Name Age SexMaleFemale Blood group—Please choose an option—A+A-B+B-AB+AB-O+O- Place Parent/Guardian Number Email Address Ailment Description Basic Information 1. Weight 2. Age of onset/first symptom : 3. Age at diagnosis: 4. Any misdiagnosis : 5. Any family history: 6. Current physician/Hospital: 7. Flare ups in last one year /Treatment given : 8. Any other problems: 9. Education/Occupation: 10. Mobility: 11. Genetic Test:Yes (Please attach it below in this case)NoNo but I'd like to get one done Previous treatment details/reports Genetic test result Xrays/CT/MRI Any other attachments (1) Any other attachments (2)
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