Please tell us about your medical institution in the survey below. You will only need to enter this information once, and will have the opportunity to enter information for multiple patients associated with your institution. For example, if you have 3 patients that you think meet the eligibility criteria for Remdesivir at hospital X, you will complete this Facility Information survey once for hospital X, and once you have clicked ‘submit’ at the bottom of this survey your first patient information survey will appear.

If you have more than one patient to submit for the medication, each time you submit the Patient Information survey you will be given the opportunity to both download a PDF of the data you provided and ‘take the survey again’ if necessary, i.e. enter another patient for your institution.

Please note that once you submit a form you cannot return to edit it. Do not use your browser's back button as this will require you to start over with the public link.

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You have selected an option that triggers this survey to end right now. To save your responses and end the survey, click the button below to do so. If you have selected the wrong option by accident and do not wish to leave the survey, you may click the other button below to continue, which will also remove the value of the option you just selected to allow you to enter it again and continue the survey.
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