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姓名(Name) *
病歷號碼(Medical record number)
身分證號碼( ID card number) *
手機號碼(mobile phone or telephone) *
懷孕週數(Number of weeks of pregnancy) *
懷孕是單胞胎、雙胞胎還是多胎以上?(Is pregnancy a single, twin or multiple births?) *
電子信箱(E-MAIL) *
產檢醫院(Birth inspection hospital) *
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