10

BCG mark

Present = 1

Absent = 2

□

11

Lymph node

Enlarged = 1

Not enlarged = 2

□

12

If lymph node enlarged

Cervical = 1

Axillary = 2

Inguinal = 3

Others = 4

□

13

Hepatomegaly

Present = 1

Absent = 2

□

14

Splenomegaly

Present = 1

Absent = 2

□

15

Serositis

Present = 1

Absent = 2

□

16

Slit lamp examination and findings

Yes = 1

No = 2

□