Page 175 - Demo

Development and validation of the TSC-PROM1736Baseline information1. What is your sex?□ Male□ Female□ Other2. What is your age?_____ years3. What is your nationality?□ American□ Other (please specify): ______________4. At what age were you diagnosed with TSC?_____ years5. (a) Has genetic testing been performed?□ I don’t know (go to question 6)□ No (go to question 6)□ Yes(b) What were the results?□ I don’t know□ TSC1 mutation□ TSC2 mutation□ No mutation identified□ Mutations found but uncertain if they cause TSC6. Which organs show, or have shown, symptoms of TSC? For example: tubers, tumors, pigment changes?□ None□ Skin □ Lungs□ Heart□ Brain□ Kidneys□ Eyes □ Mouth□ Other, namely __________7. Do you use medication? □ No□ Yes (please list all the medication you use) ____________________________________________________________________________________________________________Annelieke Muller sHL.indd 173 14-11-2023 09:07