Thalassaemia

Please fill out this form for reporting new births of thalassaemia major in Pakistan

Child's Name*
Child's Date of Birth*
Basis of Diagnosis*
- Hb-Electrophoresis
- PCR
- Clinical (Transfusion dependent)
- Other
Father's Name*
Father's ID Card no.
Father's Phone No*
District of Residence*
Was prenatal diagnosis done?
Submitted by*
Email of the person/organization submitting the information
What was the Prenatal Diagnosis?

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