Neonatal and Maturity onset of youth registry india
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NEONATAL AND MONGENIC DIABETES RESGISTRY INDIA

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Home
About us
Neonatal Diabetes Registry
MODY Diabetes Registry
Doctor Registration Form
Neonatal Registration Form
MODY Registration Form
Consent Form
How to Send The Blood Sample
Our Collaborators
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Molecular Genetic testing in diabetes diagnosed before 12 months
   
Patient Name *
Gender  
Date Of Birth                          
Age
M.No  
Contact Address
City *    
State *    
Pincode *    
Clinical information         
Age at diagnosis *    
Birth Weight  
Blood glucose at presentation      
Pancreatic autoantibodies eg. GAD-antibodies if done      
If on insulin current Insulin dose/day *    
C-peptide if available *    
Any history of low sugar reactions
Any history of developmental delay
Any history of epilepsy
Whether diabetes disappeared after sometime or it still continues
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
Children (if applicable)
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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