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ParentsPatient

Name of Parent* :

Name of patient* :

Age* :
Sex* :
MaleFemale

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Email Id : * :

Location*

Doctor’s Name :


Transfusion Center Name :


Iron Chelating Medicine :

Serum Ferritine :

T2* Cardiac MRI :
(In last 12 months)

T2* Liver MRI :
(In last 12 months)

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