COVID-HEP.PK

Reporter Information

Name of Reporter*

Email address of Reporter*

Name of lead physician providing carefor liver disease/post-liver transplant*

Name of center providing care for liverdisease/post-liver transplant*

Name of hospital where patient received carefor COVID 19 (enter 'NA' if patient not hospitalized)*

Is the patient >90 years of age?*

Yes

Separator

Age*

Country of residence

Gender*

Male

Female

Other