Page 185 - Demo

Development and validation of the TSC-PROM1836Baseline information1. What is the individual’s sex?□ Male□ Female□ Other2. What is the individual’s age?_____ years3. What is the individual’s nationality?□ American□ Other (please specify): ___________4. What is your relationship to the individual?□ Father□ Mother□ Brother□ Sister□ Caretaker□ Other (please specify): __________5. At what age was TSC diagnosed?_____ years6. (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 TSC7. 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 __________Annelieke Muller sHL.indd 183 14-11-2023 09:07