Through this form you can point out to Guariamoli a case that meets the acceptance requirements *.
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Name of the reporting person:

Email address:

Phone address:

Pathology summary:

Patient's age group:

Patient's nationality:

Other notes to be reported:
(Es. where is the patient, his current medical condition, availability of clinical tests carried out at home, certificate of non-curability)


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(*) It improves performance and prevents the execution of unauthorized automated scripts.

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