Platform Randomised trial of INterventions against COVID-19 In older peoPLE - PRINCIPLE
Participant Registration
Screening Form
Thank you for considering participating in the PRINCIPLE trial.
If you have not already read the Participant Information Leaflet you can download it by clicking the link below.
Click here to download the PRINCIPLE Participant Information Leaflet
There is also an illustrated summary of the Participant Information Leaflet that you can download by clicking the link below:
Click here to download an illustrated summary of the PRINCIPLE Participant Information Leaflet
Click here to access translated versions of the PRINCIPLE Participant Information Leaflet
To start your registration, please complete this screening form.
After you have answered all the questions on this form
please click the "Submit" button at the bottom of the page to proceed to your Consent Form
Are you willing to give informed consent for participation in the study?
Do you have symptoms of possible COVID-19 in the community which have been present for less than 15 days?

Symptoms of COVID-19 are defined as:
A new continuous cough - this means coughing a lot for more than an hour, or 3 or more coughing episodes in 24 hours (if you usually have a cough, it may be worse than usual)
and/or
A high temperature - this means you feel hot to touch on your chest or back
(you do not need to take your temperature)

What date did you start to feel unwell with this illness?
- -
Are you feeling almost recovered from this illness (i.e. generally much improved and your symptoms are now mild or almost absent)?
Are you aged 65 years old or over?

Are you aged 50 to 64 years old with at least one of the comorbidities/conditions listed below?

  • weakened immune system due to a serious illness or medication (e.g. chemotherapy)
  • heart disease or high blood pressure
  • asthma or lung disease
  • diabetes not treated with insulin
  • liver disease
  • stroke or neurological problem
Are you pregnant or planning on becoming pregnant within the next few weeks?
Are you breastfeeding or planning on starting during the course of the trial?
Do you have porphyria?
Do you take insulin for diabetes?
Do you have a G6PD deficiency?
Do you have myasthenia gravis?
Do you have severe psoriasis?
Do you have a history of epilepsy?

Have you had a previous allergic (adverse) reaction to any of the following:

  • Azithromycin
  • Chloroquine
  • Clarithromycin
  • Hydroxychloroquine

Are you currently taking any of the following:

  • Amiodarone
  • Chloroquine
  • Ciclosporin
  • Digoxin
  • Hydroxychloroquine
  • Penicillamine
  • Sotalol
Do you have a disease which affects the retina
(e.g. macular degeneration)?
Are you currently taking antibiotics for a recently diagnosed illness?
Are you currently admitted in hospital?
Do you have a specific heart rhythm abnormality called "prolonged QT syndrome" or condition that prolongs the heart QT interval?
Do you have an allergy to soya or peanuts?
Have you previously participated in the PRINCIPLE trial?
After you have answered all the questions on this form and clicked "I'm not a robot" below
please click the "Submit" button at the bottom of the page to proceed to your Consent Form
PRINCIPLE Participant Registration v2.3 22-04-2020
REC Number: 20/SC/058, IRAS Number: 281958, EudraCT Number: 2020-001209-22, Chief Investigator: Professor Christopher Butler