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Doctor Identification CodePatient IdentificationReporting Interval Year/QuarterReporting Interval EvaluationRIGHT Eye InvolvementRight Eye FootRight Eye MetreRight Eye DecimalRight Eye LogMARRight Eye Ocular involvement during reporting intervalRight Eye Other Ocular Tissue InputRight Eye Vitrectomy during reporting intervalRight Eye Intraocular methotrexateRight Eye Number of MTX InjectionsRight Eye MTX Unit Dose [mg/0.1mL]Right Eye Intraocular rituximabRight Eye Number of RITUX InjectionsRight Eye RITUX Unit Dose [mg/0.1mL]Right Eye Other Intraocular DrugRight Eye Other Intraocular Drug NameRIGHT Eye Number of other Intraocular Drug InjectionsRight Eye Unit dose of other Intraocular drugRight Eye other Intraocular Drug Units (e.g. mg/mL)Right Eye Ocular IrradiationRight Eye Total dose [ Gy ]Right Eye Focal ocular treatment during reporting intervalRight Eye Complications during reporting intervalRight Eye Other ComplicationRight Eye status at end of reporting intervalRight Eye Status Define ThisLEFT Eye InvolvementLeft Eye FootLeft Eye MetreLeft Eye DecimalLeft Eye LogMARLeft Eye Ocular involvement during reporting intervalLeft Eye Other Ocular Tissue InputLeft Eye Vitrectomy during reporting intervalLeft Eye Intraocular methotrexateLeft Eye Number of MTX InjectionsLeft Eye MTX Unit Dose [mg/0.1mL]Left Eye Intraocular rituximabLeft Eye Number of RITUX InjectionsLeft Eye RITUX Unit Dose [mg/0.1mL]Left Eye Other Intraocular DrugLeft Eye Other Intraocular Drug NameLeft Eye Number of other intraocular drug injectionsLeft Eye Unit dose of other Intraocular drugLeft Eye other Intraocular Drug Units (e.g. mg/mL)Left Eye Ocular IrradiationLeft Eye Total dose [ Gy ]Left Eye Focal ocular treatment during reporting intervalLeft Eye Complications during reporting intervalLeft Eye Other ComplicationLeft Eye status at end of reporting intervalLeft Eye Status Define ThisExtra-ocular involvement at any time during reporting intervalExtra-ocular involvement Other InputExtensive treatment during reporting intervalExtensive Treatment Other InputComplications of extensive treatment during reporting intervalExtensive Complications Other InputYearsMonthsPatient Status at End of Reporting IntervalCause of deathRevised non-lymphoma diagnosis inputCommentsProgress
Doctor Identification CodePatient IdentificationReporting Interval Year/QuarterReporting Interval EvaluationRIGHT Eye InvolvementRight Eye FootRight Eye MetreRight Eye DecimalRight Eye LogMARRight Eye Ocular involvement during reporting intervalRight Eye Other Ocular Tissue InputRight Eye Vitrectomy during reporting intervalRight Eye Intraocular methotrexateRight Eye Number of MTX InjectionsRight Eye MTX Unit Dose [mg/0.1mL]Right Eye Intraocular rituximabRight Eye Number of RITUX InjectionsRight Eye RITUX Unit Dose [mg/0.1mL]Right Eye Other Intraocular DrugRight Eye Other Intraocular Drug NameRIGHT Eye Number of other Intraocular Drug InjectionsRight Eye Unit dose of other Intraocular drugRight Eye other Intraocular Drug Units (e.g. mg/mL)Right Eye Ocular IrradiationRight Eye Total dose [ Gy ]Right Eye Focal ocular treatment during reporting intervalRight Eye Complications during reporting intervalRight Eye Other ComplicationRight Eye status at end of reporting intervalRight Eye Status Define ThisLEFT Eye InvolvementLeft Eye FootLeft Eye MetreLeft Eye DecimalLeft Eye LogMARLeft Eye Ocular involvement during reporting intervalLeft Eye Other Ocular Tissue InputLeft Eye Vitrectomy during reporting intervalLeft Eye Intraocular methotrexateLeft Eye Number of MTX InjectionsLeft Eye MTX Unit Dose [mg/0.1mL]Left Eye Intraocular rituximabLeft Eye Number of RITUX InjectionsLeft Eye RITUX Unit Dose [mg/0.1mL]Left Eye Other Intraocular DrugLeft Eye Other Intraocular Drug NameLeft Eye Number of other intraocular drug injectionsLeft Eye Unit dose of other Intraocular drugLeft Eye other Intraocular Drug Units (e.g. mg/mL)Left Eye Ocular IrradiationLeft Eye Total dose [ Gy ]Left Eye Focal ocular treatment during reporting intervalLeft Eye Complications during reporting intervalLeft Eye Other ComplicationLeft Eye status at end of reporting intervalLeft Eye Status Define ThisExtra-ocular involvement at any time during reporting intervalExtra-ocular involvement Other InputExtensive treatment during reporting intervalExtensive Treatment Other InputComplications of extensive treatment during reporting intervalExtensive Complications Other InputYearsMonthsPatient Status at End of Reporting IntervalCause of deathRevised non-lymphoma diagnosis inputCommentsProgress