Sierra Rheumatology
Symptom screening

ANA Screening for Systemic Lupus Erythematosus

Symptom screen used when a patient has a positive ANA blood test result.

About this form

If your blood test was positive for antinuclear antibodies (ANA), this short screen helps us determine whether further evaluation for lupus or another autoimmune condition is appropriate. Please check every symptom you have currently or have experienced recently.

About 4 minutes
Progress
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Symptoms

Check all that apply.

Have you experienced any of the following?
Notes
Sign & submit

Submitting transmits this form securely to our office. For urgent medical issues please call our office or 911.

Trouble with the form?

Call our office and we'll either walk you through it or send a paper version.