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IBDホットライン質問票
IBDホットラインを利用する際に可能な範囲で記載をお願いします。
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1.
基本情報入力
紹介元医師名
*
Your answer
紹介元施設名
*
Your answer
折り返し連絡先 (電話番号)
*
Your answer
折り返し連絡先 (メールアドレス)
*
Your answer
患者年齢
*
Your answer
病名
*
クローン病
潰瘍性大腸炎
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