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Leishmania Data Form
List of Leish Center
Contact Us
Province
*
District
*
Date
*
Name of Clinic
*
Name person who Filled form
*
Email or phone number
*
New case (Male) 0-5
*
New case (Male) 5-15
*
New case (Male) 15 Above
*
Follow up case (Male) 0-5
*
Follow up case (Male) 5-15
*
Followup(Male)15 Above
*
New case (Female) 0-5
*
New case (Female) 5-15
*
Follow up case (Female) 0-5
*
Follow up case (Female) 5-15
*
New case (Female) 15 Above
*
Number of positive cases
*
Number of Negative cases
*
Number of Clinical cases
*
Local
*
Im
*
Follow up case (Female) 15 Above
*
Submit
Home
Leishmania Data Form
List of Leish Center
Contact Us