Activities
Activities

60 Thalassemics visited the Check Up Clinic at Sir Ganga Ram Hospital

 

Abstract Book

Blood Donation

Thalassemics India
A-9, Nizamuddin West, New Delhi - 110 013 (INDIA)
+(91)-(11)-4659584, 41827334
+(91)-(11)- 4659584
thalcind@yahoo.co.in
(* represent Compulsory Fields)
 
Name (In Capital Letters) Mr./ Ms. Mrs.*
Blood Group*
Age*
Sex*
Nationality
Fathers / Husband's Name *
Address (Residence / Telephone)*
Place of work / study Telephone
Mobile No.
Your E-Mail :

History of past illness (Mark)
Jaundice (Hep- A, B o C)
Cancer
Tuberculosis
Any Heart Disease
Diabetes (if on insulin)
Abnormal Bleeding Tendency
Acute Respiratory Disease/ Asthma
Convulsions
Drug addiction/alcoholism
Sign & Symptoms Suggestive of AIDS
Any skin disease on the puncture site
Polycythaemia Vera
Malaria
Breast Feeding/ Mensturation
Recent Immunization
History of Blood Transfusion
Any Major Surgery
Abortion/ Pregnancy
Typhoid
Tattoo
Unexplained Wt. Loss
Epilepsy
Leprosy
Schizophrenia

Any other disease  
*Weight
*Height
*Would you like to be a regular Donor
 Yes  No
When did you donate last
How often would you like to donate
3 Months
6 Months
1 year and more
*Enter the code shown on image: