Neonatal and Maturity onset of youth registry india
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MONOGENIC DIABETES REGISTRY OF INDIA

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  Home
  About us
  Neonatal Diabetes Registry
  MODY Diabetes Registry
  Congenital Hyperinsulinism (CHI)
  Neonatal Registration Form
  MODY Registration Form
  CHI Registration Form
  Consent Form
  How to Send The Blood Sample
  Our Collaborators
  Publications
  Contact us
  Report
     
     
   
  Molecular Genetic testing for Congenital hyperinsulinism (CHI)
     
  Patient Name *
  Date Of Birth
 
  Gender
  Height  
  Weight
  Age
  M.No
  Contact Address
  City  
  State  
  Pincode  
  Clinical information     
  Age at presentation  
  Birth Weight
  Blood glucose  
  Insulin level   
  C-peptide if available   
  Hyperammonemia  if yes
  Current treatment
  Any other medical problems
   
 
  Consanguinity of Parents      
  Were parents related before marriage    
  Family history of diabetes:      
  Father
  Mother
  Paternal grandfather
  Paternal grandmother
  Maternal grandfather
  Maternal grandmother
  Siblings
     
  Referring Physician’s details  
  Doctor’s Name
  Qualification
  Specialization
  Mobile No  
  Clinic No  
  Residence No  
  E-mail address  
  Address to which the report should be sent
  City  
  State  
  Pincode  
       
 
       
         
         

 
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