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Fill your details carefully
Full Name *
Your liquid input?(in 24hrs) *
City/Village *
Have you been on dialysis? *
Yes
No
Phone number *
How long have you been on dialysis? *
Constipation *
If it is Heamodialysis - what is the frequency?(/week) *
Age *
Lab Investigation *
HB *
Hand/feet Movement *
Blood Sugar *
B.P *
Serum Uric Acid *
Blood Urea *
Serum Creatanine *
Your blood pressure?(Systolic) *
Your blood pressure?(Diastolic) *
Any family history of kidney disease? *
Are you diabetic? *
Yes
No
Please leave this field empty.
