| Your medical records |
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Name
Name shown in your passport
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DOB (dd/mm/yyyy)
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Gender
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Address(in full)
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Email
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Phone number
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Emergency contact
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Height/Weight
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Diagnosis / Suspected diagnosis from your doctor
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Symptoms
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Medical examinations/screenings you went through
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Treatments you have received so far
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What is your doctor’s treatment plan?
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History of illness
(Hepatitis, tuberculosis, diabetes, hypertension and etc.)
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Allergies
(Food, Medications and etc.)
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Have you been through any surgeries in the past?
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Do you take any regular medications? What are they?
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Is there any medication that you currently stopped?
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Upload Medical Records
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