%

10%-30%

>30%

What is the average age of patients daignosed with Dermatophytosis in your OPD? *

20-30 years

30-40 Years

40-50 Years

>50 Years

Which is the most frequent Type of dermatophytoses *

Tinea cruris

Tinea corporis

Tinea pedis

Onychomycosis

Any other

Please Specify

What is the average duration of dermatphytoses patients suffer *

<1 week

1-2 week

2-4 week

>4 week

Do you routinely do KOH mount test *

Yes

What % of patients with dermatophytosis are treatment naïve *

5%-10%

10%-30%

>30%

What % of patients there is a family history (past/present) of dermatophytosis *

5%-10%

10%-30%

>30%

What % of patients have co-morbid conditions *

a. Diabetes mellitus

5%-10%

10%-30%

>30%

b. Hypertension

5%-10%

10%-30%

>30%

c. Obesity

5%-10%

10%-30%

>30%

Which is the topical antifungal prescribed to the patient *

Luliconazole

Amorolfine

Terbinafine

Clotrimazole

Duration of treatment of topical antifungal cream *

2 week

2-4 week

>4 week