AI-Agent Screening Question Guide Knowledge-Base
Participant eligibility screening. For client review.
BASICS
- 01
Are you willing and able to read, understand, and sign a consent form before taking part?
- 02
What is your age?
- 03
Let's work out your BMI — what is your weight in pounds (lbs)?
- 04
What is your height in inches?
About your vitiligo
- 05
Have you been diagnosed by a doctor with vitiligo?
- 06
How long ago were you diagnosed as having vitiligo by a doctor?
- 07
What type of vitiligo do you have, if you know? (Segmental — one area or one side; Non-segmental — both sides of the body)
- 08
What % of your body is affected?
- 09
Do you have any white or grey hair growing within your vitiligo patches on your face or body?
- 10
Do you have any vitiligo patches on your face?
- 11
Have you been diagnosed with any other condition that causes pale, white, or discolored skin patches?
Treatment history
- 12
Have you tried any approved vitiligo treatments before?
- 13
Did these treatments not work well enough, or are you unable to use them (e.g. side effects, another medical reason)?
- 14
Are you willing to stop all current vitiligo treatments from the start of screening until the end of the study?
Recent health history
- 15
In the recent past, have you had any of the following? (serious infection requiring hospitalization, TB or positive TB test, shingles, major surgery, cancer, blood clots, heart attack or stroke)
- 16
Have you been vaccinated against shingles (herpes zoster)?
- 17
If not already vaccinated, are you willing to get the shingles vaccine before the study begins?
- 18
Do you currently have, or have you been told you have, any of the following? (diabetes, high blood pressure, liver disease, kidney disease, heart disease, autoimmune disease other than vitiligo, HIV)
- 19
Have you had a chest X-ray that showed an abnormal result?
Medications
- 20
Are you currently taking any medications that affect your immune system, or any other ongoing prescription medications?
- 21
Which other medications are you on?
- 22
Do you have any other medical conditions?
About you
- 23
Are you currently pregnant or breastfeeding?
- 24
If relevant, are you willing to use effective contraception during the study?
- 25
Let's find your nearest clinic — where do you live?
- 26
What day and time works best for the nurse to call about the study?
- 27
Please confirm you have read and agree with the following privacy assurance.