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(19)

US 20040010421A1

(12) Patent Application Publication (10) Pub. No.: US 2004/0010421 A1

United States

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68 DIALYSIS TREATMENT, BUT I KNOW MY PERCENT
KIDNEY FUNCTION.
MY DOCTOR HAS TOLD ME TRAT I HAVE KIDNEY TRQCK
DISEASE, BUTI DON T KNOW WHICH ANSWER ON
THIS PAGE IS BEST FOR ME. L
NEXT SCREEN TRQCK
I /I r72
70 78 z PLEASE SELECT YOUR "PERSONAL TRACK
66 CREATININE LEVEL. INFO FORM" ‘
76 \ @ >3 §9
- o 3 - 5.5 H
78 i. ARE YOU @<5.5 EERSONAI-.. TRACK
DIABETIC ? 70 nu-0 FORM 2
- 2. PLEASE SELECT YOUR ‘ "PERSONAL
NEXT SCRE ) QOREATININIE LEVEL. 76 INFOSIBORM" TRQCK
> 4.5 _
7'4 T Q 4'5 ' 6 "PERSONAL
-,0 /I O <6-— mm FORM" TRACK
78 NEXT SCREEN Q I
. 70/ 76 L/74 "PERSONAL. TRACK
78 2. PLEASE SELECT YOUR INFOGZORM 2
EEREEVELOF KIDNEY ____-___
76 ' "PERSONAL
"1 O ‘T045/2.0/-"25°/O '“F°6"'R“" TRSCK
I. ARE You O <2s% -_-- _ 72
DIABETIC? NEXT SCREEN 70 EKJ4 "PERSONAL T'R;cK
O YES lb INFO FORM"
' O NO /_ so I
FTEREEFEFFEIIEIR --———
NEXT SCREEN ] "PERSONAL
I , Q ;u3N5c;iON. l_, INFO FORM. TRé\O<
.
P ’“TSa;I~;F>% Q‘-’
0 — "PERSONAL
78/‘ NEXT SCREEN 70 A ___I-—- INFO FORM" TRACK
\74 __ 3

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Patent Application Publication Jan. 15, 2004 Sheet 1 of 4 US 2004/0010421 A1

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MMMMW . MZGZM
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ow
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BEFORE WE BEGIN, PLEASE ENTER YOUR FIRST NAME
AND YOUR E-MAIL ADDRESS HEREISO WE CAN SEND

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YOU ANY NEWS OR UPDATES): I HRSTNAMEHT ‘ .________J FE-MAIL ADDRESSJI __"_—1

PLEASE CLICK ON THE STATEMENT THAT DESCRIBES YOU BEST:
(IF YOU ARE A MEDICAL PROFESSIONAL, CLICK HERE.)

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54 -/‘I AM NOT ON DIALYSIS, BUT MY DOCTOR HAS TOLD ME THAT

56

/ KIDNEY DISEASE.

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I HAVEKIDNEY DISEASE. -I WOULD LIKE TO SEE IF I COULD BE AT RISK FOR

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“PERSONAL
INROFORM"
60

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£72

TRACK 4

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A/‘

48'

"KIDNEY DISEASE
SUB SCREENER"
53

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"PERSONAL INFO FORM" §_Q

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