Chronic Obstructive Pulmonary Disease Registry Form Page 4

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DEPARTMENT OF HEALTH
Integrated Chronic Non-Communicable Disease Registry System
50d.
Email Address
51.
Completed By
Write the name, position title /designation of the personnel completing the form on this portion including the address and
51a.
Address
contact details (landline no., mobile no. and email address).
51b.
Landline #
51c.
Mobile #
51d.
Email Address
52.
Date Completed
Write the Date of registry was completed and encoded using the mm/dd/yyyy format.

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