OVERVIEW: Enter one record for each case. You may enter as many cases as you would like to provide. The option to enter another record becomes available following each submission. All questions are optional except for several critical case questions. after you submit each response. Each record has its own unique access code, so please record each individual code and link to its respective record.
Due to the importance of collecting accurate information, all contributors are asked to respond to the following attestation statement.Attestation Statement:
* must provide value
Yes
No
What world region do you practice in?
Americas (South, Central, North)
Africa
Asia (including India)
South Pacific (Australia, New Zealand, Pacific Islands)
Europe (Eastern, Western)
Americas (South, Central, North)
Africa
Asia (including India)
South Pacific (Australia, New Zealand, Pacific Islands)
Europe (Eastern, Western)
Please specify which country you practice?
Afghanistan Akrotiri Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina Armenia Aruba Ashmore and Cartier Islands Australia Austria Azerbaijan Bahamas - The Bahrain Bangladesh Barbados Bassas da India Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia and Herzegovina Botswana Bouvet Island Brazil British Indian Ocean Territory British Virgin Islands Brunei Bulgaria Burkina Faso Burma Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Clipperton Island Cocos (Keeling) Islands Colombia Comoros Congo - Democratic Republic of the Congo - Republic of the Cook Islands Coral Sea Islands Costa Rica Cote d'Ivoire Croatia Cuba Cyprus Czech Republic Denmark Dhekelia Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Europa Island Falkland Islands (Islas Malvinas) Faroe Islands Fiji Finland France French Guiana French Polynesia French Southern and Antarctic Lands Gabon Gambia - The Gaza Strip Georgia Germany Ghana Gibraltar Glorioso Islands Greece Greenland Grenada Guadeloupe Guam Guatemala Guernsey Guinea Guinea-Bissau Guyana Haiti Heard Island and McDonald Islands Holy See (Vatican City) Honduras Hong Kong Hungary Iceland India Indonesia Iran Iraq Ireland Isle of Man Israel Italy Jamaica Jan Mayen Japan Jersey Jordan Juan de Nova Island Kazakhstan Kenya Kiribati Korea - North Korea - South Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macau Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia - Federated States of Moldova Monaco Mongolia Montenegro Montserrat Morocco Mozambique Namibia Nauru Navassa Island Nepal Netherlands Netherlands Antilles New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island Northern Mariana Islands Norway Oman Pakistan Palau Panama Papua New Guinea Paracel Islands Paraguay Peru Philippines Pitcairn Islands Poland Portugal Puerto Rico Qatar Reunion Romania Russia Rwanda Saint Helena Saint Kitts and Nevis Saint Lucia Saint Pierre and Miquelon Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa South Georgia and the South Sandwich Islands Spain Spratly Islands Sri Lanka Sudan Suriname Svalbard Swaziland Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand Timor-Leste Togo Tokelau Tonga Trinidad and Tobago Tromelin Island Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United States Uruguay Uzbekistan Vanuatu Venezuela Vietnam Virgin Islands Wake Island Wallis and Futuna West Bank Western Sahara Yemen Zambia Zimbabwe Other
If other, please specify practice location by country:
What is your medical and/or complementary medicine background?
Have you received training in functional medicine through the IFM Functional Medicine Certification Program (IFMCP)?
Yes
No
What type of Ayurvedic professional are you?
Please provide more details on your background as an Ayurvedic professional:
Please provide more details on your background:
If you are not a MD or DO,* was this patient/client under concurrent care by a MD or DO?
Yes
No
Unsure
Enter patient's/client's age in years:
Male bodied
Female bodied
Other
Male bodied
Female bodied
Other
How long has/was this patient been under your care toward prevention of, or for COVID?
< 1 week
1-2 weeks
>2 weeks but < 1 month
1-3 months
>3 months and < 6 months
> 6 months and < 1 year
> 1 year
< 1 week
1-2 weeks
>2 weeks but < 1 month
1-3 months
>3 months and < 6 months
> 6 months and < 1 year
> 1 year
Case Symptoms:
* must provide value
Specify other case symptoms:
COVID-19 Status
* must provide value
Tested_positive
Tested_negative
Suspected due to case symptoms, not tested
Suspected due to known exposure to COVID positive person through home, work, school or travel, not tested
Not applicable, supportive care
Tested_positive
Tested_negative
Suspected due to case symptoms, not tested
Suspected due to known exposure to COVID positive person through home, work, school or travel, not tested
Not applicable, supportive care
Asymptomatic
Mild/Moderate
Severe/Critical
Asymptomatic
Mild/Moderate
Severe/Critical
Do you have vital signs or other objective clinical data?
Yes
No
cm
inches
kg
lbs
Body Mass Index (BMI) (autocalculated):
View equation Body Mass Index (BMI) (autocalculated):
View equation Systolic blood pressure (mmHg)
mmHg
Diastolic blood pressure (mmHg)
mmHg
Heart rate (beats per minute):
beats/min
Respiratory rate (breaths per minute):
breaths/min
Lymphocyte count (absolute):
cells/µL
High-sensitivity C-reactive protein (hs-CRP):
mg/L
Lactate dehydrogenase (LDH):
U/L
ng/mL
Vitamin D status, if checked?
Lab normal (>30 ng/ml)
Insufficient (<30 ng/ml)
Deficient (< 20 ng/ml)
Unknown
Lab normal (>30 ng/ml)
Insufficient (<30 ng/ml)
Deficient (< 20 ng/ml)
Unknown
Enter 25-OHD status, if available:
Specify other co-morbidities:
Was the patient/client pregnant?
Yes
No
Please specify approximate weeks of gestation?
Patient/client characteristics
What is your therapeutic goal? (select one or more)
Please specify your therapeutic goal:
Supportive Care: Immune support
Please specify probiotics product name OR species and strain when known:
Please specify homeopathic remedy(ies) used:
Specify other immune support used:
Supportive Care: Anti-viral
Please specify homeopathic remedy(ies) used:
Please specify other anti-viral support used:
Supportive Care: Respiratory Health
Please specify essential oils used:
Please specify homeopathic remedy(ies) used:
Specify other respiratory support:
Supportive Care: Inflammation
Please specify homeopathic remedy(ies) used:
Specify other inflammation support:
Care site: (check all that apply)
Components of care provided (check all that apply):
Acupuncture
Moxibustion
Dietary therapy
Herbal medicine
Lifestyle recommendations
Manual therapies (e.g., anma, cupping, gua sha, shiatsu, tuina)
Qi gong / Tai ji quan
Telehealth instruction in self-care (e.g., self-acupressure, self-moxa)
Other
Acupuncture
Moxibustion
Dietary therapy
Herbal medicine
Lifestyle recommendations
Manual therapies (e.g., anma, cupping, gua sha, shiatsu, tuina)
Qi gong / Tai ji quan
Telehealth instruction in self-care (e.g., self-acupressure, self-moxa)
Other
Please describe other components of care provided:
Did you provide care based on an East Asian medicine diagnosis?
Yes
No
Which of the following best describes your approach to care:
STANDARDIZED A: Standardized protocol based on biomedically-defined disease stage (e.g. asymptomatic, mild/moderate, severe)
STANDARDIZED B: Standardized protocol based on an East Asian medicine differential diagnosis
SEMI-STANDARDIZED A: Standardized protocol based on biomedically-defined disease stage with individualized modifications
SEMI-STANDARDIZED B: Standardized protocol based on East Asian medicine diagnosis with individualized modifications
INDIVIDUALIZED: An individually-tailored treatment based primarily on the patient/client's symptoms and East Asian medicine diagnosis
STANDARDIZED A: Standardized protocol based on biomedically-defined disease stage (e.g. asymptomatic, mild/moderate, severe)
STANDARDIZED B: Standardized protocol based on an East Asian medicine differential diagnosis
SEMI-STANDARDIZED A: Standardized protocol based on biomedically-defined disease stage with individualized modifications
SEMI-STANDARDIZED B: Standardized protocol based on East Asian medicine diagnosis with individualized modifications
INDIVIDUALIZED: An individually-tailored treatment based primarily on the patient/client's symptoms and East Asian medicine diagnosis
Components of care provided (check all that apply):
Dietary recommendations
Herbal medicine (e.g,, herbal teas/spices; single herbs; herbal blends; herbal-mineral-metal formulations, etc.)
Lifestyle recommendations (e.g., nasya, gandusha, specific daily routine, etc.)
Manual therapies (e.g. massage; steam inhalation; dhoomapana etc.)
Meditation
Yoga / yoga therapy, pranayama
Other
Dietary recommendations
Herbal medicine (e.g,, herbal teas/spices; single herbs; herbal blends; herbal-mineral-metal formulations, etc.)
Lifestyle recommendations (e.g., nasya, gandusha, specific daily routine, etc.)
Manual therapies (e.g. massage; steam inhalation; dhoomapana etc.)
Meditation
Yoga / yoga therapy, pranayama
Other
Please specify other components of care:
If using herbal medicine, please specify:
Please provide additional details on the use of herbal medicines:
If using lifestyle recommendations, please specify:
Please specify other lifestyle recommendations:
If using manual therapies, please specify:
Please specify other manual therapies:
Did you provide care based on an Ayurvedic diagnosis?
Yes
No
Which of the following best describes your approach to care:
STANDARDIZED A: Standardized protocol based on biomedically-defined disease stage (e.g. asymptomatic, mild/moderate, severe)
STANDARDIZED B: Standardized protocol based on an Ayurvedic diagnosis
SEMI-STANDARDIZED A: Standardized protocol based on biomedically-defined disease stage with individualized modifications
SEMI-STANDARDIZED B: Standardized protocol based on an Ayurvedic diagnosis with individualized modifications
INDIVIDUALIZED: An individually-tailored treatment based primarily on the patient/client's symptoms and Ayurvedic medicine diagnosis
STANDARDIZED A: Standardized protocol based on biomedically-defined disease stage (e.g. asymptomatic, mild/moderate, severe)
STANDARDIZED B: Standardized protocol based on an Ayurvedic diagnosis
SEMI-STANDARDIZED A: Standardized protocol based on biomedically-defined disease stage with individualized modifications
SEMI-STANDARDIZED B: Standardized protocol based on an Ayurvedic diagnosis with individualized modifications
INDIVIDUALIZED: An individually-tailored treatment based primarily on the patient/client's symptoms and Ayurvedic medicine diagnosis
Pharmaceutical drugs being used by my patient/client:
Please specify other prescription medications used:
Other contributions to health:
Please specify digestive support:
Please specify details on lifestyle measures recommended:
Please specify other support:
Case outcome:
* must provide value
Did not become infected with COVID
Full recovery_remained outpatient
Partial recovery_remained outpatient
Hospitalization_ICU
Hospitalization_other
Death
Patient/client remains under care_outcomes to be added at a later date
Other
Not applicable
Did not become infected with COVID
Full recovery_remained outpatient
Partial recovery_remained outpatient
Hospitalization_ICU
Hospitalization_other
Death
Patient/client remains under care_outcomes to be added at a later date
Other
Not applicable
REMINDER: Please record the "Survey Access Code" for this record in the patient/client record so the outcome can be updated. The survey access code becomes visible after submitting each record. Thank you!
Which of the following symptoms have resolved?
Please describe other symptoms that have resolved:
Indicate level of recovery from fatigue:
Partial
Complete
Indicate level of recovery from fever:
Partial
Complete
Indicate level of recovery from cough:
Partial
Complete
Indicate level of recovery from dyspnea:
Partial
Complete
Indicate level of recovery from diarrhea:
Partial
Complete
Indicate level of recovery from pain:
Partial
Complete
Indicate level of recovery from cognitive impairment/'brain fog':
Partial
Complete
Indicate level of recovery from renal complications:
Partial
Complete
Indicate level of recovery from vascular complications:
Partial
Complete
Indicate level of recovery from cardiovascular complications:
Partial
Complete
Indicate level of recovery from other complications:
Partial
Complete
To your knowledge, was there any increase in symptomology or unexpected/unintended change in clinical status that may be considered harmful? not linked to you or your practice unless you provide contact information below so please enter accurate information to help others.
Yes
No
Unsure
Not applicable
Yes
No
Unsure
Not applicable
If yes, was the adverse event associated with any of the following:
Acupuncture adverse event
Herbal medicine adverse event
Other
Acupuncture adverse event
Herbal medicine adverse event
Other
Please describe the other adverse event:
Did this event resolve favorably?
Yes
No
Unsure
Provide any additional details you think are necessary to provide context and/or details about changes in symptoms and/or resolution:
How many years have you been in clinical practice as an East Asian medicine professional?
Please indicate your licensure / registration status (check all that apply)
Please specify your licensure / registration status:
Ideally each case would be entered as separate records in this registry. We recognize this may not be feasible. If you used exactly the same protocol for multiple patients, and all patients had the identical outcome, please specify the number of patients supported through your protocol:
How many years have you been in clinical practice as an Ayurvedic Medicine professional?
Are you formally certified or registered in your nation?
Yes
No
Please provide any additional details you would like to share about this case?
Provide contact information if you give consent to be contacted by the investigators for more information about this case:
Submit
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