SGP_lyme


1. Identification

GP code

Startdate of consultation week (monday)

Format: mm-dd-yyyy

Sex patient
Agegroup patient
< 15 year
15 - 29 year
30 - 44 year
45 - 59 year
60 - 74 year
>= 75 year

2. Tick bite

Confirmed tick bite?

3. Symptoms, diagnosis and treatment

Symptoms
Erythema migrans
Other skin manifestation
Influenza-like illness
Lyme arthritis
Neurological symptoms due to lyme
Lyme carditis
Other symptoms caused by lyme (eg. conjunctivitis, uveitis, keratitis, ear disease,...)
No symptoms
Did you request a serological test?
Antibiotics?