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    Reporter Information

    Name of reporter
    Email address of reporter
    Name of the hospital/ treatment center
    Location
    Subspecialty

    Patient Information

    Age (years)

    Gender
    Weight (Kilogram)
    Height (Cm)

    Patient history

    Diabetes, especially with diabetic ketoacidosisCancerOrgan transplantStem cell transplantNeutropeniaLong-term (prior) corticosteroid useInjection drug useHIVAsthma/COPD

    COVID Severity

    Admission CRP value in mg/dL

    Last noted hemoglobin A1c

    Oxygen

    COVID Medications

    Vaccination Status

    Select Vacccine:
    Select dose
    Please specify your Vacccine
    Select dose

    Mucormycosis diagnosis

    Mucormycosis treatment

    Outcome

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